The temporomandibular joint (TMJ) is the joint that connects your mandible (lower jaw) to your skull. The joint can be found on both sides of your head in front of your ears. It allows your jaw to open and close, enabling you to speak and eat.
This abbreviation has also been used to refer to a group of health problems related to your jaw, but this is becoming more commonly abbreviated as TMD or TMJD to distinguish the temporomandibular joint itself from TMJ disorders. These disorders can cause tenderness at the joint, facial pain, and difficulty moving the joint.
In many cases, it’s not known what causes a TMJ disorder. Trauma to the jaw or joint may play a role. There are also other health conditions that may contribute to the development of TMJD. These include:
arthritis
erosion of the joint
habitual grinding or clenching of the teeth
structural jaw problems present at birth
There are some other factors that are often associated with the development of TMJD, but they haven’t been proven to cause TMJD. These include:
the use of orthodontic braces
poor posture that strains the muscles of the neck and face
prolonged stress
poor diet
lack of sleep
Diagnosis
Your doctor or dentist will discuss your symptoms and examine your jaw. He or she will probably:
Listen to and feel your jaw when you open and close your mouth
Observe the range of motion in your jaw
Press on areas around your jaw to identify sites of pain or discomfort
If your doctor or dentist suspects a problem, you may need:
Dental X-rays to examine your teeth and jaw
CT scan to provide detailed images of the bones involved in the joint
MRI to reveal problems with the joint's disk or surrounding soft tissue
TMJ arthroscopy is sometimes used in the diagnosis of a TMJ disorder. During TMJ arthroscopy, your doctor inserts a small thin tube (cannula) into the joint space, and a small camera (arthroscope) is then inserted to view the area and to help determine a diagnosis.
Treatment
In some cases, the symptoms of TMJ disorders may go away without treatment. If your symptoms persist, your doctor may recommend a variety of treatment options, often more than one to be done at the same time.
Medications
Along with other nonsurgical treatments, these medication options may help relieve the pain associated with TMJ disorders:
Pain relievers and anti-inflammatories. If over-the-counter pain medications aren't enough to relieve TMJ pain, your doctor or dentist may prescribe stronger pain relievers for a limited time, such as prescription strength ibuprofen.
Tricyclic antidepressants. These medications, such as amitriptyline, are used mostly for depression, but in low doses, they're sometimes used for pain relief, bruxism control and sleeplessness.
Muscle relaxants. These types of drugs are sometimes used for a few days or weeks to help relieve pain caused by TMJ disorders created by muscle spasms.
Therapies
Nondrug therapies for TMJ disorders include:
Oral splints or mouth guards. Often, people with jaw pain will benefit from wearing a soft or firm device inserted over their teeth, but the reasons why these devices are beneficial are not well-understood.
Physical therapy. Along with exercises to stretch and strengthen jaw muscles, treatments might include ultrasound, moist heat and ice.
Counseling. Education and counseling can help you understand the factors and behaviors that may aggravate your pain, so you can avoid them. Examples include teeth clenching or grinding, leaning on your chin, or biting fingernails.
Surgical or other procedures
When other methods don't help, your doctor might suggest procedures such as:
Arthrocentesis. Arthrocentesis (ahr-throe-sen-TEE-sis) is a minimally invasive procedure that involves the insertion of small needles into the joint so that fluid can be irrigated through the joint to remove debris and inflammatory byproducts.
Injections. In some people, corticosteroid injections into the joint may be helpful. Infrequently, injecting botulinum toxin type A into the jaw muscles used for chewing may relieve pain associated with TMJ disorders.
TMJ arthroscopy. In some cases, arthroscopic surgery can be as effective for treating various types of TMJ disorders as open-joint surgery. A small thin tube (cannula) is placed into the joint space, an arthroscope is then inserted and small surgical instruments are used for surgery. TMJ arthroscopy has fewer risks and complications than open-joint surgery does, but it has some limitations as well.
Modified condylotomy. Modified condylotomy (kon-dih-LOT-uh-mee) addresses the TMJ indirectly, with surgery on the mandible, but not in the joint itself. It may be helpful for treatment of pain and if locking is experienced.
Open-joint surgery. If your jaw pain does not resolve with more-conservative treatments and it appears to be caused by a structural problem in the joint, your doctor or dentist may suggest open-joint surgery to repair or replace the joint. However, open-joint surgery involves more risks than other procedures do and should be considered very carefully, after discussing the pros and cons.
If your doctor recommends surgery or other procedures, be sure to discuss the potential benefits and risks, and ask what all your options are.
