Temporomandibular joint disorders (TJDs) are problems that affect the joint between the lower jaw and the base of the skull.
A TJD is not usually a serious condition, but symptoms can impact significantly on quality of life. Doctors sometimes also refer to the condition as myofascial pain disorder.
It has been estimated that approximately 20-30% of the adult population will experience a TJD at some point. Symptoms usually last for a few months before getting better.
What are the symptoms?
TJDs can cause:
- clicking, popping or grating noises as you chew or move your mouth
- muscle spasms around the jaw
- pain in front of the ear that may spread to the cheek, ear and temple
- difficulty opening the mouth – the jaw may feel tight, as if it is stuck, making eating difficult
- headache or earache
What are the causes?
The main causes of TJD are:
- clenching your jaw or grinding your teeth during sleep, which overworks the jaw muscles and puts pressure on the joint (often caused by [stress])
- wear and tear of the inside of the jaw joint, usually caused by osteoarthritis
- a disease causing inflammation of the jaw joint, such as rheumatoid arthritis or gout
- injury to the jaw joint, for example after a blow to the face or surgery
You can click on the above links for more information on these conditions.
How are TJDs treated?
If your TJD is severe, you may need to see more than one medical professional, such as a dentist, oral and maxillofacial surgeon, doctor, or ear, nose and throat (ENT) specialist.
Generally, non-surgical treatments such as lifestyle changes are tried first.
There are a number of self-help measures that can help improve TJD, including:
- resting the joint by eating soft food and avoiding chewing gum
- holding a warm or cold flannel to the jaw after doing a few gentle jaw-stretching exercises
- avoiding opening the joint too wide
- massaging the muscles around the joint
- relaxation exercises to relieve stress (people tend to clench their jaw when stressed)
- not resting your chin on your hand
Mouth guards (plastic mouthpieces that fit over your teeth) may be helpful if you grind your teeth. These cover the teeth at night to reduce jaw clenching and teeth grinding, and can be made to measure by your dentist.
Read more about treatments for teeth grinding.
Paracetamol, ibuprofen or codeine can help relieve pain. If these are not strong enough, ask your doctor if they can prescribe you a muscle relaxant or tricyclic antidepressant, which may be more effective at relieving the pain.
If your TJD is caused by a disease such as arthritis, you may benefit from a steroid injection into the jaw joint.
A steroid injection can help reduce pain and swelling in a joint or the surrounding soft tissue. Most people report feeling less pain within the first 24 hours to one week. You may find that your pain improves for a period of a few weeks to several months, and in some cases the injection resolves the pain completely.
Read more about corticosteroids (steroids).
If the above measures do not help, you may wish to consider a surgical treatment such as:
- arthrocentesis – needles are inserted into your upper jaw cavity and a solution is injected to help loosen up the joint and flush out any microscopic particles.
- arthroscopy – a small incision is made in front of your ear and a small thin instrument is inserted that allows your surgeon to examine the area and remove any inflamed tissue, or realign the jaw.
- open joint surgery – the entire area around the jaw joint is opened up so the surgeon can get a better view and full access. This may be needed if the bony structures are deteriorating or if there are tumours around the joint. It has a longer healing time than arthroscopy, as well as a greater chance of scarring and nerve injury.
There is always a risk that surgical procedures may lead to more serious symptoms. You should discuss these risks with your surgeon.
People with TJD who experience severe disability may wish to try an artificial temporomandibular joint replacement. Patients have reported finding it much easier to speak, sing and kiss with an artifical jaw.
The medical name for this procedure is total prosthetic replacement of the temporomandibular joint.
Under a general anaesthetic, a cut is made in front of the ear and behind or below the lower jaw. The diseased parts of the jaw are replaced with artificial joints, which can be made from various materials.
The benefits of joint replacement can be significant for some patients.
Possible risks include:
- weakness in the face muscles caused by nerve damage
- nerve pain
- failure of the joint (the joint parts coming loose, dislodging, breaking or getting infected)
- your immune system reacting to the joint
You should discuss these risks with your surgeon.
Most TJDs improve over time and do not get worse, and most people will not need surgery.
In the meantime, symptoms can often be improved with the treatments mentioned above.