TEMPOROMANDIBULAR JOINT SYNDROME

General Information

DEFINITION--Pain and inflammation in the temporomandibular joint (TMJ), the joint on either side of the jaw that opens and closes the mouth, and adjoining muscles.

BODY PARTS INVOLVED-- Temporomandibular joint; facial muscles; sensory nerves.

SEX OR AGE MOST AFFECTED--Adults of both sexes, but more common in women.

SIGNS & SYMPTOMS

• Dull, aching pain on one side of the jaw (below the ear) that radiates to the temples, back of the head and along the jaw line.
• Tenderness of the muscles used to chew.
• "Clicking" or "popping" sounds when opening the mouth.
• Inability to open the jaw completely.
• Headache and toothache.
• Aching back, shoulders or neck.
• Pain brought on by yawning.

CAUSES

• Faulty alignment ("bite") between the upper and lower jaws (disk derangement).
• Displacement of the joint as a result of jaw, head or neck injuries.
• TMJ inflammation.
• Myofacial pain dysfunction.
• Hypermobility or hypomobility of the TMJ.

RISK INCREASES WITH

• Grinding or clenching teeth.
• Tension of the masticatory (chewing) muscles.
• Stress.
• Poorly aligned teeth.
• Poorly fitting dentures.
• Osteoarthritis or rheumatoid arthritis.

HOW TO PREVENT--Don't grind your teeth. Learn techniques for relaxing muscles and relieving tension, such as biofeedback, meditation and exercise.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor or dentist.
• Jaw range-of-motion studies, dental x-rays, arthroscopy and MRI (See Glossary for both).

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Treatment program may involve correction of occlusal disorders, attainment of normal muscle function, pain control, stress management and behavior modification.
• Psychotherapy or counseling, including biofeedback training, to learn new ways to cope with stress.
• Correction of poorly aligned teeth with braces or other orthodontic device.
• A dentist may manufacture, fit and install a night-guard prosthesis to prevent tooth-grinding while asleep. A night-guard prosthesis consists of removable splints that fit over the tops of the teeth to eliminate incorrect biting pressure.
• Rarely, surgery may be recommended for severe cases that do not respond to simpler measures. Be sure you understand all aspects involved with surgery and seek a second opinion.

POSSIBLE COMPLICATIONS

• Loss of joint range-of-motion.
• Secondary degenerative joint disease.
• Depression and chronic pain syndrome.

PROBABLE OUTCOME--With conservative treatment, symptoms can usually be controlled within 3 months.

How To Treat

GENERAL MEASURES--

• Ice and/or heat may be of slight benefit in relieving discomfort, but will not cure. Try one and then the other to see what works best for you.
• Massage the TMJ muscle area.
• Don't chew gum.
• Don't use a pillow for sleeping. Roll up a towel and place it under your neck. Sleep on your back.
• Try to limit jaw movements and learn to relax the jaw. Block a yawn by putting your fist under your chin.

MEDICATION--

• Your doctor may prescribe: Tranquilizers or muscle relaxants for a short time. Nonsteroidal anti-inflammatory drugs.
• For minor pain, you may use non-prescription drugs, such as aspirin or acetaminophen.

ACTIVITY--No restrictions.

DIET--Eat a soft diet until symptoms subside. Avoid hard, chewy foods such as bagels.

Call Your Doctor If

• You have symptoms of temporomandibular joint syndrome.
• Symptoms do not improve or worsen after self-care treatment.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.