Temporomandibular Joint Dysfunction (TMD)

What is Temporomandibular Disorder (TMD)?

Temporomandibular disorders (TMDs) are a group of disorders that cause dysfunction and discomfort in the jaw joints, surrounding muscles, and nerves.

People with TMD will feel chronic pain in the jaw joint and muscles that control jaw movement. Occasional jaw discomfort doesn’t necessarily mean you have TMD.

Some people develop long-term symptoms that occur more frequently. This often results in the diagnosis of a temporomandibular disorder.

People with TMD experience different kinds of pain, including headaches, earaches, or discomfort when opening or closing the mouth.

What Are the Symptoms of Temporomandibular Disorder?

The signs and symptoms of TMD vary widely. The most common symptoms include:

• Jaw pain or discomfort
• Facial pain
• Headaches and neck aches
• Shoulder pain
• Pain or soreness around the ear and jaw
• Stiffness in the jaw and chewing muscles when opening and closing the mouth
• Lockjaw or difficulty moving the jaw normally
• A change in the alignment of the upper and lower teeth
• Jaw clicking or popping
• Ringing in the ears and earaches
• Pain in the temple area

What Causes Temporomandibular Disorder?

Various factors can contribute to TMD. Most of the time, TMD develops without a clear cause.

Risk factors for developing TMD include:

• Stress and anxiety, which causes tense muscles and jaw clenching
• Long-term teeth grinding (bruxism), especially while sleeping
• Malocclusion (misaligned teeth) with recurring pain in the jaw muscles
• Jaw injury
• Rheumatoid arthritis or osteoarthritis
• Other degenerative joint disease
• Excessive gum chewing, which puts constant pressure on the TMJ
• Obstructive sleep apnea (OSA)
• Conditions that cause myofascial pain, such as fibromyalgia

Who Does Temporomandibular Joint Disorder Affect?

TMDs can affect anyone, but it’s most common in adults between ages 20 and 40. Women are much more likely to get TMD than men.

As many as 60 to 70% of people show signs of TMD, but only about 5 to 12% require treatment.

How Is TMD Diagnosed?

To diagnose TMD, a general dentist or other healthcare provider will review your symptoms and medical history. They’ll perform an exam and check the jaw joint area while you open and close your mouth.

They may take X-rays and measure how far your mouth opens before diagnosing TMD.

TMD Treatment Options

There are several different treatment options available for TMD. These include:

Conservative Treatment

TMD is not life-threatening, and most cases respond well to conservative treatment. This includes lifestyle changes, relaxation techniques, and over-the-counter (OTC) medications.

Your healthcare provider may recommend the following:

• Avoid opening the mouth too wide when yawning or eating
• Eat soft foods
• Avoid hard, chewy, and sticky foods and chewing gum
• Manage stress to reduce involuntary clenching of the jaw
• Practice relaxation techniques to ease tension and stop teeth clenching
• Exercise your jaw and tongue (as directed by an oral surgeon or physical therapist)
• Apply alternating heat and ice packs to the painful areas
• Take nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen or ibuprofen
• Practice good posture
• Get enough sleep
• Maintain space between your upper and lower teeth and breathe through your nose

Arthrocentesis

Arthrocentesis is a surgical procedure that uses sterile fluid to wash out the TMJ. The goal of the surgery is to remove any debris inside the joint.

You will most likely be under IV sedation during arthrocentesis, which eliminates any pain or discomfort. A local anesthetic is also administered to the TMJ using two needles.

During the procedure, the maxillofacial surgeon will manipulate your jaw, realign the cartilage disc, and administer a steroid drug into the joint.

Arthroscopy

Arthroscopies (“keyhole surgeries”) use a small telescope/camera to diagnose and treat TMD. Similar to arthrocentesis surgeries, you will undergo sedation.

During the TMJ arthroscopy procedure, an arthroscope is inserted into a small incision the surgeon makes in front of the ear. Then the surgeon removes any scar tissue around the joint to relieve pain and discomfort.

Medications

Medications are administered after minimally invasive or invasive TMJ surgeries. They may also be used to relieve pain for people with minor TMD symptoms.

Common medications include:

• Pain Relievers — if OTC medications aren’t enough, your dentist may prescribe stronger pain relievers to reduce TMD pain and discomfort.
• Muscle Relaxants — these medications are often recommended for people with constant muscle spasms in the jaw or difficulties opening and closing their mouths.
• Antidepressants — low doses of antidepressants may be used to reduce pain, sleeplessness, and bruxism.
• Trigger point injections — this may include dry needling or injecting botulinum toxin type A or a corticosteroid into the painful jaw muscles.

Therapies

Oral therapies are used to treat people with minor TMD symptoms. They’re minimally invasive and less expensive than surgeries.

When used in combination with conservative treatments, therapy effectively relieves symptoms and pain long-term for most people. Types of therapies for TMD include:

Mouthguards and Oral Splints

These are both considered occlusal appliances because they help with teeth positioning and jaw alignment, especially while sleeping. Nightguards are custom-made devices used to reduce the effects of teeth grinding, which can ultimately help relieve jaw pain.

Physical Therapy

Dentists often recommend exercises designed by physical therapists to help strengthen and stretch the jaw muscles affected by TMD.

Other common forms of physical therapy that may help relax the jaw and facial muscles include:

• Laser therapy
• Ultrasound therapy
• Transcutaneous electrical nerve stimulation (TENS)

Sleep Study

A sleep study can help rule out airway issues that may cause TMD. These include:

• Primary snoring
• Upper airway resistance syndrome (UARS)
• Central sleep apnea
• Sleep bruxism
• Parasomnias
• Restless leg syndrome (RLS)
• Narcolepsy
• Insomnia
• OSA

TMD Treatment Cost & Insurance

Surgeries are usually partially covered under a good health care plan. The prices below reflect treatment costs without insurance:

• TMD mouthguards — $500 to $1,500
• Physical therapy — $50 to $300 (per session)

The cost of TMD treatment depends on the type chosen, state of residence, and how many treatments you need. In many cases, dental insurance does not cover the total cost of the mouthguards, or they only cover a certain percentage.

What Is the Difference Between TMJ and TMD?

People often use TMD and TMJ interchangeably. Although related, these acronyms refer to different terms. Here’s how to tell them apart:

Temporomandibular Joint (TMJ)

TMJ refers to the jaw joint itself. You have two temporomandibular joints — one on each side of your head just below your ears. They’re among the most complex joints in your body.

Temporomandibular Disorders (TMDs)

TMD refers to a group of disorders that involve the TMJ. They’re sometimes called temporomandibular joint disorders (TMJDs) or TMJ disorders.

It’s common to call this disorder TMJ. However, that creates confusion about whether a person is speaking about the joint or the disorder.

What Are the Temporomandibular Joints?

The TMJs connect the lower jaw bone (mandible) to the temporal skull bone on both sides of your head.

You can feel these joints if you move your mouth while pressing your fingers to each side of your head where your jaw meets your ear. The TMJ and jaw muscles allow you to chew, swallow, talk, and yawn.

When people open their mouths, the round edges of the lower jaw bone (condyles) slide along the temporal bone’s joint sockets. A soft disc sits between the temporal bone and condyle, which keeps the movement smooth.

Outlook

TMDs affect people differently. For some people, the symptoms of TMD subside in a week or two. For others, TMD can become a chronic condition that negatively affects their quality of life.

If you have frequent or ongoing jaw pain or other TMD symptoms, tell your healthcare provider. They’ll determine the most effective approach to treatment.

Summary

Temporomandibular disorders (TMDs) are a group of conditions involving the temporomandibular joint (TMJ). They’re sometimes called TMJ disorders.

The TMJ is the jaw joint located on each side of your head. TMD can cause pain, a clicking sensation, and jaw locking in the TMJ and facial muscles.

TMD usually isn’t serious, and there are many treatment options available. However, it may become a chronic condition for some people.