Temporomandibular Joint Dysfunction (TMD)

What is Temporomandibular Joint Disorder (TMD)?

Temporomandibular joint and muscle disorders (TMJD) are a group of disorders that cause dysfunction and pain in the jaw and surrounding muscles, bones, and joints that control jaw movement.

Temporomandibular joint dysfunction, also known as TMJ disorder or TMD, is the most common jaw disorder that affects over 10 million Americans.

Many people experience temporary pain in the jaw joint and muscles throughout their lifetimes. This occasional discomfort typically doesn’t signal a serious underlying condition, such as TMD. Some people develop long-term symptoms that occur more frequently, which often results in the diagnosis of a temporomandibular disorder.

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

Who Does TMD Affect?

According to a study by the National Institutes of Health, pain in the temporomandibular joint and the masseter muscle while resting is significantly higher in females than in males. This is related to the difference in hormonal, biological, and anatomical characteristics.

Women in their “child-bearing years,” typically 35 years or older, make up 90 percent of all TMD sufferers due to hormonal changes during this stage of life. Men and women with extreme jaw pain due to stress, habits, or genetics are also at risk of TMD.

Women are twice as likely to develop TMD than men, especially mothers and those taking oral contraceptives.

Temporomandibular Joint: How it Works

The temporomandibular joint connects the mandible (lower jawbone) to the temporal bone on both sides of a person’s head. The joint moves the mouth seamlessly up and down and side to side, which allows people to chew, swallow, talk, and yawn.

When people open their mouths, the round edges of the mandible (lower jaw), referred to as condyles, slide along the temporal bone’s joint sockets. Then the condyles move back into their original positions as the mouth closes. A soft disc also sits between the temporal bone and condyle, which keeps the jaw movement smooth.

An individual with TMD will feel pain in the jaw joint and muscles that control movement for a long period of time.

Causes, Signs & Symptoms of TMD Pain

There are many possible causes of TMD. Symptoms often start without an obvious reason. This makes distinguishing the difference between normal jaw pain and a TMJ disorder difficult for medical professionals.

Jaw popping and clicking sounds are common in many people and are not necessarily correlated with TMD. Although, if there is consistent clicking or popping of a TMJ, that means it is dysfunctioning. It is possible to have TMD without any pain.

Risk factors for developing TMD include:

• Stress and anxiety, which causes tense muscles and jaw clenching
• Teeth grinding (bruxism), especially while sleeping
• Malocclusion (misaligned teeth) with recurring pain in the jaw muscles
• Teeth misalignment or damage caused by trauma or injury
• Rheumatoid arthritis, which is a chronic inflammatory disorder that affects the joints
• Excessive gum chewing, which puts constant pressure on the TMJ
• Obstructive sleep apnea

The most common sign of a TMJ-related issue is connected to pain in the jaw joint and chewing muscles.

In some cases, TMD symptoms go away on their own. Although, if the jaw pain persists for a few months, TMD may be present. Common symptoms include:

• Severe pain in the jaw, neck, and surrounding muscles
• Facial pain or pain in your ear when you chew, speak, or open your mouth wide.
• Stiffness in the jaw muscles when opening and closing the mouth
• Lockjaw or difficulty moving the jaw normally
• A change in upper and lower teeth alignment
• Painful popping or clicking in the jaw when opening and closing the mouth
• Popping sounds in the ears, ringing in the ears, and earaches
• Pain in the temple area

TMD Treatment Options

There are a few different treatment options available for patients suffering from TMD.

Depending on the severity of pain, the amount of time the pain has been present, medical history, and habits, your dentist will recommend the best option. This includes conservative remedies, arthrocentesis, arthroscopy, medications, therapy sessions, or a combination of treatments.

Diagnosis

During the first assessment, the general dentist reviews the patient’s detailed medical history. Next, they look for symptoms following an intra-oral and extra-oral examination, which includes examining inside the patient’s mouth and outside (near the jaw, neck, and temple). Dentists also typically check the joint area while the patient opens and closes their mouth.

Medical imaging, x-rays, and measuring how far a patient’s mouth opens may also be necessary for the proper diagnosis of TMD.

Conservative Treatment

TMD is not life-threatening, and most cases of the disorder respond well and experience pain relief with conservative treatment. These treatments include joint rest, lifestyle changes, and eliminating old habits.

Dentists recommend the following:

• Avoid opening the mouth too wide when yawning or eating
• Eat more soft foods and refrain from hard, chewy, and sticky foods and chewing gum
• Practice relaxation techniques to ease tension in the jaw and reduce chronic pain
• Avoid habits such as nail-biting, chewing on pens, or excessive gum chewing
• Gentle jaw and tongue exercises (as directed by an oral surgeon or clinician)
• Apply gentle heat to the painful areas, such as a folded towel or warm water bottle
• Use of non-steroidal anti-inflammatory drugs (as directed by your dentist)
• If grinding (bruxism) or an airway breathing issue is present, stress may be to blame. So, your dentist should be made aware of these habits to determine if more treatment is necessary
• Don't rest your chin on your hand
• Keep your teeth slightly apart during the day 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 return the cartilage disc to its correct position and remove any debris inside the joint.

Patients are asleep under IV sedation during arthrocentesis surgeries, 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 then 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, patients also undergo sedation.

During the 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 patients with minor TMD symptoms.

Common medications include:

• Pain Relievers — if ibuprofen or similar over-the-counter anti-inflammatory medications aren’t enough, your dentist may prescribe stronger pain medications to reduce discomfort caused by TMD
• Muscle Relaxers — muscle relaxant medications are often recommended for those 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 teeth grinding (bruxism)

Therapies

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

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

• Mouthguards and Oral Splints — these treatments are both considered occlusal appliances because they help with teeth positioning and jaw alignment, especially while sleeping. In short, nightguards are used to relieve jaw pain and discomfort caused by TMD. The hard acrylic devices are custom-made for every patient. 
• 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 include gentle heat, ice, and ultrasounds.
• Transcutaneous Electrical Nerve Stimulation (TENS) — this therapy uses low-level electrical currents to provide pain relief by relaxing your joint and facial muscles.
• Sleep Study — a sleep study can help rule out airway issues, including primary snoring, upper airway resistance syndrome (UARS), central sleep apnea, sleep bruxism, parasomnias, restless leg syndrome, narcolepsy, insomnia, and obstructive sleep apnea (OSA).

Other Treatments

Doctors may also treat TMD with:

• Ultrasound
• Trigger-point injections
• Radio wave therapy
• Laser therapy

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-$1,500
• Physical Therapy: $50-300 (per session)

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