What Is Temporomandibular Joint Disorder (TMJ)?

Disorders of the temporomandibular (TMJ) joint, also called TMJ disorder or simply TMJ, affect the “hinges” that connect the jaw to the skull on either side of the head. TMJ can cause pain in the jaw and face and dental problems, among other symptoms. TMJ and related temporomandibular disorders (TMDs) are common, and it’s estimated that 60 to 70% of the population experience it at some point.

The symptoms of TMJ disorder vary from person to person. Many cases resolve on their own or with conservative treatment, though some people develop chronic or recurring symptoms. Treatment for the condition depends on its severity and underlying cause. Luckily, both at-home methods and medical treatments can help manage TMJ. 

Types of TMJ Disorders

TMJ is actually a term for several conditions called temporomandibular disorders (TMDs), which are a subset of conditions affecting the TMJ joint. Disorders of the TMJ are broken based on the underlying cause. In clinical practice, healthcare providers generally categorize cases into those related to muscles in the jaw, or myofascial pain, and those caused by issues within the joint, or intraarticular TMJ.

Myofascial pain

Myofascial pain is a term for pain, tension, and fatigue in the muscles and surrounding connective tissues. When this affects the muscles that control your jaw movements and chewing, TMJ symptoms arise. Conditions that can cause myofascial pain include autoimmune conditions, teeth grinding (bruxism), stress, and anxiety, among others.

Intraarticular Disorders

TMJ symptoms can also be caused by issues that affect the joint directly. These intraarticular disorders can arise due to damage directly to the joint or inflammation (swelling). Conditions causing these disorders include dislocation of the disc of the TMJ (articular disc displacement), dislocated jaw, rheumatoid arthritis, and osteoarthritis, among others.

TMJ Symptoms

The symptoms of TMJ can differ from case to case. In some cases, the associated discomfort and pain resolve on their own, while in others, the issues are constant or can fade away before flaring up again.

Jaw and Facial Pain

By far the most common symptom of TMJ is pain in the jaw and face. This pain can be the result of either myofascial pain or intraarticular TMJ, and it can remain fixed in one spot or spread to the face. It usually worsens with jaw movement. TMJ pain and tenderness are seen in:

• The jaw joint
• The muscles used for chewing (which can also be stiff)
• The temples
• Other parts of the face
• The neck or shoulders
• The ears

Restricted Jaw Motion

Especially when associated with inflammation or problems within the jaw, TMJ disorder can also make opening and closing your mouth difficult. In certain cases, you become unable to close or open it all the way. You may experience a locked jaw, where your mouth gets stuck in position.

Clicking Jaw

Popping or clicking in the jaw when you move your mouth isn’t necessarily a symptom of TMJ, but it can often coincide with TMJ. If you experience popping and clicking in your jaw alongside pain and discomfort, then your healthcare provider will suspect an issue.

Dental Symptoms

TMJ can cause your jaws to move out of alignment, a condition known as malocclusion. The misalignment affects the angle and overall health of both upper and lower sets of teeth, which can affect your dental health. This raises the risk of developing crooked teeth, cavities, tooth pain, and other dental problems.

Other Symptoms

Additional symptoms can occur due to TMJ. These include:

• Headaches
• Tinnitus, which is a ringing in the ears
• Hearing loss
• Dizziness
• Swelling along the jaw
• Tired muscles in the face

Causes

As noted above, there are two primary types of TMJ disorders, which differ based on their causes. However, some cases have no identified cause, and a mixture of genetics, injury, general health, and psychological factors can all play a role.

Myofascial pain due to TMJ arises due to inflammation of the muscles surrounding the jaw as well as mechanical issues with the jaw. Possible causes of this type include:

• Stress
• Teeth grinding (bruxism)
• Abnormal spine posture
• Depression and/or anxiety
• Autoimmune diseases
• Fibromyalgia (a heightened sensitivity to pain)

Intraarticular TMJ cases are caused by:

• Displacement (dislocation) of the disk of the TMJ
• Displacement of the TMJ
• Injury or impact to the jaw
• Capsular inflammation (severe inflammation of the shoulder)
• Osteoarthritis
• Hypermobility (too much range of motion of the TMJ)
• Rheumatoid arthritis, or other diseases that cause inflammation in the joint
• Birth defects affecting the TMJ

Diagnosis

There’s no standard approach to the diagnosis of TMJ. As such, health providers primarily rely on your medical history and current medical status to help determine if you have it. However, other tests may help them assess your case and rule out other conditions.

Alongside asking about your medical history, current symptoms, and medications, several tests may be performed, including:

• Physical exam: A physical assessment of the muscles of the jaw, including assessments of pain levels, helps providers determine the location and scope of the issue.
• Dental exam: Dental assessment for signs of jaw misalignment, tooth grinding, or other dental issues, can also help providers identify TMJ disorders.
• Neurological exam: A series of tests to determine alertness, awareness, mood, memory, and other core tasks, may be used to rule out other causes of pain.
• Otoscopy: Evaluation of the inner ear (otoscopy) may be needed, especially if symptoms are affecting hearing or the comfort of the ears.
• Magnetic resonance imaging (MRI): MRI is a form of imaging that relies on magnetic waves. It can provide highly detailed images of bone and tissue structures of the face and jaw.
• Panoramic X-ray: This type of imaging relies on radioactive light to develop detailed images, which may be used to view the bone structure of your jaw.
• Computerized tomography (CT): CT scans rely on multiple X-rays to perform detailed images of tissues and bones affected by TMJ.
• Diagnostic injections: Physical reactions to injections with nerve blocks, botulinum toxin A (Botox), or other medications can help providers assess any nerve damage or patterns of pain. These newer methods may assist in diagnosis.

Treatments for TMJ  

Many cases of TMJ disorder resolve on their own. If treatments are needed for this condition, they are usually done by a dentist, primary care provider, oral surgeon, or otolaryngologist (a specialist in ear, nose, and throat issues, also called an ENT). Generally, less invasive and more conservative treatments are tried first.

Home Management

Conservative treatments for TMJ begin with patient education and home management. Recommended strategies include:

• Resting the jaw
• Eating only soft or pureed foods
• Applying moist, warm compresses on affected areas
• Passive stretching exercises for the jaw muscles

Physical Therapy

Alongside home management, there’s some evidence that physical therapy approaches can help. This can include learning from a trained physical therapist to use special devices or techniques to exercise and stretch the jaw muscles and improve their mobility. They may also perform manual therapy, directly massaging the muscles to improve symptoms.

Complementary and Alternative Medicine

Several complementary and alternative medicine (CAM) approaches can also be attempted to manage TMJ symptoms. They aren’t expected to work on their own but may help as part of a broader treatment plan. Among these, two approaches have been studied:

• Acupuncture: A practice with origins in traditional Chinese medicine, acupuncture involves inserting thin needles in specific spots (known as “meridians”) in the body for pain management. Though the evidence is mixed, some studies have found this effective for TMDs.
• Transcutaneous electrical nerve stimulation (TENS): This involves using a battery-powered device to electrically stimulate affected nerves, essentially scrambling your body’s pain perception. TENS has shown a limited effect on TMJ pain and mobility issues, though more research is needed.

Behavioral Therapy

Since stress, anxiety, depression, and other mental health conditions can cause or worsen TMJ, behavioral therapies can also play a role in management. These include:

• Self-management techniques: It can be helpful to learn as much as possible about your condition, try meditation and relaxation techniques (breathing exercises, mindfulness practices), and set goals and track your progress.
• Cognitive behavioral therapy: This involves developing strategies to help you cope with your condition and reframe your thinking about it. This is done using talk therapy with your mental health counselor or therapist.
• Biofeedback: This therapy involves learning to detect when tension is rising in the jaw using sensors and other devices. With this knowledge, you develop relaxation strategies that you can use to help prevent flare-ups.

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil and Motrin (ibuprofen) or Aleve (naproxen), are the first-line treatment for TMJ pain and inflammation. Many of these are available over-the-counter.

In cases linked to myofascial pain and jaw muscle problems, health providers may prescribe benzodiazepines, such as Xanax (alprazolam), Ativan (lorazepam), and Klonopin (clonazepam) to aid in relaxation.

Intraoral Appliances

Intraoral appliances are dental devices that fit over the teeth. They may help ease TMJ symptoms related to severe teeth grinding (bruxism) and malocclusion (misalignment of the teeth). Dentists may have you wear a fitted nightguard, which you can have specially made at their office to fit your teeth, or purchase a general nightguard over-the-counter (OTC).

These appliances change how your teeth fit together. The evidence is mixed for how well intraoral appliances treat TMJ symptoms. In some cases, these approaches can make the problem worse.

Orthodontic Treatment

To change the shape of your bite, dental crowns, filing of the teeth, or orthodontic treatments, such as braces or retainers, can be attempted. As with intraoral appliances, significant evidence for how well these therapies work for TMJ is lacking.

Injections

Injections are usually only tried only If non-invasive treatments haven’t worked and if the cause of your TMJ warrants it. These therapies include:

• Botulinum toxin A (Botox): Botox injection is often used for migraine and some other chronic pain conditions; it may help ease myofascial pain, though the evidence is limited.
• Prolotherapy: Injections of an irritant into the joint trigger the body’s immune response to repair; studies have found it effective, though more research is needed. 
• Arthrocentesis: This therapy involves injecting a solution into the joint. This solution increases pressure and removes scar tissue and chemicals associated with inflammation, which has been shown effective for TMJ caused by disk displacement.

Surgery

In TMJ disorder that doesn’t respond to other therapies, several surgeries can be attempted:

• Arthroscopy: This is a minimally invasive surgery that involves using a camera on a tube to access the affected area to adjust the position of the jaw or remove scar tissue.
• Open surgery: This involves opening up the TMJ to repair it; it makes permanent changes to your jaw and is only considered when cases are severe or the joint is damaged.
• TMJ implants: In cases of severe damage, implants replacing all or part of the joint are indicated.

Preventing Episodes

Depending on the underlying cause of TMJ disorder, there may be no way to outright prevent the condition. However, several strategies can help stop recurrences and minimize symptom severity. These include:

• Stretching the jaw while applying hot or cold compresses
• Jaw strengthening exercises
• Adjusting your posture
• Meditation, breathing exercises, or other relaxation techniques
• Avoiding nail biting, jaw clenching, or tensing the jaw muscles
• Ensuring you get enough sleep (7 to 8 hours for adults)
• Going to bed and waking at consistent times
• Managing teeth grinding by wearing a nightguard 
  

Living With TMJ 

While TMJ can be very debilitating, up to 40% of cases resolve completely on their own, with only 5 to 12% needing significant medical treatment. Still, in some cases, TMJ does become chronic. Living with this condition can significantly impact quality of life, affecting your ability to eat, speak, and yawn.

That said, therapies alongside at-home management can help with symptoms. To help you cope with the burden of TMJ, additional strategies include:

• Making regular appointments with your dentist, healthcare provider, or a specialist
• Tracking and monitoring your condition and learning as much as you can about it
• Seeking out mental health counseling services
• Looking into local, online support groups, or social media groups for chronic pain
• Advocacy organizations, such as the TMJ Association or the Chronic Pain Association