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TMJ disorders

Skull of an adult
Causes of secondary headache

Definition

Temporomandibular joint and muscle disorders (TMJ disorders) are problems or symptoms of the chewing muscles and joints that connect your lower jaw to your skull.

See also: Facial pain

Alternative Names

TMD; Temporomandibular joint disorders; Temporomandibular muscle disorders

Causes

There are two matching temporomandibular joints -- one on each side of your head, located just in front of your ears. The abbreviation "TMJ" literally refers to the joint but is often used to mean any disorders or symptoms of this region.

Many TMJ-related symptoms are caused by the effects of physical stress on the structures around the joint. These structures include:

For many people with temporomandibular joint disorders, the cause is unknown. Some causes given for this condition are not well proven. These included:

Poor posture can also be an important factor in TMJ symptoms. For example, holding the head forward while looking at a computer all day strains the muscles of the face and neck.

Other factors that might make TMJ symptoms worse are stress, poor diet, and lack of sleep.

Many people end up having "trigger points" -- contracted muscles in your jaw, head, and neck. Trigger points can refer pain to other areas, causing a headache, earache, or toothache.

Other possible causes of TMJ-related symptoms include arthritis, fractures, dislocations, and structural problems present since birth.

Symptoms

Symptoms associated with TMJ disorders may be:

Exams and Tests

You may need to see more than one medical specialist for your TMJ pain and symptoms. This may include a primary care provider, a dentist, or an ear, nose, and throat (ENT) doctor, depending on your symptoms.

A thorough examination may involve:

Sometimes, the results of the physical exam may appear normal.

Your doctor will also need to consider other conditions, such as infections, ear infections, or nerve-related problems and headaches, as the cause of your symptoms.

Treatment

Simple, gentle therapies are usually recommended first.

Read as much as you can, as opinion varies widely on how to treat TMJ disorders. Get the opinions of several doctors. The good news is that most people eventually find something that helps.

Ask you doctor or dentist about medications you can use:

Mouth or bite guards, also called splints or appliances, have been used since the 1930s to treat teeth grinding, clenching, and TMJ disorders.

Failure of more conservative treatments does not automatically mean you need more aggressive treatment. Be cautious about any nonreversible treatment method, such as orthodontics or surgery, that permanently changes your bite.

Reconstructive surgery of the jaw, or joint replacement, is rarely required. In fact, studies have shown that the results are often worse than before surgery.

Support Groups

For more information, see The TMJ Association -- www.tmj.org

Outlook (Prognosis)

For many people, symptoms occur only sometimes and do not last long. They will go away in time with little or no treatment. Most cases can be successfully treated. Some cases of pain go away on their own without treatment. TMJ-related pain may return again in the future. If the cause is nighttime clenching, treatment can be very tricky because it is a sleeping behavior that is hard to control.

Mouth splints are a common treatment approach for teeth grinding. While some splints may silence the grinding by providing a flat, even surface, they may not be as effective at reducing pain or stopping clenching. Splints may be effective in the short-term but could become less effective over time. Some splints can also cause changes in your bite. This may cause a new problem.

Possible Complications

When to Contact a Medical Professional

See your health care provider right away if you are having trouble eating or opening your mouth. Keep in mind that a wide variety of possible conditions can cause TMJ symptoms, from arthritis to whiplash injuries. Experts who are specially trained in facial pain can help diagnose and treat TMJ.

Prevention

Many of the home-care steps to treat TMJ problems can prevent such problems in the first place:

References

Beuscher JJ. Temporomandibular joint disorders. Am Fam Physician. 2007;76(10):1477

Hampton T. Improvements needed in management of temporomandibular joint disorders. JAMA. 2008;299(10):1119-1121.

Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008;359:2693-2705.


Review Date: 2/22/2012
Reviewed By: Paul Fotek, DMD, Florida Institute for Periodontics & Dental lmplants, West Palm Beach, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.