Symptoms

Signs and symptoms of TMJ disorders may include:

• Pain or tenderness of your jaw
• Aching pain in and around your ear
• Difficulty chewing or discomfort while chewing
• Aching facial pain
• Locking of the joint, making it difficult to open or close your mouth
• Headache
• Uncomfortable bite
• An uneven bite, because one or more teeth are making premature contact

TMJ disorders can also cause a clicking sound or grating sensation when you open your mouth or chew. But if there's no pain or limitation of movement associated with your jaw clicking, you probably don't have a TMJ disorder.

When to see a doctor
Seek medical attention if you have persistent pain or tenderness in your TMJ or if you can't open or close your jaw completely. Your doctor, your dentist or a TMJ specialist can discuss possible causes and treatments of your problem.

Causes

The temporomandibular joint combines a hinge action with sliding motions. The parts of the bones that interact in the joint are covered with cartilage and are separated by a small shock-absorbing disk, which keeps the movement smooth.

TMJ disorders can occur if:

• The disk erodes or moves out of its proper alignment
• The joint's cartilage is damaged by arthritis
• The joint is damaged by a blow or other impact
• The muscles that stabilize the joint become fatigued from overwork, which can happen if you habitually clench or grind your teeth

In many cases, however, the cause of TMJ disorders isn't clear.

Risk factors

Factors that have been associated with TMJ disorders include:

• Sex and age. TMJ disorders most commonly occur in women between the ages of 30 and 50.
• Jaw deformity. You may be more likely to develop a TMJ disorder if you were born with a deformity of your facial bones that affects how your jaw works or how your teeth come together.
• Other diseases. TMJ disorders occur more often in people who have rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome or sleep disorders.

Preparing for your appointment

You'll probably first talk about your TMJ symptoms with your family doctor or dentist. If home treatments don't provide enough relief, you may eventually be referred to a doctor who specializes in TMJ disorders.

What you can do
You may want to prepare a list that answers the following questions:

• What type of symptoms are you experiencing?
• When did your symptoms start?
• Does any activity seem to trigger the pain?
• Does your jaw click or pop when you move it?
• Do you have problems sleeping?
• Is your life very stressful?

What to expect from your doctor or dentist
During the physical exam, your doctor or dentist will probably:

• Listen to and feel your jaw when you open and close your mouth
• Observe the range of motion in your jaw
• Examine your bite to check for abnormalities in the alignment of the jaws
• Check for conditions — such as a high filling, teeth displaced due to earlier loss of other teeth or certain inherited characteristics — that can cause misalignment of your jaw
• Examine your teeth for wear patterns that would indicate chronic grinding
• Press on areas around your jaw to identify sites of pain or discomfort
• Ask questions about your level of stress or anxiety and how you're coping

Tests and diagnosis

If your doctor or dentist suspects a problem with your teeth, you may need X-rays. A CT scan can provide detailed images of the bones involved in the joint, and MRIs can reveal problems with the joint's disk.

Treatment and drugs

In some cases, the symptoms of TMJ disorders may go away without treatment. If your symptoms persist, your doctor may recommend medications or a bite guard to help keep you from grinding your teeth at night. In very rare cases, surgery may be required to repair or replace the joint.

Medications

• Painkillers. If over-the-counter pain medications aren't enough to relieve TMJ pain, your doctor or dentist may prescribe stronger painkillers.
• Tricyclic antidepressants. Antidepressants, such as amitriptyline or nortriptyline, taken at bedtime help relieve TMJ pain in some people.
• Muscle relaxants. These types of drugs are sometimes used for a few days or weeks to help relieve pain caused by TMJ disorders.
• Corticosteroid drugs. For significant pain and joint inflammation, corticosteroid drugs injected into the joint space may provide relief.
• Botulinum toxin. Injecting botulinum toxin (Botox, others) into the jaw muscles used for chewing may relieve pain associated with TMJ disorders.

Therapies

• Bite guard. If you grind your teeth in your sleep, you may benefit from wearing a soft or firm device inserted over your teeth. This bite guard prevents your teeth from meshing together. Bite guards sometimes aggravate sleep apnea symptoms.
• Cognitive behavioral therapy. If your symptoms of TMJ disorder are made worse by poorly managed stress or anxiety, your doctor or dentist may refer you to a psychotherapist with experience in cognitive behavioral therapy. This approach includes interventions to help you be aware of and change behaviors, learn relaxation techniques, and manage stress.

Surgical or other procedures

• Corrective dental treatment. Your dentist may improve your bite by balancing the biting surfaces of your teeth, replacing missing teeth, or replacing needed fillings or crowns. However, these types of treatments sometimes worsen TMJ pain.
• Arthrocentesis. This procedure involves insertion of a needle into the joint so that fluid can be irrigated through the joint to remove debris and inflammatory byproducts.
• Surgery. As a last resort, your doctor or dentist may suggest surgery to repair or replace the joint. But the National Institute of Dental and Craniofacial Research considers TMJ surgery to be controversial and recommends that it be avoided whenever possible.

Lifestyle and home remedies

Becoming more aware of tension-related habits — clenching your jaw, grinding your teeth or chewing pencils — will help you reduce their frequency. The following tips may help you alleviate symptoms of TMJ disorders.

Avoid overuse of jaw muscles
To minimize the use of jaw muscles:

• Eat soft foods
• Cut food into small pieces
• Avoid sticky or chewy food
• Avoid chewing gum
• Don't open your mouth too wide during yawns

Stretching and massage
Your doctor or dentist may show you how to do exercises that stretch your jaw muscles and how to massage the muscles yourself. He or she may also show you exercises to improve your head, neck and shoulder posture.

Heat or cold
Applying warm, moist heat or ice to the side of your face may help relax your muscles or alleviate pain.

Alternative medicine

Because stress can contribute to TMJ disorders, stress-relieving relaxation techniques may reduce jaw clenching or teeth grinding and may help alleviate TMJ symptoms. Beneficial techniques include:

• Deep breathing. To practice deep breathing, sit comfortably with your feet flat on the floor. Breathe in through your nose, and allow your abdomen to expand as you breathe in. Pause for a second, and then exhale through your mouth, gently pushing in your abdomen with your hand.
• Progressive muscle relaxation. This involves relaxing a series of muscles one at a time. First increase the tension level in a group of muscles, such as a leg or an arm, by tightening the muscles and then relaxing them. Then move on to the next muscle group. It may also help to apply warm, moist heat.
• Guided imagery. Also known as visualization, this method of relaxation involves lying quietly and picturing yourself in a pleasant and peaceful setting. You experience the setting with all of your senses, as if you were actually there. For instance, imagine lying on the beach. Picture the beautiful blue sky, smell the salt water, hear the sounds of the waves, and feel the warm breeze on your skin. The messages your brain receives as you experience these senses help you to relax.
• Meditation. Meditation is a way to calm your mind and body. During meditation you sit quietly and focus on nothing or on a mantra — a simple sound repeated over and over. This causes you to enter a deeply restful state that reduces your body's stress response. Your breathing slows, your muscles relax and your brain wave activity indicates a state of relaxation.
• Yoga. Yoga incorporates proper breathing, movement and posture. It involves completing a series of postures, during which you pay special attention to your breathing — inhaling during certain movements and exhaling with others.