TMD

Definition
TMJ disorders cause tenderness and pain in the temporomandibular joint (TMJ) - the joint on each side of your head in front of your ears, where your lower jawbone meets your skull. This joint allows you to talk, chew and yawn.
Women are more likely than men to develop TMJ disorders.
In most cases, pain and discomfort associated with TMJ disorders can be alleviated with self-managed care or nonsurgical treatments, but more-severe cases may need to be treated with dental or surgical interventions.

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
If you have persistent pain or tenderness in your TMJ, if you have facial pain and experience clicking or grating when you chew or move your jaw, or if you can't open or close your jaw completely, seek medical attention. Our specialized team can discuss possible causes and treatments of TMJ disorders with you.

Causes
Because it combines a hinge action with sliding motions, the temporomandibular joint is one of the most complex joints in your body. The lower jaw has rounded ends that glide in and out of the joint socket when you talk, chew or yawn. 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.
'The teeth are improperly aligned or improperly occlude together.
'You are subjected to chronic psychological stresses.
In many cases, however, the cause of TMJ symptoms isn't clear.

Risk factors
TMJ disorders most commonly occur in women between the ages of 30 and 50. Other factors associated with TMJ disorders include:
'Jaw clenching
'Teeth grinding (bruxism)
'Rheumatoid arthritis
'Fibromyalgia
'Facial or jaw trauma
'Congenital deformity of the facial bones

Preparing for your appointment
What you can do
Preparing a list of questions ahead of time will help us make the most of our time together. List your questions from most important to least important in case time runs out. For TMJ disorders, some basic questions to ask your doctor include:
'What is the most likely cause of my symptoms?
'Are there other possible causes?
'What types of tests do I need, if any?
'What treatments are available?
'What approach do you recommend?
What to expect from us
During your appointment, we will probably:
'Conduct a medical history, including questions about how long you've experienced pain, whether you've had an injury to your jaw, and whether you've had recent dental treatment
'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, a tipped tooth, 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
What you can do in the meantime
Before your appointment, you may be able to reduce your discomfort in the following ways:
'Avoid clenching or grinding your teeth.
'Use warm, moist heat or ice on the painful area.
'Take over-the-counter anti-inflammatories, such as ibuprofen.
'Work on reducing your stress and anxiety.

Tests and diagnosis
If a problem with your teeth is suspected, 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.

Treatments and drugs
Treatment modalities vary from simple self-regulation protocols, medications, physical exercise to various types of occlusal appliances or splints. In very rare cases, surgery may be required to repair or replace the joint.
Medications
'Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as aspirin or ibuprofen, usually don't provide enough relief for pain caused by TMJ disorders. However, there's some evidence that naproxen (Aleve, others) may be helpful if combined with exercises designed to stretch jaw muscles.
'Tricyclic antidepressants. Antidepressants, such as amitriptyline taken at bedtime have proved effective in relieving TMJ pain.
'Muscle relaxants. Such drugs may be used for a few days or weeks to help relieve pain caused by TMJ disorders. These drugs can be habit-forming and should be withdrawn gradually.
'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 has relieved 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.
'Cognitive behavioral therapy. If your symptoms of TMJ disorder are made worse by poorly managed stress or anxiety, we 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.
'Corrective dental treatment. Your bite may need to be improved by balancing the biting surfaces of your teeth, replacing missing teeth, or replacing needed fillings or crowns.
'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. If the other approaches don't work, our oral and maxillofacial surgeon might recommend surgery to repair or remove the disk between your mandible and temporal bone. When advanced osteoarthritis is present, a partial or total joint replacement may help remove bone-on-bone contact and improve joint mechanics and motion.
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 reduce your TMJ symptoms.
'Maintain good jaw 'posture.' This involves keeping the jaw muscles relaxed with the teeth slightly apart and the tongue lightly touching the roof of your mouth and resting directly behind your upper teeth.
'Avoid overuse of jaw muscles. Eating soft foods, cutting food into small pieces, avoiding sticky or chewy food, and avoiding gum will minimize muscle use and may help alleviate pain. When yawning, try not to open your mouth too wide.
'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 you 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.