Exodontia.Info
Jaw Joint Problems
The temporomandibular joint (TMJ / jaw joint) is located in
front of the ear where the skull and the lower jaw meet.  
The joint allows the lower jaw (
mandible) to move and
function for eating, talking etc.  The joint itself is made up of
two bones that are separated by a disc of cartilage (a
tough tissue).  Ligaments and muscles surround the joint.
Diagram Showing the Position & Anatomy
of the
TMJ / Jaw Joint
Problems with the jaw joint are very common but typically
only last a few months before getting better.  In some
instances, only the muscles are affected (known as
myofacial pain dysfunction), whereas in others, the
cartilage and ligaments may also be a problem (known as
internal derangement of temporomandibular joint).

The most common symptoms are:

  • Joint noise - such as clicking, cracking, crunching,
    grating or popping.
  • Pain - usually a dull ache in and around the ear.  The
    pain may radiate, i.e. move forwards along the
    cheekbone or downwards into the neck.
  • Headache.
  • Trismus - inability to open your mouth fully.

Most jaw joint problems are made worse by chewing and
are aggravated at times of stress.

What causes jaw joint problems?

Pain is caused by the muscles in and around the jaw joint
tightening up.  
Joint noise occurs if the disc of cartilage
moves out of its normal position between the bones of the
jaw joint.  Most commonly, the disc slips forward and a
noise is made when it returns to its normal position in
between the bones.  The noise sounds louder to some
patients than others because the joint is just in front of the
ear.  The ligaments and muscles surrounding the joint can in
turn go into spasm, producing pain and a difficulty in
opening the mouth properly.

Why have I got jaw joint problems?

The cartilage in the jaw joint is thought to slip forwards
because of over-use of the muscles surrounding the jaw.  
The over-use commonly produces tightening of the muscles
and may occur as a result of chewing habits, such as
grinding or clenching the teeth when under stress (usually
when asleep).  Nail biting or holding things between the
teeth can also cause jaw joint problems.  Less commonly,
missing back teeth, an uneven bite or an injury to the jaw
can lead to the problem.  Often, no obvious cause is found.

Are my problems anything to worry about?

Jaw joint problems are usually not serious and do not lead
on to other problems, e.g. arthritis of the jaw joint.  
However, they are a nuisance.  Fortunately, jaw joint
problems usually respond well to simple treatments.
What are the Treatments?

Treatments vary depending on whether you are suffering
from
myofacial pain dysfunction, internal derangement of
the temporomandibular joint
or a combination of both.  On
the whole, treatment is aimed at trying to reduce the
workload of the muscles, so allowing the disc of cartilage to
return to a normal position in the joint.

This includes such
advice as:

  • Eat a soft diet that requires little chewing - allowing the
    over-worked muscles to rest.

  • Take painkillers - anti-inflammatory medication (e.g.
    Ibuprofen) is good and can be taken as either tablets
    or applied as a gel on the outside of the joint.

  • Use heat - e.g. wrap a hot water bottle filled with
    warm water in a towel and apply it to the side of your
    face.

  • Identify and stop any bad habits, such as clenching or
    grinding.  Although, this may be difficult as they are
    often 'subconscious', i.e. you may not be aware you
    are doing them.

  • Use relaxation therapy and learn techniques to control
    tension and stress.

  • Jaw joint exercises - your doctor will advise you on the
    best kind of exercises for your problems.  Please
    remember to follow them as instructed.

  • Rest the joint as much as possible, e.g. avoid yawning.

  • Wear a clear plastic splint that fits over the teeth and is
    worn mainly at night (a Bite Raising Appliance).  This
    helps support the joint and surrounding muscles.

  • Follow a physiotherapy programme.

  • Replace missing teeth to balance the bite (if
    appropriate).

What happens if these methods do not help?

Surgery is only carried out in a small number of cases.  
This can involve manipulation of the joint whilst you are
asleep, or more rarely, surgery carried out with a mini
telescope.  In extreme cases, it may be necessary to open
the joint and operate on the bones, cartilage and ligaments.

Can jaw joint problems develop into anything worse?

It is important to realise that jaw joint problems, although a
nuisance, are not sinister and usually respond well to
relatively simple measures over a period of time.

Patients can manage most of the treatments themselves.

Occasionally,
jaw joint problems may return after several
years.  It is very rare for jaw joint problems to progress to
anything serious, like arthritis.


Useful Websites:

Dental Health Information Center (Temperomandibular
[TMJ] Disorders)

American Society of Temperomandibular Joint Surgeons

Quality Dentistry (TMJ)

TMJ Association (TMJ Archive)

American Academy of Otolaryngologists - Head & Neck
Surgery

Mayo Clinic

Emedicine.com


Useful Articles:

Guidelines for Diagnosis & Management of Disorders
Involving the TMJ & Related Musculoskeletal Structures
(2001).

McKinley Health Center, University of Illinois 2002.  
Temporomandibular Joint Disorders

BAOMS 2003. Jaw Joint Problems

BDJ 2004.  Treatment of TMJ disorders by stabilising
splints in general dental practice - results after initial
treatment

TMJ Disorders (2006) - US Department of Health & Human
Services, National Institutes of Health.

BAOS Information Sheet (2006).  Temporomandibular
(Jaw) Joint Problems

ENT News 2008 - Assessment & Initial Management of
TMJ Disorders

J Oral Maxillofac Surg 2009.  Temporomandibular
Disorders in Surgical Practice. Does Science Support
Treatment Decisions.

BJOMS 2009.  Leading article.  Current Thinking in
Temporomandibular Joint Management.

J Oral Maxillofac Surg 2010.  Oral & Maxillofacial Surgery
& Chronic Painful Temporomandibular Disorders — A
Systematic Review.

BJOMS 2010.  Review article - Oral Surgery and TMJ-
related papers published in BJOMS in 2008 and 2009.

International Dentistry SA 2010.  Etiology of
temporomandibular disorders - the journey so far

BDJ 2010.  Risk management in clinical practice. Part 8.  
Temporomandibular disorders
Please click here to send any comments via email.
Last Updated 24th November 2010