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Temporomandibular disorders (TMD) is the name given to several problems with jaw
movement and pain in and around the
You may also hear TMD called TMJ or
The jaw joints, or
temporomandibular (TM) joints, connect the lower
jawbone (mandible) to the skull. These flexible joints are used more than any
other joint in the body. They allow the jaw to open and close for talking,
chewing, swallowing, yawning, and other movements.
have problems with jaw movement and pain in and around the jaw joints at some
time during their lives. These joint and muscle problems are complex. So
finding the right diagnosis and treatment of TMD may take some
Temporomandibular disorders (TMD) can affect the
jaw and jaw joint as well as muscles in the face, shoulder, head, and neck.
Common symptoms include joint pain, muscle pain, headaches, joint sounds,
trouble with fully opening the mouth, and jaw locking.
cases, symptoms of TMD are mild and don't last long. They tend to come and go without
getting worse and usually go away without a doctor's care.
people who have TMD develop long-lasting (chronic) symptoms. Chronic pain or difficulty moving the jaw may affect talking, eating, and
swallowing. This may affect a person's overall sense of well-being.
The most common cause of
TMD symptoms is muscle tension, often triggered by stress. When you are
under stress, you may be in the habit of clenching or grinding your teeth.
These habits can tire the jaw muscles and lead to a cycle of muscle spasm,
tissue damage, pain, sore muscles, and more spasm.
can start when there is a problem with the joint itself, such as:
Although there is
no one way to identify a TMD, your doctor can most likely check your
condition with a physical exam and by asking questions about your past health.
In some cases, an
CT scan, or
MRI is also used to check for bone or soft tissue
problems related to symptoms of TMD.
TMD symptoms usually go
away without treatment. Simple home treatment can often relieve mild jaw pain.
There are things you can do at first to reduce pain.
Getting physical therapy and learning ways to reduce
stress may also help to reduce pain and TM joint problems. Continue to use some
of these methods over time to prevent and manage symptoms that might come back.
If your pain is chronic or severe or is caused by problems with how the joint
is shaped, your doctor may recommend other treatments.
also called bite plates, are a common dental treatment for TMDs. Splints
are usually clear pieces of plastic that fit between the upper and lower teeth.
They help reduce grinding and clenching. Splints are used for a short time so
that they do not cause permanent changes in the teeth or jaw.
Before you try treatments such as surgery or reshaping or shaving down
the teeth, think it over. These treatments cannot be reversed and can even
damage the TM joint.
For most people, surgery is not used to treat
TMDs. Surgery has few benefits, and there is the chance of causing more
serious problems. You and your doctor can carefully weigh a decision to have
surgery. Talking with another doctor to get a second opinion can also help you
make your decision.
Chronic pain can lead to
anxiety, and other problems. If you have chronic pain,
talk to your doctor about medicine and mental exercises to manage the pain.
Give special attention to treating any related anxiety or depression.
Learning about temporomandibular disorder (TMD):
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Temporomandibular disorders (TMD) can result from a single cause or, more commonly, a
combination of causes.
The main causes of TMDs
In many cases, TMD symptoms appear to be caused by both muscle tension (tightness) and
joint dysfunction. It is not always clear which came first. For example,
osteoarthritis can cause changes in the joint, which may then bring on muscle
spasms. Conversely, muscle spasms over time hinder jaw function and can
eventually cause osteoarthritis in the jaw joint. A similar relationship
appears to exist between muscle tension and disc displacement within the
Orthodontic treatment and
malocclusion do not seem to trigger TMDs or make them
When jaw joint problems are caused by diseases such as
rheumatoid arthritis, treatment for that condition is important. Many
other conditions cause symptoms similar to those of TMDs, such as
migraine headaches and infections.
temporomandibular disorders (TMDs) are usually mild and
temporary and typically do not get worse with time. Common symptoms
around the ear, with pressure or ringing in the ears (tinnitus), develops with
TMDs. Some people with these symptoms report that they also have
hearing loss, although test results show that their hearing is normal.
Symptoms often go away on their own. And they may recur over time without
getting much better or worse. Occasional discomfort in the jaw joint or chewing
muscles is quite common and usually is not a cause for concern. But for some people symptoms can be
very painful, disabling, and last a long time.
The course of
temporomandibular disorders (TMDs) caused by muscle
tension varies depending on the cause of the muscle tension.
TMDs caused by problems in the
structure of the jaw joint may:
In some cases, TMDs can be
extremely painful and disabling and last a long time. Such
chronic pain can affect a person's overall quality of
life by increasing stress, making it hard to do a job, and
interfering with personal life.
anxiety are common results of chronic pain. Treatments may not relieve pain due to the lasting
psychological and biological impact of
chronic pain. These biological effects can lead to a sense of helplessness and biochemical
changes in the body that perpetuate pain. In these
cases, it is especially important to seek treatment for TMD pain and
for related depression and anxiety.
Risk factors for
temporomandibular disorders (TMDs) include:
Call your dentist or doctor immediately if you have had an
injury to your jaw or face and:
Call your dentist or doctor if
Your treatment for
temporomandibular disorder (TMD) may involve several
different health professionals.
Initial evaluation can be done by
Further diagnosis and treatment may be done by a:
Additional treatment may be provided by:
If a doctor suggests that you try a
treatment that might make permanent changes to your jaw, be sure to get a second opinion.
Health and dental
insurance plans might not cover diagnosis and treatment. Because some
tests and treatments are quite expensive, you may want to
check your coverage before incurring expenses.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Currently there is no widely accepted
standard test for identifying the cause of
temporomandibular disorders (TMDs). But your dentist or
doctor will most likely be able to accurately diagnose your
condition with information from a
medical history and physical exam.
TMDs are caused or made worse by muscle tension (tightness). Expect
your doctor to suggest treatment that does not involve surgery or
permanent changes to the jaw (conservative treatment) to relieve your jaw pain,
muscle tension, and TM joint problems.
If you have sudden pain
after a facial or jaw injury, your doctor is likely to order some
type of imaging test, such as an X-ray, a CT scan, or magnetic resonance
conservative treatment has not worked and your jaw is locking in place (a sign
of disc displacement), your pain is severe or chronic, or
you have other medical problems, such as
rheumatoid arthritis, other tests may be needed. These
tests are usually done only if knowing their results could change your
recommended treatment plan.
If you still have symptoms after the
first period of treatment, your doctor may begin to look for
problems in the jaw joint structure. Other tests may include:
The goal of treatment for
temporomandibular disorders (TMDs) is to relieve pain in
the jaw and restore normal jaw movement and function. Several treatment
approaches are effective. The first treatments that are tried for TMDs are called conservative, because they are simple and temporary. They are not invasive or permanent. They can be stopped or reversed. They include over-the-counter pain medicine and self-care that you can do at home.
Often, simple home treatment measures can
successfully relieve jaw pain. Less than
1 out of 10 adults have jaw problems or pain that is so severe that they need medical or dental treatment.1
muscle-related TMDs, standard medical care can include muscle
biofeedback, stress management, or
For chronic pain caused by a TMD, it is important to seek treatment for pain and
for related depression and anxiety.
Dental splints are the most common dental
treatment for TMDs. These splints or bite plates are typically used for a short period of
time. They can help relieve muscle tension and pain.
Most people do not need permanent dental work or surgery. Permanent dental work might include orthodontic treatments involving permanent changes to
the jaw. At best, permanent treatments or surgery may not work any better than physical therapy and temporary treatments. At worst, they can cause irreversible damage. If your doctor recommends surgery or other treatment that involves permanent
changes, be sure to get a second opinion before you start treatment.
Often, structural problems in
the jaw, such as
disc displacement, can be improved with conservative (nonsurgical) treatment,
especially when they are treated early.
temporomandibular disorders (TMDs), try to reduce muscle
tension in your jaw. You can reduce muscle tension in these ways:
In the past, various procedures such as dental restoration
and orthodontic treatment were used to prevent joint sounds from developing
into TMDs. Such measures are not only unneeded but also
potentially damaging to a joint that may never become painful on its
See Home Treatment for other ways
to prevent or reduce muscle tension in your jaw.
temporomandibular disorder (TMD) symptoms are mild, try
home treatment for at least 2 weeks. If your symptoms get worse during this
time, call your doctor or dentist.
involves reducing your stress, resting your jaw (by eating only soft or pureed
foods), taking steps to reduce pain, and exercising your jaw.
help relieve pain and restore jaw function:
If you have been diagnosed with a TMD, these home
treatment measures will optimize the treatments prescribed by your doctor or dentist, such as a
splint therapy or physical therapy.
You can use medicine to relieve the
pain of a
temporomandibular disorder (TMD). Short-term use of
nonsteroidal anti-inflammatory drugs (NSAIDs), narcotics, muscle relaxants, or
antidepressant medicines can relieve or reduce
inflammation, control pain, and relax the jaw muscles.
drugs (NSAIDs) do not cure TMDs. But they may reduce pain and
inflammation, which allows you to do prescribed jaw exercises that can start
the healing process. NSAIDs may be prescribed on a regular basis for 1 to 2
weeks to help reduce inflammation even though the pain has subsided.
Your doctor may prescribe an antidepressant, not necessarily because you
suffer from depression but to help treat chronic pain or nighttime
Surgery is rarely used to treat
temporomandibular disorders (TMDs). Surgical treatment
does not guarantee a cure and can further damage the temporomandibular joint.
Because most TMDs can be treated nonsurgically, most doctors believe that surgery should be the last option tried and should
be avoided if possible.
Surgery may be a treatment option for you
if both of the following apply:
The goals of surgery for TMDs
Surgery may include:
Another type of surgery, called total joint replacement,
is rarely done. It has sometimes resulted in permanent jaw damage. Total joint
replacement replaces the jaw joint with artificial parts. In some cases the
artificial parts have not worked correctly or have broken. The available
technology for this surgery is still considered to be experimental and
Further pain complications or
joint dysfunction can result from temporomandibular joint surgery.
Surgery is not needed in most
cases of disc displacement.2 Splint therapy (a
dental treatment), jaw rest, and physical therapy, including moist heat and jaw
exercises followed by an ice pack, can work very well for treating this
condition. If this and other nonsurgical treatment to relax the muscles are not
successful, arthrocentesis may effectively treat your condition.
If you are thinking about surgery, get a second opinion on your condition
Many types of treatment can
temporomandibular disorder (TMD) symptoms. Different
doctors will suggest different treatments, any of which may work
to relieve jaw and facial pain.
If a doctor
recommends that you try a treatment that might make permanent changes to your
jaw or teeth, get a second opinion.
Depending on your condition, one of the following choices
may be more effective than another. Safe options for treatment of TMD
safe and effective for some people include:
Many different types of
treatment for temporomandibular disorders (TMD) have potential for successfully
relieving your condition. If your problem is linked to muscle tension, any
treatment that helps you relax your jaw muscles with no adverse effects is
likely to be helpful. Different treatments work for different people.
Treatments vary greatly in safety, cost, and how well they work.
The National Institute of Dental and Craniofacial Research (NIDCR)
is a governmental agency that provides information about oral, dental, and
craniofacial health. By conducting and supporting research, the NIDCR aims to
promote health, prevent diseases and conditions, and develop new diagnostics
Scrivani SJ, et al. (2008). Temporomandibular disorders. New England Journal of Medicine, 359(25): 2693–2705.
Tucker MR, et al. (2008). Management of
temporomandibular disorders. In JR Hupp et al., eds., Contemporary Oral and Maxillofacial Surgery, 5th ed., pp.
629–649. St. Louis: Mosby Elsevier.
Other Works Consulted
Goddard G (2008). Temporomandibular disorders. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology – Head and Neck Surgery, 2nd ed., pp. 389–396. New York: McGraw-Hill.
American Academy of Pediatric Dentistry (2010). Guideline on acquired temporomandibular disorders in infants, children, and adolescents. American Academy of Pediatric Dentistry Clinical Guidelines Reference Manual, 32(6): 232–237. Also available online: http://www.aapd.org/media/policies.asp.
American Association for Dental Research (2010). Temporomandibular Disorders (TMD). Available online: http://www.aadronline.org/i4a/pages/index.cfm?pageid=3465#TMD.
American Society of Temporomandibular Joint Surgeons (2003). Guidelines for diagnosis and management of disorders involving temporomandibular joint and related musculoskeletal structures. Cranio, 21(1): 68–76.
Okeson JP (2011). Temporomandibular disorders. In ET Bope et al., eds., Conn’s Current Therapy 2011, pp. 1008–1011. Philadelphia: Saunders.
November 11, 2013
Adam Husney, MD - Family Medicine & Arden Christen, DDS, MSD, MA, FACD - Dentistry
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