Temporomandibular joint disorder (TMJD or TMD), or TMJ syndrome, is an acute or chronic inflammation of the temporomandibular joint, which connects the lower jaw to the skull. The disorder and resultant dysfunction can result in significant pain and impairment. Because the disorder transcends the boundaries between several health-care disciplines—in particular, dentistry, neurology, physical therapy and psychology—there is a variety of quite different treatment approaches.

Symptoms

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These are the symptoms of TMJD, although not everyone who has TMJD may feel any or all of the symptoms. These include, but are not limited to:

1. Unable to open mouth all the way
2. Pain when trying to close mouth or bite down
3. Feeling as if lower jaw muscles are tensed too tight
4. Popping or clicking when the jaws are opened
5. Popping or clicking when attempting to chew
6. Transient headache
7. Persistent headache
8. Stiffness in the neck and shoulders TMJ Syndrome: The Overlooked Diagnosis, A. Richard, D. D. S. Goldman Virginia McCullough, chapter 5, http://www.headandneck.com/book/Chapter5.htm
9. Upper backache
10. Lower backache
11. Numbness in the extremities

Precipitating factors

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There are many external factors that place undue strain on the TMJ. These include but are not limited to the following:

Over-opening the jaw beyond its range for the individual or unusually aggressive or repetitive sliding of the jaw sideways (laterally) or forward (protrusive). These movements may also be due to wayward habits or a malalignment of the jaw or dentition. This may be due to:

1. Modification of the occlusal surfaces of the teeth though dentistry or accidental trauma
2. Speech habits resulting in jaw thrusting.
3. Excessive gum chewing or nail biting.
4. Excessive jaw movements associated with exercise.
5. Repetitive unconscious jaw movements associated with bruxing
6. Size of foods eaten.

Treatment

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Restoration of the occlusal surfaces of the teeth

If the occlusal surfaces of the teeth have been damaged though dentistry or accidental trauma, the proper occlusion must be restored through modification of the occlusal surfaces of the teeth.

Pain relief

While conventional analgesic pain killers such as paracetamol or NSAIDs provide initial relief for some sufferers, the pain is often more neuralgic in nature which often does not respond well to these drugs.

An alternative approach is for pain modification, for which off-label use of low-doses of Tricyclic antidepressant that have anti-muscarinic properties (e.g. Amitriptyline or the less sedative Nortriptyline) generally prove more effective. Because of their primary therapeutic functions are for psychiatric disorders their use should be monitored by a physician.

Long term approach

It is suggested that before the attending doctor commences any plan or approach utilizing medications or surgery a thorough search for inciting para-functional jaw habits must be performed. Correction of any discrepancies from normal can then be the primary goal.

An approach to eliminating para-functional habits involves the taking of a detailed history and careful physical examination. The medical history should be designed to reveal duration of illness and symptoms, previous treatment and effects, contributing medical findings, history of facial trauma and a search for habits that may have produced or enhanced symptoms. Particular attention should be directed in identifying perverse jaw habits such as clenching or teeth grinding, lip or cheek biting, or positioning of the lower jaw in an edge to edge bite. All of the above puts strain of the muscles of mastication (chewing) and resultant jaw pain. Palpation of these muscles will cause a painful response.

Treatment is oriented to eliminating oral habits, physical therapy to the masticatory muscles and alleviating bad posture of the head and neck. A flat plane full coverage oral appliance, non-repositioning, often is helpful to control bruxism and take stress off the temporomandibular joint. Mandibular Repositioning Devices can be worn short term to help alleviate symptoms related to painful clicking when opening the mouth wide but 24 hour wear for long term may lead to changes in the position of the teeth which can complicate treatment. A typical long term permanent treatment (if the device is proven to work especially well for the situation) would be to convert the device to a flat plane bite plate fully covering either the upper or lower teeth and to be used only at night. Full mouth reconstruction, or building up of teeth to achieve the proper bite relation is not supported by strong evidence based studies.

Surgical

Attempts in the last decade to develop surgical treatments based on MRI and CAT scans now receive less attention. These techniques are reserved for the most recalcitrant cases where other therapeutic modalities have changed. Exercise protocols, habit control, splinting, or more recently neuromuscular dentistry should be the first line of approach, leaving oral surgery as a last resort. Certainly a focus on other possible causes of facial pain and jaw immobility and dysfunction should be the initial consideration of the examining oral-facial pain specialist, oral surgeon or health professional. One option for oral surgery, is to manipulate the jaw under general anaesthetic and wash out the joint with a saline and anti-inflammatory solution in a procedure known as arthrocentesis "Temporomandibular Disorders", the Cleveland Clinic.. In some cases, this will reduce the swelling of the joint, and allow for fluid movement when the jaw opens and closes.

See also

• Bruxism
• Fibromyalgia

External links

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• WebMD Includes some basic treatments
• Migraine Headache Pain has some information regarding TMJ/TMD problems

Footnotes

Dentistry | Musculoskeletal disorders | Medical terms

Craniomandibuläre Dysfunktion | Articolazione temporo-mandibolare | Disfunção da articulação temporo-mandibular | 顎関節症