Temporomandibular joint (tMJ)

The temporomandibular joints connect your jaw to your skull. You have one joint on each (left and right) side of your jaw. When the joint is injured or damaged, it can lead to temporomandibular joint (TMJ) disorders. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.

Temporomandibular (TMJ) joint disorders

TMJ disorders include jaw clicking, jaw locking, joint degeneration, traumatic damage, jaw damage through osteoarthritis or arthritis that damages the joint directly or stretch or tear the muscle ligaments, damage due to an accident, or had part of the jaw bone removed due to a cancerous tumor. You might clench or grind your teeth, tightening your jaw muscles and stressing your temporomandibular joint.  As a result, the disk, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position and cause a misaligned bite, pain, jaw clicking and popping (crepitus), or grating noise when you open your mouth or trouble opening your mouth wide, ear pain/earache, headaches, stiff or sore jaw muscles, pain in the temple area or locking of the jaw joint. TMJ disorders can be treated conservatively with a soft diet, warm compress and massage, gentle range of motion exercises, dental splints, and over-the-counter non-steroidal anti-inflammatories. If conservative therapy does not help, treatment may include Botox injections, physical therapy, prescription medications, and possibly surgery.  Understanding TMJ disorders will also help you understand how they are treated.

The following are conditions that may indicate a need for consultation of your temporomandibular joint(s):

  • Grinding or clenching your teeth
  • Waking up with sore, stiff muscles around your jaws
  • Frequent headaches or neck aches
  • Pain is worse when you clench your teeth
  • Jaw clicking, popping, grating, catching, or locking when you open your mouth
  • Difficult and painful to open your mouth, eat, or yawn
  • Injury to your neck, head, or jaws
  • Systemic problems (such as arthritis) with other joints
  • Teeth that no longer touch when you bite
  • Teeth meet differently from time to time
  • Is it hard to use your front teeth to bite or tear food
  • Teeth are sensitive, loose, broken or worn

TMJ Treatment

There are various treatment options for TMJ that Dr. Robinson, Dr. Lung, Dr. Davis and Dr. Forrest can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Drs. Robinson, Lung, Davis or Forrest will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care combined with professional care.

The initial goals are to relieve the muscle spasms and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory, or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation. Self-care treatments can often be effective as well and include:

  • Resting your jaw
  • Keeping your teeth apart when you are not swallowing or eating
  • Eating soft foods
  • Applying ice and heat
  • Exercising your jaw
  • Practicing good posture

Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as a splint or nightguard). A splint (or nightguard) fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of appliances used for different purposes. A nightguard helps you stop clenching or grinding your teeth and reduces muscle tension at night. It also helps to protect the cartilage and joint surfaces. An anterior positioning appliance moves your jaw forward, relieves pressure on parts of your jaw, and aids in disk repositioning. It may be worn 24 hours/day to help your jaw heal. An orthotic stabilization appliance is worn 24 hours/day, or just at night, to move your jaw into proper position. Appliances also help protect tooth wear.

What about bite correction or surgery?

If your TMJ disorder has caused problems with how your teeth fit together, you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options, such as arthroscopy and open joint repair restructuring are sometimes needed but are reserved for severe cases. Drs. Robinson, Lung, Davis and Forrest do not consider TMJ surgery unless the jaw can’t open, is dislocated and non-reducible, has severe degeneration, or the patient has undergone conservative and appliance treatment unsuccessfully.