The temporomandibular joint (TMJ) is the medical name for the left and right jaw joint, unique in the body as one joint cannot be moved without influencing the other, i.e. the right side can not move without the left doing so too. It is also complex, as it consists of two compartments separated by a cartilage disc. One compartment allows a hinge movement for opening and closing the jaw, and the other an orbiting movement for side to side chewing.
When the joint does not function correctly it may cause painful symptoms, jaw joint popping or limitations of movement and this is called temporomandibular joint dysfunction.
How do problems arise?
If the disc, situated between the base of the skull and the lower jaw, is displaced it can sublux (become misaligned), causing a clicking, popping and grating sound when the mouth opens or shuts. This may cause pain or restriction of function, but painless joint noises do not generally require any treatment. Severe tooth grinding (bruxism) may exacerbate TMJ dysfunction. Complete dislocation of the jaw will require reduction and repositioning of the lower jaw into its correct arrangement. This may damage or weaken the joint ligaments and needs exercises and care to avoid recurrence.
What can be the symptoms of TMJ dysfunction?
- Headaches/migraine type pain
- Opening or closing the jaw joint, causing clicking or grating, with or without restriction of movement
- Difficulty in opening the mouth fully (trismus)
- Atypical face pain on one side or both sides and neuralgias
- Facial and jaw muscle aches on one side or both sides
- Neck and shoulder pain
- Ear pain, tinnitus (ringing/buzzing in ears)
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Who gets TMJ problems?
Up to one in four people have some symptoms and both men and women are affected equally.
What can you do about jaw joint problems?
Avoid overstretching the jaw joints; stifle yawns and cut up food into smaller pieces. Ask you dentist’s advice; in simple cases he/she may be able to treat the problem, or may refer you to a specialist in TMJ problems.
What will the dentist do?
Diagnosing the problem correctly is essential. The dentist will take a history, consider your symptoms and palpate the muscles and joints around the jaw area. A full examination by a specialist may include muscle testing, movement analysis, X-rays and possibly magnetic resonance imaging (MRI) or CT scanning.
What is the treatment?
Treatment can involve reducing any stress on the joints, wearing splints and biteguards on the teeth to attempt to realign the jaw into a more comfortable position and further prevent damage. This may improve the symptoms, especially muscular problems associated with headaches and migraine type pains. In severe cases there may be adhesions in the joint needing arthroscopy or surgical intervention.
What other therapies are helpful?
Some patients’ TMJ symptoms are helped by physiotherapy, ultrasound and muscular exercises. Alternative therapies that may be of use include cranial osteopathy, osteopathy, chiropractic and acupuncture. Some TMJ problems are made worse by stress, so therapies aimed at relaxation may be helpful.