The Basics of the Jaw Joint

Temporomandibular Disorders

Temporomandibular Disorders (TMJD), commonly called TMJ, are a collection of poorly understood conditions characterized by pain in the jaw and surrounding tissues and limitations in jaw movements. Injury and conditions that routinely affect other joints in the body, such as arthritis, also affect the temporomandibular joint.  One or both joints may be affected in people with TMJD, which can affect a person's ability to speak, eat, chew, swallow, make facial expresions, and even breathe.

Overlapping Conditions

People diagnosed with TMJD may be experiencing other symptoms and medical conditions as part of broad multi-systems illnesses that go unrecognized.  Research is now looking at TMJD and many other conditions to see if there is a common mechanism.  These may include chemical sensitivity, chronic fatigue syndrome, endometriosis, fibromyalgia, hypermobile joints, irritible bowel syndrome, mitral valve prolapse, sleep disorders, and vulvodynia.  Moreover, certain medical conditions such as ehlers-danlos syndrome, dystonia, lyme disease, and scleroderma may also have an effect on TMJD.

TMJ disorders are a highly complex -  involvoing genetic and hormonal influences as well as a myriad of complex biologic factors.

Who is Affected by TMJ Disorders?

Approximately 35 million people in the United States suffer from TMJ problems. While both men and women experience TMJ disorders, the majority of those seeking treatment are women in their childbearing years.

Symptoms of TMJ Disorders

Pain is the most common symptom of TMJ Disorders. TMJ pain is often described as a dull ache in the jaw joint and nearby areas, including the ear, which comes and goes. Some people, however, report no pain, but still have problems using their jaws.

Other symptoms can include:

• pain in the neck and shoulders
• migraine and/or chronic headache
• jaw muscle stiffness
• limited movement or locking of the jaw
• painful clicking, popping or grating in the jaw joint when opening or closing the mouth
• a bite that feels "off'
• ear pain, pressure, and/or ringing in the ears
• decreased hearing
• dizziness and vision problems

NOTE: Jaw noises unaccompanied by pain or decreased mobility do not mean you have a TMJ problem.

Keep in mind that occasional discomfort in the jaw joint or chewing muscles is common, and is not always a cause for concern. Certain TMJ sufferers get better without treatment. Often the problem goes away on its own in several weeks to months. However, if the pain is severe and lasts more than a few weeks, see your healthcare provider.

Diagnosis of TMJ Disorders

Diagnosing TMJD can be difficult and confusing. For example, facial pain can be a symptom of many conditions, such as sinus or ear infections, decayed or abscessed teeth, various types of headache, and facial neuralgia (nerve-related facial pain). At present, there is no widely accepted, standard test to correctly identify all TMJ conditions.

In most cases, however, a complete evaluation, including a detailed medical history, the patient’s description of symptoms, and physical examination of the head, neck, face and jaw provide information useful for making a diagnosis. Tests that are recommended are often intended to rule out other possible medical conditions.

A diagnosis of TMJD may be made only after every other possibility has been considered and eliminated. Many TMJ patients see multiple healthcare providers, such as:

• primary care physicians,
• dentists,
• sleep specialists,
• ear and nose and throat specialists,
• neurologists,
• endocrinologists,
• rheumatologists,
• pain specialists,
• chiropractors,  etc.,

in their search for answers. Before undergoing any costly diagnostic test, it is always wise to get an independent opinion from another healthcare provider of your choice and one not associated with your current provider.

Can TMJ Disorders be Prevented?

Patients who are told they should undergo treatment(s) to prevent the development of a TMJ problem should know that there is currently no evidence that such conditions can be prevented.

Causes

Not all causes are known. Some possible causes are injuries to the jaw area, various forms of arthritis, some dental treatments, your genes and/or hormones, an infection, and auto-immune diseases. Research has shown that TMJ patients are hypersentive to pain, which may explain why they may also have other chronic pain conditions

Progression of TMJ Disorders

Most people with TMJ problems have relatively mild or periodic symptoms. Some TMJ problems improve on their own, within weeks or months with simple home therapy. For others, symptoms worsen over time and they develop long-term, persistent and debilitating pain.

Treatment of TMJ Disorders

Because most common jaw joint and muscle problems are temporary, lasting only weeks or months, simple care is all that is usually needed to relieve the discomfort. Self-care practices, such as eating soft foods, applying ice or moist heat, and avoiding extreme jaw movements (such as wide yawning, loud singing, and gum chewing) are useful in easing symptoms.

Unfortunately, many  treatments recommended by TMJ "specialists" are based largely on beliefs that are not grounded in thorough scientific research. As a result, some patients are made worse by these treatments.

Insurance Coverage

Many medical and dental insurance plans do not pay for treatment of jaw joint and muscle disorders, or only pay for some procedures. Until the causes of the various TMJ disorders have been discovered, and quality science demonstrates that treatments are effective without causing harm, insurance companies will not recognize treatments that have questionable outcomes. Contact your insurance company to see which treatments are covered.

Costs

 There are no standardized costs for TMJ treatments.