Frequently Asked Questions

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Adolescence

Question: I’m 18 years old and having a jaw problem. Are TMJ problems common during adolescence?

Answer: TMJ disorders can affect adolescents. In fact, such conditions are observed much more often during puberty than in the years prior to it. These conditions can often affect a young person’s ability to participate in school and many extracurricular activities. Far greater education about TMJ problems and their impact on those affected by them is needed in schools. Because   TMJ problems are poorly understood and trivialized by some, it isn’t uncommon for children to be ridiculed or bullied when experiencing such issues at school. This further adds to the pain and stigma associated with TMJ problems.

Braces

Queston: Will braces help my TMJ problem?

Answer: There is no scientific basis for orthodontic treatment of disorders of the temporomandibular joint. The National Institutes of Dental and Craniofacial Research Brochure states, “other irreversible treatments that are of little value – and may make the problem worse – include orthodontics to change the bite; restorative dentistry, which uses crown and bridge work to balance the bite; and occlusal adjustment, grinding down teeth to bring the bite into balance. Even when the TMJ problem has become chronic, most patients still do not need aggressive types of treatment.”

Causes of TMJ Problems

Question: I recently had my tonsils and adenoids removed and a little over a month later I started experiencing jaw pain. I have since been diagnosed with TMJ and was wondering if the surgery could possibly be the cause?

Answer: Intubation during surgical procedures has been known to cause jaw joint disorders. The patient’s mouth must be opened widely to insert the respiration tube and that may stretch the joint capsule and ligaments.

Question: I recently had a crown put on my lower left molar. A week later, I woke up one morning with pain and could not open my mouth widely. The pain has been with me for about two weeks and I have yet to see a for fear that it is a TMJ problem. Is it normal to wake up and have a TMJ problem so suddenly or does it usually creep up on you?

Answer: There are a number of complications that can occur during tooth preparation and placing a crown. Sensitivity of the tooth, or aches and pains are the most common occurrences. Some patients report the onset of a TMJ condition after dental work. A study by Dr. Paul Durham found that keeping the mouth in a near maximum jaw opening position for a long period can lead to inflammation and pain in the TMJs. We suggest you contact the dentist who crowned your tooth and have it evaluated with respect to the cause of your complaint.

Question: I would like to know if you have ever heard of anyone having TMJ-like symptoms after a bad car accident. I never had these problems until my auto accident. I did not hit my head on anything. I was in so much pain after the accident that I was unable to eat anything for three days. Now, four months later it’s getting worse and worse. I can’t stand the pain. I will be seeing a dentist soon, but I want to be sure that he is going to be treating me correctly. Any suggestions?

Answer: Yes, it is possible that your TMJ problems were caused by your auto accident. You point out that your face did not come into contact with a hard surface; however, the rapid forward and then backward movement of the head at the time of impact (whiplash injury) can produce injury to the TMJs. Such injuries often remain undetected during the emergency room visit because other matters need immediate treatment and get all the attention. You should follow up with your primary care physician to determine what next steps he/she considers appropriate at this time.

Question: About a year ago I noticed popping and clicking in my jaw joints when I open wide or yawn. There is no pain, but it is bothersome. My dentist is very emphatic that I get my wisdom teeth removed and says that they are causing these TMJ symptoms. My previous dentist said she did not think my wisdom teeth needed to be removed. I have read that wisdom teeth extraction can actually worsen TMJ symptoms. I am very confused about what course of action to take.

Answer: Impacted wisdom teeth do not cause TMJ problems. These teeth only need to be removed when local events justify their extraction. This includes inflammation of the gums around the wisdom teeth, or their negative impact on the neighboring teeth. They should not be extracted as a treatment for TMJ problems.

Question: I am 18-years-old. A few months ago I was diagnosed with a TMJ problem. I never had any problem with my jaw locking, clicking, or making grinding noises until I had my wisdom teeth removed. My jaw was in perfect condition, but now I have to press on my joint just to be able to open my mouth all the way. Could something have gone wrong during the removal of my wisdom teeth that could have caused these problems?

Answer: Lengthy dental work requiring the patient’s mouth to be open very wide for extended periods can cause or aggravate a TMJ problem. We frequently hear from patients who experienced their first symptoms after having their wisdom teeth extracted or other type of dental treatment. Clicking or locking is caused by a displacement of disc that is located in the TMJ. You should consult the doctor who removed your wisdom teeth regarding your problem.

Dislocated TMJ Disc

Question: I just found out that I have a dislocated disc in my TMJ. Is this common? Is there anything that can be done for this; if so, will it relieve the pain?

Answer: Yes, a dislocated disc is common. However, a diagnosis of a dislocated disc isn’t an indication for treatment. If you have a dislocated disc but experience no pain and there is no clicking or only faint clicking, no treatment is needed. But if your dislocated disc causes pain and restricts movement you may require treatment.

Question: I was diagnosed with a dislocated TMJ disc but have no pain. Should I proceed with treatment to reposition my disc?

Answer: Many people have a dislocated disc and don’t even realize it. You’re fortunate that you have no pain. Since you have no pain, you should be cautious about seeking treatment. There are many opinions regarding the clinical significance of displaced discs and, not surprisingly, treatments vary among practitioners. Although some claim they are able to recapture a disc, or to replace the failed tissue, others question if and when it should be done. Moreover, there are clinical data that the physical displacement is not the cause of the pain, and that any restriction in range of motion will improve with time.

Question: Every time I open my mouth to yawn or to eat a sandwich, my jaw on my right side makes a popping sound. My dentist says that since I don’t have any pain there’s really nothing I should do for it. Is this good advice?

Answer: Management of jaw joint noises is one of the most controversial subjects in the TMJ field. Many people with clicks have no complaints, whereas others have associated pain. Most doctors feel that if you have no pain or limited mouth opening, a click or popping sound in the jaw joint is nothing to worry about.

Ear Issues

Question: I have had an earache and am hard of hearing since my TMJ problem began. Is this problem reversible?

Answer: Earache and perceived hearing loss are symptoms frequently reported by patients with TMJ problems. However, the problems may or may not be related to a TMJ disorder. Because of the proximity of the TMJ to the ear, it is possible that joint pain is mistakenly reported as earache. Pain arising from the lateral pterygoid muscle (myofascial pain) may also feel like an earache. However, a patient may actually have a problem in the ear that is producing the pain. We suggest an appointment with an Otolaryngologist (ear, nose and throat doctor) to determine if there is actually a problem arising from the ear.

Question: Is tinnitus (ringing in the ears) related to a TMJ problem?

Answer: Tinnitus is a sound heard in one or both ears when no external sound is present. It is often referred to as “ringing in the ears,” although some people hear hissing, roaring, whistling, chirping, or clicking sounds. Although it has been reported to occur in patients with TMJ disorders, its etiology in most cases remains unknown. If management of the TMJ problem does not eliminate the condition, an Ear, Nose, and Throat (ENT) doctor should be seen to determine if there is another cause for the tinnitus.

Question: Can medications I’m taking for TMJ problems cause ear ringing?

Answer: One cause of tinnitus can be medications. Over 200 different drugs can cause ear ringing, including aspirin – especially when taken in high doses. The American Tinnitus Association has printed a list of medications which can cause tinnitus.

Insurance Issues

Question: Why are TMJ treatments not covered by most insurance companies?

Answer: One of the most frustrating problems is trying to obtain insurance coverage for TMJ diagnosis and treatment. Many medical and dental insurance plans do not provide coverage for the treatment of jaw joint and jaw muscle disorders. Some provide limited coverage in benefit insurance packages or if mandated by the State. Insurance companies look at the science underlying the treatments they cover, and with the lack of formally established guidelines, best practices, and standards of care in this area, management of TMJ problems generally tend to be excluded from coverage.

Jaw Joint Issues

Question: Are both temporomandibular joints always involved or is it possible that only one side can be affected?

Answer: Most TMJ disorders tend to be unilateral. However, in long-standing cases, since both joints work in unison, there can ultimately also be symptoms on the opposite side.

Playing a Musical Instrument

Question: Will playing a saxophone make a TMJ condition worse?

Question: Will playing a saxophone make a TMJ condition worse?

Answer: There have been studies to show that playing of brass and wind instruments can cause TMJ problems, especially in non-professional players.

Facial Numbness

Question: Does facial numbness occur with TMJ?

Answer: There have been no scientific studies to show that this can occur.

Overlapping Conditions

Question: In addition to TMJ I also have been diagnosed with fibromyalgia and suffer from chronic headaches and sleep disorders. Are these related?

Answer: Scientists have found that 85% of patients with TMJ also experience painful conditions in other parts of the body. These comorbid conditions include chronic fatigue syndrome, chronic headache, endometriosis, fibromyalgia, interstitial cystitis, irritable bowel syndrome, low back pain, sleep disorders, and vulvodynia. They are considered comorbid because they occur together more often than chance can explain. In addition, the conditions share other features. These findings are stimulating research into common mechanisms underlying all of these comorbid conditions.

Prevention of TMJ Problems

Question: Our dentist told us that our 16-year-old daughter has a “bite problem” that will lead to TMJ problems if not treated. He recommended us to an orthodontist for braces to realign her bite and eliminate stress on her joints. She has worn braces and had them off about a year before the dentist noticed her “bite problem.” She wasn’t complaining of symptoms but now says that sometimes her jaw hurts. We don’t know whether or not to pursue treatment or see how it plays out. Any thoughts on “pre-TMJ” treatment?

Answer: At present there is insufficient evidence to support the prevention of TMJ disorders through treatment. According to the National Institutes of Health there are no data to support some commonly held beliefs. Studies have shown that orthodontic treatment neither prevents nor causes TMJ problems. The decision to use such treatment should be based on the presence of a correctable malocclusion and not a TMJ problem.

Sleep Apnea

Question: I have sleep apnea and use a Continuous Positive Airway Pressure (CPAP) device. Can the mask that covers my nose or the airway pressure aggravate a TMJ problem?

Answer: The nasal mask and the positive pressure should not cause or aggravate a TMJ problem.

Trigeminal Neuralgia

Question: What is trigeminal neuralgia? How is it different from a TMJ problem? Is there any relationship between the two?

Answer: According to The Facial Pain Association, www.fpa-support.org,  Trigeminal Neuralgia is a disorder of the fifth cranial nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed. While some of the same kinds of pain may be experienced by TMJ patients, to date no scientific evidence has established a relationship between the two conditions.

We are grateful to Dr. Daniel Laskin, Adjunct Clinical Professor and Chairman Emeritus at Virginia Commonwealth University School of Dentistry, Oral and Maxillofacial Surgery, for his many years as our clinical advisor and for writing the content in this section.