Temporomandibular Pain and Dysfunction Syndrome

Temporomandibular pain and dysfunction syndrome affects the jaw joints and surrounding muscles, causing pain, clicking sounds, and difficulty moving the jaw. This common condition impacts millions of adults, particularly women, but most cases improve with conservative treatment and self-care measures.

Table of contents

• What Is Temporomandibular Pain and Dysfunction Syndrome?
• Other Names for This Condition
• Associated Anatomy
• Types of Temporomandibular Disorders
• Who Is Affected?
• Symptoms and Signs
• Causes and Risk Factors
• How Is It Diagnosed?
• Treatment Options
• Self-Care and Management
• Outlook and Recovery

What Is Temporomandibular Pain and Dysfunction Syndrome?

Temporomandibular pain and dysfunction syndrome refers to a group of more than 30 conditions that cause pain and problems with the jaw joint and the muscles that control jaw movement^[1]. The term temporomandibular joint, often abbreviated as TMJ, describes the actual joint itself. You have two of these joints, one on each side of your jaw, located just in front of your ears. When healthcare providers talk about disorders affecting these joints, they use the term temporomandibular disorders or TMD^[2].

The temporomandibular joint works like a sliding hinge, connecting your lower jaw (the mandible) to the temporal bone of your skull^[1]. These joints allow you to move your jaw in three directions: up and down, side to side, and forward and back. When intact, they are the only joints in the human body that work together as a unit^[7]. A soft cartilage disk sits between the bones of the joint, acting as a cushion so the joint can move smoothly^[1].

The combination of synchronized and three-dimensional movements makes the temporomandibular joint the most complicated joint in the body^[7]. This complexity means that problems can develop in different parts of the system, leading to various types of disorders.

TMJ disorders, TMD, Temporomandibular joint dysfunction, Temporomandibular disorders

Associated Anatomy

• Temporomandibular joint
• Mandible (lower jaw)
• Temporal bone (skull)
• Articular disc
• Masticatory muscles (chewing muscles)
• Temporalis muscle
• Masseter muscle
• Pterygoid muscles

Types of Temporomandibular Disorders

Healthcare professionals classify temporomandibular disorders into three main categories, and a person may have one or more of these conditions at the same time^[3].

The first category includes disorders of the jaw joints themselves. These can involve disc disorders, where the soft cartilage disc that cushions the joint is displaced or damaged. This category also includes degenerative joint diseases like osteoarthritis or rheumatoid arthritis that affect the jaw joint^[3].

The second category covers disorders of the muscles used for chewing, known as masticatory muscles. These are the muscles that control jaw movement, including the temporalis, masseter, and pterygoid muscles. Muscle disorders can cause pain in the jaw area and may involve muscle tension, fatigue, or spasm^[3].

The third category includes headaches that are associated with a temporomandibular disorder^[3]. These headaches often occur alongside jaw pain and dysfunction.

Who Is Affected?

Temporomandibular disorders affect a significant number of people. Recent studies found that about 11 to 12 million adults in the United States experience pain in the region of the temporomandibular joint^[3]. The condition affects up to 15 percent of adults overall^[12].

Women are affected more often than men. Temporomandibular disorders are twice as common in women than in men^[3]. The condition most commonly affects adults between the ages of 20 and 40, with peak incidence in women between 35 and 44 years old^[2].

Most people who experience temporomandibular disorder symptoms do not seek treatment. Population studies show that while 10 to 15 percent of adults have TMD, only about 5 percent seek professional care^[12].

Symptoms and Signs

It is important to know that clicking or popping sounds in the jaw without pain are common, considered normal, and do not need treatment^[3]. However, certain symptoms may signal a temporomandibular disorder that needs attention.

The most common symptom is pain in the chewing muscles or jaw joint^[3]. This pain may feel worse when you are chewing and when you feel stressed^[4]. The pain can spread to other areas, including the face, neck, or around the ear^[1].

Many people with temporomandibular disorders experience jaw stiffness or difficulty opening their mouth fully. Some people notice that their jaw locks when they try to open their mouth^[2]. Others have trouble chewing or experience pain while chewing^[1].

Clicking, popping, or grinding noises when moving the jaw are common symptoms, especially when these sounds are accompanied by pain^[2]. Some people experience headaches, particularly around the temples, or aching facial pain^[1].

Other symptoms can include earaches, ringing in the ears (tinnitus), hearing loss, or dizziness^[3]. Some people notice tooth pain, neck pain, or shoulder pain^[2]. Temporomandibular disorders can also disrupt sleep, making it difficult to get a good night’s rest^[4].

Causes and Risk Factors

In most cases, the exact cause of temporomandibular disorders is not clear. For many people, symptoms seem to start without an obvious reason^[3]. The pain may be due to a mix of factors rather than a single cause^[1].

Sometimes injury to the jaw or temporomandibular joint can lead to TMD. This might include a jaw fracture, dislocation, or even a whiplash injury to the neck^[5]. However, injury accounts for only some cases of temporomandibular disorders.

Recent research suggests that a combination of factors plays a role in why a TMD starts and whether it will last a long time. These factors include genes, psychological stress, life stressors, and how someone perceives pain^[3]. Temporomandibular disorders often occur alongside other medical conditions such as chronic headaches, back pain, sleep problems, fibromyalgia, and irritable bowel syndrome^[3].

Certain habits can increase the risk of developing TMD or make symptoms worse. These include teeth grinding or clenching, also known as bruxism^[2]. This habit can occur during sleep or while awake. Excessive gum chewing, nail biting, or chewing on pens or ice can strain the jaw^[2].

Poor posture, especially while working at a desk or using electronic devices, can contribute to TMD. Taking large bites of food or using teeth as tools to open packages also puts stress on the jaw joint^[2]. Stress that causes jaw tension is another important risk factor^[4].

Arthritis in the jaw, either osteoarthritis or rheumatoid arthritis, can cause temporomandibular disorders. An uneven bite or misaligned bite may also play a role in some cases^[2]. However, research does not support the belief that orthodontic braces cause TMD^[3].

Because temporomandibular disorders are more common in women than in men, researchers are studying whether differences in TMJ structure and mechanics between females and males may contribute to the condition^[3].

How Is It Diagnosed?

There is no single standard test used to diagnose temporomandibular disorders, and some other conditions can cause similar symptoms. This can make TMD challenging to diagnose^[8].

Diagnosis is most often based on your medical history and a physical examination^[3]. Your healthcare provider or dentist will take a detailed medical history, including asking about your symptoms. They will want to know where the pain is located, when you experience it, what makes it better or worse, and if it stays in one area or spreads to other parts of your body^[8].

During the physical examination, your provider will examine your head, neck, face, and jaw. They will listen to and feel your jaw when you open and close your mouth^[9]. They will check how wide you can open your mouth and press around your jaw to check for tenderness or trigger points^[2]. They will also feel your joints as you open and close your mouth and watch the range of motion in your jaw^[9].

Pain that gets worse when your provider applies finger pressure to the joint when your mouth is opened suggests a TMJ disorder^[5]. Your provider will also check for clicking, popping, or grinding sounds and look for signs of pain or stiffness^[2].

If your healthcare provider thinks there is an issue with the joint itself or suspects other problems, they may order imaging tests. These can include dental X-rays to look at your teeth and jaw, a CT scan to show detailed images of the bones involved in the joint, or an MRI to show problems with the joint’s disc or surrounding soft tissue^[9].

Finding temporomandibular disorders early can make treatment more effective^[2]. It is important that your doctor rules out any other conditions that could be causing your symptoms before confirming a diagnosis of TMD.

Treatment Options

Many temporomandibular disorders last only a short time and go away on their own^[3]. Most of the time, the pain and discomfort related to TMJ disorders lasts for only a limited period^[1]. Treatment depends on what is causing your symptoms and how severe they are, and most people start with noninvasive options^[2].

Initial management focuses on a conservative approach that includes multiple types of treatment used together. As many as 50 percent of patients have symptomatic improvement within one year, and 85 percent improve within three years^[15].

Medications

Medicines can help ease pain, swelling, and muscle tension. Over-the-counter pain medicines like acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve) are often recommended initially^[2].

If pain medicines available without a prescription are not enough, your provider may prescribe stronger medications. Muscle relaxers can help if there is clinical evidence of muscle spasm or if you clench or grind your teeth^[2]. For chronic cases, antidepressants may be added to help with pain management^[2]. Some providers may prescribe benzodiazepines or anti-anxiety medicines for certain patients.

Physical Therapy

Physical therapy can be very helpful for temporomandibular disorders. A physical therapist can teach you specific jaw exercises to gently stretch and strengthen your jaw muscles. These exercises can improve jaw mobility and reduce tension in the muscles around the TMJ^[2].

Other physical therapy treatments include massage of the painful jaw muscles, ultrasound therapy to relax muscles, and TENS (transcutaneous electrical nerve stimulation), which uses gentle electrical currents to ease tension^[2].

Oral Appliances

Custom mouth guards or splints can help some people. These devices fit over your teeth and may reduce pain by keeping the jaw more properly aligned and limiting nighttime teeth grinding^[2]. These appliances are typically used at night.

Injections

If conservative therapies do not help, or for severe acute flare-ups, your provider may suggest injections. These can include trigger point injections with local anesthetics or steroids into the affected muscles^[2]. Some healthcare providers use injections of botulinum toxin (Botox) into the jaw muscles to help reduce muscle tension and pain.

Behavioral and Psychological Therapies

Because psychological factors play a role in TMD, approaches like cognitive behavioral therapy can be beneficial^[15]. This type of therapy helps you identify negative thoughts and change them while teaching coping skills. Biofeedback, which teaches you to control muscle tension, can also help^[8].

Surgical Options

Surgery is usually considered a last resort after conservative measures have failed^[1]. If other treatments do not help and you have functional jaw limitations or unexplained persistent pain, your provider may refer you to an oral and maxillofacial surgeon^[2].

Surgical options include arthrocentesis (flushing the joint), TMJ arthroscopy (a minimally invasive procedure using a small camera), or open-joint surgery for more serious problems^[2]. Surgical treatments may help some people with TMJ disorders, but they carry more risks than conservative treatments.

Self-Care and Management

Self-managed home care can be very effective in treating symptoms of temporomandibular disorder^[1]. There are many things you can do at home to ease your symptoms and help your jaw heal.

Heat and Cold Therapy

Applying moist heat or cold packs to your jaw can provide relief. Hold a warm, moist towel or a cold pack wrapped in a towel to your jaw for 15 minutes several times a day^[4]. You can try switching back and forth between moist heat and cold to see which works better for you. A dull, steady ache often responds better to heat, while sharp pain may improve with cold^[19].

Eat Soft Foods

Choose softer foods that are easy to chew, like pasta, eggs, yogurt, soup, or cooked vegetables. Avoid hard and crunchy foods like nuts, potato chips, or raw carrots and broccoli^[4]. Cut your food into smaller pieces so you do not have to open your mouth wide. Avoid biting food with your front teeth; instead, use your back teeth to chew^[19].

Jaw Exercises

Gentle jaw exercises can help. One simple exercise is to gently open and close your mouth, moving your jaw straight up and down while watching yourself in a mirror. Keep your movements controlled and stop if this makes your pain worse^[4].

Rest Your Jaw

Make a habit of keeping your teeth apart except when eating. A good reminder is “lips together, teeth apart”^[19]. Be conscious of jaw clenching and make a point to relax your jaw whenever you notice tension.

Avoid Straining Your Jaw

Do not chew gum, bite your nails, or chew on pen tops. Avoid yawning too wide or opening your mouth very wide, such as when singing loudly^[4]. Try not to stick out your jaw when putting on lip balm or applying makeup. When brushing or flossing your teeth, avoid opening your mouth wider than necessary.

Improve Your Posture

Use good posture when sitting and standing. Slumping your shoulders disturbs the alignment of your facial bones and muscles^[4]. Poor posture, especially while working at a desk, can strain your neck and jaw.

Manage Stress

Try to find ways to relax and reduce stress in your life. Stress can lead to jaw clenching and teeth grinding^[4]. Deep breathing, meditation, or gentle yoga can help you manage stress. Getting regular exercise, at least two and a half hours of moderate to vigorous activity each week, can also help relieve stress^[4].

Massage

Gently massage the painful jaw muscles. Apply low to moderate pressure in a kneading motion over the affected area^[19]. Massage helps stimulate blood flow, which aids in healing.

Outlook and Recovery

The outlook for people with temporomandibular disorders is generally good. Most cases improve with conservative treatment and do not require surgery^[1]. Temporomandibular disorder is treatable and rarely causes lasting problems^[2].

Many temporomandibular disorders last only a short time and go away on their own. However, in some cases they can become chronic or long lasting^[3]. Early care can make a big difference in how you feel day to day^[2].

If your jaw pain, clicking, or stiffness does not improve with self-care measures within several weeks or months, you should discuss your concerns with your healthcare provider^[19]. With the right combination of treatments and self-care, most people can manage their symptoms effectively and improve their quality of life.