Updated August 2014
Most of the information from this article is based on the web site of the TMJ Association, although the opinions expressed are from NRC. For more information, see http://www.tmj.org/site/content/tmd-basics.
Temporomandibular disorders (TMD), commonly called TMJ, are poorly understood conditions including pain in the jaw joint and limits on jaw movements. Arthritis, injuries, and any health problems that can affect any joint in the body, can also affect the TMJ joint. The jaw joint is the most used joint in the body, and so TMD can affect a person’s ability to speak, eat, chew, swallow, make facial expressions, and breathe.
TMD also can involve jaw muscles. These conditions often confused with jaw joint problems because they produce similar signs and symptoms.
Overlapping Health Conditions
Researchers have found that TMD often occur along with other – and often painful – conditions in other parts of the body. These can include chronic fatigue syndrome, chronic headache, endometriosis, fibromyalgia, interstitial cystitis, irritable bowel syndrome, sleep disorders, and vulvodynia. In addition, certain medical conditions, such as Ehlers-Danlos syndrome, dystonia, Lyme disease, and scleroderma, may affect the TMJ.
Who is Affected?
Approximately 35 million people in the United States suffer from TMJ problems. Men and women can be affected, but most are women in their childbearing years. The proportion of women is especially high – almost 90% — for patients with the most severe symptoms, which can include limitations in jaw movements and debilitating pain that does not go away.
Although the cause of most of these disorders is unknown, there are some known health problems that can contribute to TMD:
- Autoimmune diseases
- Injuries to the jaw area
- Dental procedures
- Stretching of the jaw (for example, when inserting a breathing tube before surgery)
Genes, hormones, and habits or behaviors can also increase the risk for TMD. For example, a particular gene that can increase sensitivity to pain is more common among TMJ patients. The fact that TMD is more common among women in the childbearing years suggests that hormones affect TMD. Frequent gum chewing or sustained jaw positions may also contribute to TMD.
Diagnosis of TMJ Disorders
It is difficult to diagnose TMD because there is no widely accepted diagnostic test. The American Association for Dental Research (AADR) recommends that a diagnosis of TMD or related pain conditions should be based primarily on information obtained from the patient’s history and a clinical examination of the head and neck. In addition, imaging studies of the teeth and jaws may sometimes be helpful, including routine dental x-rays and panoramic radiographs, computed tomography (CT or CAT scan), magnetic resonance imaging (MRI), and scintigraphy (bone scan).
Blood tests are sometimes recommended to rule out possible medical conditions as a cause of the problem.
Before undergoing any costly diagnostic test, get an independent opinion from another health care provider of your choice who is not associated with your current provider. Remember that CT scans will expose you to radiation, and should not be used unless necessary.
Symptoms of TMJ Disorders
The pain of TMD is often described as a dull, aching pain comes and goes in the jaw joint and nearby areas. However, some people report no pain but still have problems, such as:
- Pain in the jaw muscles
- Pain in the neck and shoulders
- Chronic headaches
- Jaw muscle stiffness
- Limited movement or locking of the jaw
- Ear pain, pressure
- Painful clicking, popping or grating in the jaw joint when opening or closing the mouth
- A bite that feels “off”
Less common symptoms include: ringing in-the ears (tinnitus), dizziness, and vision problems.
If you have jaw noises but don’t have pain or decreased mobility, you do not have a TMD problem.
Keep in mind that occasional discomfort in the jaw joint or chewing muscles is common, so don’t be concerned about that. TMD often goes away on its own in several weeks or months. However, if the pain is severe and lasts more than a few weeks, see your health care provider.
Who can help?
If you think you have a TMD, you may want to see a medical doctor to rule out some other conditions with similar symptoms. For example, facial pain can be a symptom of sinus or ear infections, decayed teeth, headache, facial neuralgia (nerve-related facial pain), and even tumors. If your doctor or dentist gives you a diagnosis of TMD, you can learn more about treatment options at www.tmj.org .
There is no medical or dental specialty of qualified experts trained in the care and
treatment of TMJ patients. There are no established standards of care for TMD. Although some health care providers advertise themselves as “TMJ specialists,” the more than 50 different treatments available today are based on opinions and wishful thinking, not on scientific evidence.
As a result, finding effective treatment can be difficult. The National Institutes of Health advises patients to look for a health care provider who understands musculoskeletal disorders (affecting muscle, bone and joints) and is trained in treating pain conditions. Pain clinics in hospitals and universities are often a good source of advice, particularly when pain is long-lasting and interferes with daily life. The most complicated TMD cases, which often involve severe pain, jaw dysfunction, and harm the quality of your daily life, will probably require a team of doctors from fields such as neurology, rheumatology, pain management and others to diagnose and treat this condition.
Treatment of TMD
The good news is that most people with TMD have relatively mild or infrequent symptoms that may improve on their own within weeks or months with simple home therapy. Eating soft foods, applying ice or moist heat, and avoiding extreme jaw movements (such as wide yawning, loud singing, and gum chewing) can help.
Since TMD can go away by itself or with simple changes like those described above, and since there are no great cures, always start with the simplest treatments. Do not choose treatments that change the structure or position of the jaws or teeth. Even when TMD is persistent, most patients are better off without aggressive types of treatment. For example, avoid any kind of surgery, including TMJ implants, because these implants rarely provide long-term relief and can cause decades of terrible suffering. Once you have one of these implants, you can never “go back” to your own natural jaw joint.
Your doctor may have mentioned trying Botox injections as a way to manage TMD pain. Some doctors inject Botox into the jaw muscles causing partial paralysis, but there is no conclusive evidence that this treatment is beneficial. Botox injections are FDA approved for cosmetic uses and for TMD-related conditions such as cervical dystonia and migraine, but is NOT approved for TMD itself. There is evidence that it could be harmful.
More research is needed but there is some evidence that Botox can cause bone loss for TMD patients. Animal studies show that Botox could possibly cause bone loss or muscle damage.1 2 In addition, a small study of 7 TMD patients who were treated with Botox (compared to 9 TMD patients who did not get Botox) found that the women who received Botox injections to treat painful headaches experienced more bone loss compared to those who did not get Botox injections. 3 In addition, some patients who received multiple Botox injections to treat headaches experience a serious side effect called disuse atrophy (muscle tissue loss) which can cause a dent on the side of the head. Also, many patients have an immune response to Botox injections, and their bodies start blocking the injections which makes them less effective.4 5
If your problems TMD get worse with time, you should seek medical help from a musculoskeletal specialist. However, before you do, educate yourself so that you won’t be talked into an unproven treatment. (Unfortunately, most treatments for TMJ are unproven treatments). For information and guidance regarding treatment options, read the treatment section of the TMJ Association web site or contact email@example.com with specific questions.
There are no proven strategies to prevent TMD. If a physician recommends one, find a new physician.
Many medical and dental insurance plans do not pay for treatment of TMD or only pay for some treatments. That may seem unfair, but since there are no treatments that are proven to be safe and effective, we think the insurance companies are right to not pay for treatments that could be harmful.
Since there is no standard treatment, the cost is not predictable. But be aware that more expensive treatments are not likely to be more effective than simpler treatments, such as eating soft foods, applying heat, or taking pain medication.
Don’t think of TMD as a problem only of the teeth and jaws. Research is needed to understand why people with TMD tend to have other conditions such as chronic fatigue syndrome, chronic headache, endometriosis, fibromyalgia, interstitial cystitis, irritable bowel syndrome, sleep disorders, and vulvodynia. Some patients may experience one of these conditions initially and then go on to develop other ones. Until more is known, get good medical care to help with individual symptoms, such as pain, but also make simple changes that can make a big difference in your life, such as avoiding foods that cause painful symptoms.
- Grimston SK, Silva MJ, Civitelli R. Bone loss after temporarily induced muscle paralysis by Botox is not fully recovered after 12 weeks. Ann N Y Acad Sci. 2007;1116:444–460. ▲
- Rafferty KL, Liu ZJ, Ye W, Navarrete AL, Nguyen TT, Salamati A et al. Botulinum toxin in masticatory muscles: short and long-term effects on muscle, bone, and craniofacial function in adult rabbits. Bone. 2012;50:651–662 ▲
- Raphael KG, Tadinada A, Bradshaw JM, Janal MN, Sirois DA, Chan KC, Lurie A G. Osteopenic consequences of botulinum toxin injections in the masticatory muscles: a pilot study. Journal of oral rehabilitation. 2014. DOI: 10.1111/joor.12180 ▲
- Guyuron B, Rose K, Kriegler JS, Tucker T. Hourglass deformity after botulinum toxin type A injection. Headache: The Journal of Head and Face Pain. 2004; 44(3): 262-264. ▲
- Laskin DM. Botulinum toxin A in the treatment of myofascial pain and dysfunction: the case against its use. Journal of oral and maxillofacial surgery. 2012;70(5):1240-1242 ▲