The two joints that connect your lower jaw to your skull are your temporomandibular joints. These joints are remarkable because they allow your jaw to move up and down, backward, and forward, and side to side. This requires a complicated balance between the joints and the many muscles and ligaments that control the movement of your lower jaw, also called your mandible. In anything goes wrong and upsets that balance, you can develop pain and other TMJ symptoms called temporomandibular joint dysfunction, TMJ dysfunction, or a TMJ disorder.
TMJ symptoms
Although 60 to 70 percent of people will have some TMJ symptoms, only about 10 percent will have symptoms that last or are severe enough to see a doctor or need treatment. The symptoms tend to go away on their own in most cases.
The most common symptom is pain in front of or below the ear. The pain may feel like it is coming from inside the ear. TMJ dysfunction may affect one or both ears. The pain is usually triggered by chewing or yawning, but it may also become a constant aching pain. In some cases, there may be facial pain and the pain may extend to the scalp or neck.
Other common symptoms include:
- Pain when pressing on the joint
- Joint movement noises, like crunching, popping, or clicking
- Limited movement of the jaw or locking
- Headaches
TMJ nerve damage symptoms
Although TMJ dysfunction rarely causes nerve damage, it can sometimes cause a type of irritation of nerves that supply the muscles, joints, or ligaments, called neuralgia. Neuralgia symptoms can include tingling and numbness of the face or TMJ area. In some cases, neuralgia can occur in nerves that supply the inner ear and cause ringing (tinnitus) or dizziness, although these symptoms are more likely to be caused by an inner ear problem, not a TMJ problem.
TMJ causes
In many cases TMJ disfunction develops without any obvious cause. Damage or stress on the muscles, muscle attachments (ligaments), or the inside of the joint can all cause TMJ dysfunction. These are some of the more common causes:
- Grinding your teeth at night, called bruxism
- Clenching your jaw when stressed or frequently chewing gum
- An injury to the joint area or the lower jaw
- Osteoarthritis, wear and tear damage to the joint that occurs over time
- Inflammatory arthritis, swelling and irritation from a joint disease like rheumatoid arthritis
TMJ diagnosis
Your health care provider will ask you about your symptoms and examine the joint by listening while you move your jaw, feeling the joint as you move it, and pressing to see if it hurts. Your provider will also check your teeth and the movement of your jaw to see if there is any limited movement or locking. In many cases, that is all that is needed to diagnose a mild TMJ disorder. In more severe or complicated cases, imaging studies may be done to evaluate the health of the joint. The best imaging study for TMJ is an MRI.
TMJ treatment
In most cases TMJ disfunction can be treated without a procedure or surgery, called conservative treatment. This is usually the first choice, and may include:
- Resting the jaw
- A soft diet
- Warm compresses or ice packs
- Gently moving the jaw, called passive stretching
- An over-the-counted NSAID, like Advil or Motrin
- Wearing a mouth guard at night to prevent grinding the teeth.
Conservative treatment may also include prescription medications for anxiety, muscle tension, or pain. If conservative therapy is not helping, a procedure to examine the joint through a small scope, called arthroscopy, may be done or joint injections to reduce pain and swelling. In rare cases, various surgical procedures may be needed, but only as a last resort.
For most people TMJ disorder goes away on its own or with treatment. However, for others the TMJ can be a source of chronic pain, pain that least three or more months. Chronic TMJ pain is more common when there is no obvious cause that can be treated. Chronic TMJ symptoms can cause or be triggered by depression or anxiety. In these cases, antidepressant or antianxiety medication, and psychotherapy may be helpful treatments.
When to call your healthcare provider
If you have bothersome TMJ symptoms that do not go away with home care or become severe, call your primary care doctor. Difficult to treat TMJ symptoms may require diagnosis and treatment by a TMJ specialist, usually and ENT doctor or oral surgeon. Call right away if you have:
- Severe or worsening pain
- Muscle spasm that keeps you from opening your mouth, called trismus
- Locked jaw
- Facial swelling
- Ear pain with fever or ear discharge
- Any sudden loss of hearing, tinnitus, or dizziness
