Temporomandibular Joint Dysfunction

Temporomandibular joint dysfunction, which may be shorted to TMJD, TMJ or TMD, is very commonly associated with chronic pain conditions such as chronic fatigue syndrome and fibromyalgia. Like so many of these conditions temporomandibular joint dysfunction can be acute with very sharp piercing pain, or it can be more chronic where constant pain in the jaw, neck and facial area is always present. Since any movement of the jaw, including eating, speaking or even smiling can cause pain, the quality of life for the individual can be dramatically reduced when the condition is present.

The specific cause or causes of temporomandibular joint dysfunction are not fully understood, but they result in an inflammation of the muscles, tendons and ligaments that connect the jaw to the skull. This may due to a trauma or injury or it can also be caused by an infection or autoimmune reaction within the body. Since the cause of temporomandibular joint dysfunction is often not understood, treatment typically is centered on controlling pain and limiting any damage to the physical structure of the jaw.

Symptoms of TMJD

There are many different symptoms that can be associated with temporomandibular joint dysfunction and, research indicates, some of these symptoms may be present at a very early age. In a study of 99 children between the ages of 3 to 5 that showed the symptoms of temporomandibular joint dysfunction it was found that many factors that were believed to contribute to the condition had no statistical influence. This included thumb sucking, nail biting, grinding the teeth, the use of a pacifier, mouth breathing and being bottle fed as opposed to breast fed. What the research did show is that atypical swallowing did have an impact on the development of TMJD. Since swallowing involves additional and atypical use of muscle groups, this may clearly indicate that this is a muscular problem.1

Adults with temporomandibular joint dysfunction typically report one or more symptoms which are present for long periods of time. The specific pain associated with each symptom may fluctuate over time, but the symptoms themselves do not disappear when treated with over the counter anti-inflammatory medications. Since these symptoms can also indicate other muscle-skeletal problems it is essential to have a full examination to rule out other similar conditions.

The most common symptoms of temporomandibular joint dysfunction include difficulty in biting, chewing or eating which may or may not be accompanied by both internal and external sounds of grating or popping of the jaw. Pain in the face that extends to the ears is common, as are chronic headaches and migraines. The pains and headaches tend to be most problematic in the morning, gradually decreasing throughout the day.

The jaw itself will be very sore and sideways movement of the lower jaw is incredibly difficult and painful. For some individuals opening the mouth may be difficult and closing the mouth firmly causes increased pain the jaw area. Dizziness, loss of hearing and tinnitus or ringing in the ears is very common with the diagnosis. Many individuals also experience neck and shoulder pain both as a result of the fibromyalgia and also because of the artificial way that people tend to carry their head to help to alleviate the pain in the jaw, ear and face area.

Diagnosis of TMJD

Although there is the possibility of a diagnosis using the symptoms reported by the patient, physical examination by your doctor is necessary to help confirm the diagnosis. Rarely will imaging studies be needed to make the diagnosis.

Early diagnosis of temporomandibular joint dysfunction is essential to minimize the chances of osteoarthritis and actual bone and joint changes developing that may mean permanent pain and discomfort for the individual. Although it may be difficult to determine if the pain is in the neck, shoulders or jaw, any difficulties with chewing, swallowing or mouth movement should raise the red flag that temporomandibular joint dysfunction may be an issue.

Treatment Options

The treatment for TMJD starts with reducing any further damage to the joint, teeth and mouth. Often patients will be required to wear night guards that protect against teeth grinding and clenching that can result in significant damage to the surface of the teeth. Various exercises can be prescribed by your doctor that may help with the pain. Biofeedback can also be used to help correct clenching of the jaws or grinding of the teeth in the night. However, if sleep is an issue and the person with fibromyalgia has difficulty in maintaining a normal sleep cycle this is not recommended. The biofeedback system will cause constant interruptions in the normal cycles, often contributing to more stress and sleep problems.

For those patients that are using antidepressants, a moderate to significant decrease in the amount of pain is not uncommon. Some patients may find that NSAIDs or nonsteriodal anti-inflammatory drugs will help, but only if the condition is not advanced and if there is no significant damage to the joint itself.

One non-traditional form of treatment for temporomandibular joint dysfunction is the use of acupuncture. In a double blind randomized test individuals were either given actual acupuncture or a sham acupuncture treatment, with the assessor and the patient both unaware of the reality or sham of the treatment. The results were clear that patients that received the actual acupuncture treatment reported a significantly lower amount of pain than those that had the sham treatment. 3

Often temporomandibular joint dysfunction is reported to dentists as opposed to doctors. If you have fibromyalgia or chronic fatigue syndrome and are experiencing any type of jaw, ear, neck or facial pain it is important to discuss your symptoms with your doctor as well as your dentist and coordinate treatment to ensure the most comprehensive pain management program possible.

References

1 Castelo, P. M., Gaviao, L. J., Pereria, M. B., & et al. (2005). Relationship between oral parafunctional/nutritive sucking habits and temporomandibular joint dysfunction in primary dentition. International Joural of Paediatric Dentistry , 29-36.

2 Tomas, X., Pomes, J., Berenguer, J., & et al. (2006). MR Imaging of Temporomandibular Joint Dysfunction: A Pictorial Review. RadioGraphics , 765-781.

3 Smith, P., Mosscrop, D., Davies, S., & et al. (2007). The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: A randomised controlled trial. Journal of Dentistry , 259-267.

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015