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Dental Factfiles

Temporo-mandibular joint

Temporomandibular joint disorders (known as TMJ disorders or TMD) are the most common condition affecting the jaw joint. TMD is also known as facial arthromyalgia, and literally means face, joint and muscle pain. It is described as a dull ache with occasional sharp episodes affecting the jaw joint and muscles. Discomfort is often felt in front of the ear and in the muscles around the angle of the jaw and up to the temple. Sufferers may also experience clicking in the joint, difficulty opening the mouth, limited jaw movement and a blocked sensation in the ears.

There is no one cause of this condition but there are many associated ones. At the onset of pain these may include:

• Mental distress, such as bereavement, occupational, marital or housing concerns.
• Clenching, grinding of the teeth, awkward movement of the jaw and continued emotional stress may then prolong the problem. Many patients also suffer from other stress related problems including headaches, neck ache, itchy skin and irritable bowel.

It can occasionally occur in childhood but it is most common in the 20s and 30s age group.

In many people, TMD settles down without treatment. When mild, the best solution is to ignore the clicking and occasional tenderness in the joint - although it is an annoyance, it does not require treatment. In others, pain comes and goes and is worse during or following a time of distress. Sometimes a constant discomfort develops which interferes with daily life and can make the sufferer feel miserable or depressed. This requires treatment.

For a sudden onset of pain the advice is to rest the jaw, eat only soft food, apply warmth or gently massage the affected side and take simple analgesics.

Resting the jaw involves:

• Avoiding chewing gum or eating hard food [e.g. crusty bread, tough meat or raw vegetables]
• Avoiding episodes of wide mouth opening [e.g. yawning, singing, shouting, or prolonged dental appointments]
• Avoid clenching or grinding the teeth during the day by keeping the teeth a few millimetres apart at rest
• Avoid habits such as biting your nails, lips or cheeks, finger sucking or pencil chewing
• Avoid activities where there is awkward jaw posturing for a while [e.g. scuba diving, snorkelling, playing a musical instrument or contact sports]
• When opening the jaw, try to move it in a simple up-and-down direction without pushing the lower jaw forwards
• Be aware that the discomfort is made worse by stress. Try to relax more and sleep comfortably to ensure a restful night’s sleep.

If the jaw remains uncomfortable, several treatment options are available. A dentist can often provide a bite guard or plastic appliance to cover the teeth, worn at night for three months. This may resolve the problem by helping to avoid clenching or grinding the teeth.

If symptoms continue, referral to a hospital may be indicated to help relieve the more persistent pain. Treatment might include: medication; learning relaxation, stress management and coping techniques; or, very occasionally, minor surgery to the joint.

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