Is Your Jaw Clicking or Causing Discomfort? What are Temporomandibular Disorders?

National Center for Health Research

Mariah Baker, National Center for Health Research

Most of the information from this article is based on information from the TMJ Association’s website, although the opinions expressed are our own.  For more information, see TMD BASICS | TMJ.org.

The Temporomandibular Joint (TMJ) is the jaw joint.  We each have two, one on each side of the head. This joint connects the mandible (the lower jaw bone) to the skull and allows the jaw to move in various directions.1 Temporomandibular disorders (TMD) are conditions that affect the jaw joint itself or the surrounding muscles, and may include pain or discomfort in the jaw joint and result in limited jaw movements.1 Approximately 35 million people in the United States suffer from TMD.1

These disorders are poorly understood, and most of the time the causes are unknown.1  Although women in their childbearing years are most likely to be affected, cases have been diagnosed in men and older women as well. Women tend to have more severe symptoms, including debilitating pain and limited jaw movement.1

Symptoms 

If you have jaw noises but don’t have pain or decreased mobility, you most likely do not have a TMD.  Occasional discomfort in the jaw joint or chewing muscles is common and not usually reason to be concerned. This discomfort often goes away on its own but if the pain is severe and lasts more than a few weeks, see your healthcare provider for further diagnosis. 

TMD patients often describe their pain as a dull, aching pain that comes and goes in the jaw joint and nearby areas. In addition, symptoms of TMD include:

  • jaw stiffness or locking 
  • painful clicking or popping of the jaw 
  • chronic headaches
  • ear pain or pressure
  • a bite that feels “off”

While less common, ringing in the ears (tinnitus), dizziness, and vision problems may also occur.1 The jaw joint is the most used joint in the body, and so more severe symptoms associated with TMD, such as severe pain or limited jaw movements, can affect a person’s ability to speak, eat, chew, swallow, make facial expressions, and breathe.1

Causes

Although the cause of most TMD is unknown, there are a few known factors that can contribute.  Arthritis, autoimmune diseases, and injuries to the jaw are all risk factors for TMD.1 Genes, hormones, and certain habits or behaviors can also increase the risk for TMD. For example, a particular gene that can increase pain sensitivity is more common among TMD patients. The fact that TMD is more common among women in their childbearing years suggests that hormones may play a role. Frequent gum chewing or unusual jaw positions sustained during long dental procedures or while being intubated during surgery may also contribute to TMD.1  In recent years, many experts have pointed out that TMD should not be considered a dental problem because researchers have found that 85% of TMD patients suffer from other painful conditions, including endometriosis and fibromyalgia. However, more research is needed to identify the link between chronic pain conditions and TMD.2

Diagnosis

If you think you have TMD, you may want to see a medical doctor to rule out other conditions with similar symptoms. Facial pain can be a symptom of sinus or ear infections, decayed teeth, headache, facial neuralgia (nerve-related facial pain), and even tumors.1 Certain diseases such as Lyme disease and scleroderma may also affect the jaw joint’s function and should be ruled out.1

The American Association for Dental Research (AADR) recommends that the 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.1  Blood tests and imaging studies of the teeth or jaw are sometimes recommended to rule out other possible medical conditions. Because there is not a widely accepted diagnostic test for TMD, it is strongly recommended to get a second opinion before undergoing any costly diagnostic test.3

Who Can Treat TMD?

If you receive a TMD diagnosis, it is important to note that there are no established treatments for TMD patients.  Although some health care providers advertise themselves as “TMD or TMJ specialists,” there is not a certified TMD specialty among doctors or dentists. The more than 50 different treatments available today are based on individual provider opinions and wishful thinking, not on scientific evidence.1 For that reason, finding an effective treatment can be difficult. The National Institutes of Health recommends patients see a provider who has experience treating pain conditions and musculoskeletal disorders (disorders affecting muscle, bone, and joints). Patients with complicated TMD cases, which often involve severe pain, jaw dysfunction, and decreased quality of daily life, may benefit from visiting a pain clinic in a hospital and may require a team of doctors from fields such as those who treat conditions of the nervous system and autoimmune diseases.  

Treatment

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 therapies. Eating soft foods, applying ice or moist heat, and avoiding extreme jaw movements (such as wide yawning, loud singing, and gum chewing) can help.1  Some patients find relief by using over-the-counter pain medications such as Ibuprofen, but it is always recommended to speak to your doctor before starting any new medication.1 

Treatments that change the structure or position of the jaw or teeth are not recommended. This includes crown work or orthodontics that change the bite, grinding down teeth (bite adjustments), repositioning splints, and TMJ implants. Implants rarely provide long-term relief and can cause decades of terrible suffering. Even when TMD is persistent, most patients are better off without aggressive types of treatment because after you’ve had a treatment that changes your natural bite, you can never “go back”.

Some doctors recommend injecting Botox into the jaw muscles causing partial paralysis, but there is no conclusive evidence that this treatment decreases TMD pain. Botox injections are FDA approved for cosmetic uses and TMD-related conditions such as cervical dystonia, a condition where the neck muscles contract involuntarily, and migraines but are not approved for TMD itself. More research is needed, but there is some evidence that Botox could cause bone loss or muscle damage in TMD patients.4,5  For example, 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.6 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.7 Also, some patients have an immune response to Botox injections, and their bodies start blocking the injections, which makes them less effective.8

For information and guidance regarding treatment options, read the treatment section of the TMJ Association website or contact info@center4research.org with specific questions.

Coverage, Cost, and Prevention

Many TMD treatments are not covered by medical or dental insurance. This may seem unfair, but it actually is reasonable since there are not any proven treatments that are safe and effective. Some patients incorrectly assume that more expensive treatments are more effective than inexpensive treatments such as eating soft foods, applying heat, or taking over-the-counter pain medication. 

The Bottom Line

TMD is defined as a problem of the jaw joint, but more research is needed to understand why people with TMD tend to have other chronic conditions such as endometriosis and fibromyalgia. Until more is known, it is best to treat individual symptoms by making simple changes that can make a difference in your daily life, like avoiding foods that cause pain. Avoid any type of permanent treatment that changes the structure of the jaw or teeth, and always get a second opinion before undergoing tests or treatments for TMD.

 

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff

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References

  1. TMD Basics. The TMJ Association. http://www.tmj.org/Page/34/17. Published December 21, 2017.
  2. Associated Conditions. The TMJ Association. http://www.tmj.org/Page/41/23#:~:text=Scientists%20have%20found%20that%2085,%2C%20sleep%20disorders%2C%20and%20vulvodynia. Published October 26, 2018.
  3.  Diagnosing you TMD. The TMJ Association. http://www.tmj.org/Page/37/19. Published July 11, 2019. 
  4. 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.
  5. 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
  6.  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
  7.  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.
  8. Torres S, Hamilton M, Sanches E, Starovatova P, Gubanova E, Reshetnikova T. Neutralizing antibodies to botulinum neurotoxin type A in aesthetic medicine: five case reports. Clin Cosmet Investig Dermatol. 2013;7:11-17. Published 2013 Dec 18. doi:10.2147/CCID.S51938