Temporomandibular joint dysfunction (TMD)

Temporomandibular joint (TMJ): What is it?

At the widest moment of a big yawn, you might hear and feel a click in your jaw. For most people, a clicking jaw is an occasional annoyance or surprising pop now and then. For others, it's a symptom of a problem that may originate in the jaw but can radiate to other parts of the body, causing headaches and earaches.

Your jaw is one of the most complicated joints in your body. It has up-and-down, side-to-side, and forward sliding ranges of motion. Several muscles tether your jaw to your skull on both sides of your head and control the motions of chewing, talking, and yawning. And the small disc that cushions the bones, the temporomandibular joint (TMJ), acts as a shock absorber or damper. When something gets thrown out of whack in the works of this complex joint, you might experience a temporomandibular disorder (TMD).

The most common problems that affect the temporomandibular joint are jaw muscle problems, disc disorders, and degenerative changes associated with the jaw joints. These problems are generally referred to as temporomandibular disorders (TMD).

But just because your jaw clicks or pops doesn't necessarily mean you have TMD and not everyone with TMD experiences clicking or popping in their jaw. TMD can have various causes including tight muscles, joint problems, arthritis, or clenching and grinding of the teeth.

The most common symptoms of TMD include:

• headaches
• earaches
• muscle soreness or tenderness
• clicking or locking of the jaw
• dizziness
• neck pain or stiffness
• difficulty opening the mouth
• difficulty chewing

If you have any of these symptoms, talk to your doctor or dentist so they can assess you for TMD.

TMD: Treatment overview

Most uncomplicated cases of TMD are treated using a combination of any of the following:

• education
• self-care
• physical therapy
• intraoral appliance therapy
• short-term medication therapy
• behavioural therapy
• relaxation techniques

Treatment of TMD must be individualized according to the cause and other factors.

Even after successful management, episodes of pain and dysfunction may recur. Re-injury or factors that contributed to earlier episodes may be responsible. For the small group of people whose TMD progresses to a chronic pain disorder, treatment becomes more complex. These cases usually require more comprehensive management to address the emotional and behavioural disabilities that result as a consequence of chronic pain.

Medication can help

Mild analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), anti-anxiety medications, and muscle relaxants are medications that can be used as part of initial treatment. NSAIDs are commonly prescribed for pain control in TMD therapy.

Anti-anxiety agents are useful especially during acute episodes of muscle pain. They are best used at night to avoid daytime drowsiness but their potential for dependence limits their usefulness.

Muscle relaxants are a class of medications that act in the central nervous system to depress muscular activity. They also have sedative effects that may contribute to their effect on symptoms. These medications are best taken at night before sleep because their sedative effects will interfere with daily activities.

What you can do

• Track your symptoms. Jot down when symptoms hit and describe their severity and nature. You can make a note in your calendar, write about it on your blog, or write in your journal. See if you notice a pattern or triggers.
• Check your posture. Slumping, slouching, or any posture problems can lead to imbalances that put stress on the muscles of your back, shoulders, neck, face, and jaw. Try your best to sit up, imagining a thread lifting the back of your head up and letting your chin lower slightly. Many people jut their chin out, especially as they drive or work on computers. This can stress the neck and exacerbate jaw pain.
• Unclench. Check throughout the day and see if you're clenching your jaw. You might be doing it right now as you read, resting your chin on your hand or leaning forward to better read your monitor. Stress can make us grit our teeth together and hold our whole face in a tense, tight mask. Relax, stretch a bit, and let your jaw hang a bit slack, allowing your teeth to not touch together.
• Soothe. Use your fingertips to slowly but firmly stroke the area that's giving you the most pain. Apply heat or ice. Try over-the-counter medication for the pain, but check with your doctor before you do. Give a weary jaw some rest by eating softer foods for a while.
• Strengthen. In some cases, TMD may be triggered by weaknesses in different muscle groups. For instance, think of your abdominal core. A strong core helps to support your back, which in turn supports better posture. Regular physical activity can also make it easier to relax and handle stress better.
• Seek help. If your attempts at self-care do not lead to some relief, take your symptom journal and visit a doctor or a dentist.

Managing chronic pain of TMD

Integrating behavioural therapy and relaxation techniques in chronic pain management to treat TMD is effective. Self-care and habit awareness may not be sufficient in some cases to change behaviours that are contributing to symptoms. A more structured program supervised by a clinician competent in behavioural therapy offers a greater chance of addressing issues that are contributing to muscle tension or pain.

Medical professionals generally agree that behavioural and educational therapies are effective in the management of chronic pain disorders. Relaxation techniques, hypnosis, cognitive-behavioural therapy, and biofeedback have all been used to produce symptom reduction in TMD.

• Relaxation techniques: These techniques generally decrease sympathetic nervous activity. 

• Cognitive-behavioural therapy: This therapy is directed toward exploring and altering the thoughts, beliefs, and attitudes associated with the problem that may be preventing or negatively affecting recovery.

• Biofeedback: This is a treatment method that provides continuous feedback. It involves using surface electrodes or temperature of the skin to measure the electrical activity of a muscle. You perform relaxation exercises aimed at either lowering the electrical activity of the muscle or raising skin temperature. Repetitive practice using the biofeedback instrumentation provides training for you to achieve a more relaxed state and also a greater sensitivity to the activities that have adverse effects.