Neck & Face

Tempro-mandibular Dysfunction

TMJ is the term commonly used to speak about various problems that involve the facial muscles and joint involved with opening and closing your mouth.  TMJ is an acronym for temporo-mandibular joint.  Newer terminology includes TMJD (temporo-mandibular joint disorder) or, more to the point, TMD (temporo-mandibular disorder).  The reason to use TMD rather than TMJ or TMJD is because a lot of the problem is not really a joint disorder and more likely affect the musculature associated with the joint including the masseter muscle along with other muscles of the face and neck.

TMD may arise from an actual problem with the TM joint, which is the swinging joint between your lower jaw and the rest of your head, located just in front of your ear, or the face and neck muscles associated with it directly and indirectly.  The joint itself may be involved in more generalized arthritic problems or it may have been injured if you ever broke your jaw.  It is also frequently hurt by dental or other oral procedures such as tonsillectomy when you are under anesthesia and the mouth is opened widely.  Other factors such as teeth grinding, gum chewing, jaw clenching and improper bite can also contribute to excess wear and tear on the joint.  Additionally, pain in one side of the jaw can lead to injury on the other side.  Many of these conditions can also lead to significant muscle tension and overstretching of the muscular bundles, a problem known as myofascial pain.

People with TMD frequently are seen at an ENT for an ear infection that was diagnosed because of ear pain.  Ear pain is very common in those who have TMD.  Facial, temple and cheek pain with or without tenderness, headaches, ringing or noise in the ears, and jaw popping or clicking are all common symptoms.  Later stages can lead to locking of the jaw and difficulty opening or closing the mouth resulting from deterioration and/or displacement of the joint.

The pain may be sharp and searing, occurring each time you swallow, yawn, talk, or chew, or it may be dull and constant. It hurts over the joint, immediately in front of the ear, but pain can also radiate elsewhere. It often causes spasms in the adjacent muscles that are attached to the bones of the skull, face, and jaws. The pain can be felt at the side of the head (the temple), the cheek, the lower jaw, and the teeth.

Treatment of TMD is conservative to begin with.  Rest the muscles and joints by eating soft foods.  It is recommended that you avoid opening your mouth wide or grinding on food or eating foods that require you to pull them to take a bite (think about a piece of pizza).  A good two week rest is often very helpful.  Avoid chewing gum, clenching or tensing your jaw and consider a bite guard that can be properly fashioned.  Use moist heat with massage over the area(s) of discomfort.  When there is no medical contraindication, use of a non-steroidal anti-inflammatory medication such as ibuprofen or naproxen should be considered on a regular basis to allow the muscle inflammation to pass.  Other medications may be considered by your doctor.   Sometimes the jaw will require splinting, realignment or rarely surgery.