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Temporomandibular joint (TMJ) syndrome is a disorder that causes persistent pain in the joints at each end of the jawbone. The pain is centered in front of the ears (myofascial pain) where the muscle comes together with the jaw. The temporomandibular joints play an active role in speech, chewing capabilities, swallowing, and facial expressions. These joints are prone to various abnormalities, including problems noted at birth and sometimes in rheumatoid arthritis or osteoarthritis when joints may be inflamed. TMJ pain may be experienced even when the joints are normal. This is generally caused by muscle spasms in the area resulting from psychological stress, muscle tension, and nocturnal grinding of the teeth (bruxism).
Risk: TMJ syndrome affects approximately 4 times as many women as men, with risk peaking in the early twenties and during perimenopause (Heffer). Incidence and Prevalence: An estimated 10 million individuals in the US develop TMJ pain (Heffer). |
Source: Medical Disability Advisor
| History: The most common complaints are jaw pain close to the ears and difficulty with jaw movement. The character of the pain may vary from dull to sharp, and may be constant or occasional. Clicking noises in the joint may be heard. A ringing sensation in the ears (tinnitus), as well as hearing problems may be present. Individuals may also complain of earache, headache, or dizziness. A history of dental work, facial trauma, or psychological stress (resulting in nocturnal teeth grinding) may be reported. The individual should be asked about frequent gum-chewing. Physical exam: An exam may reveal tenderness in the jaw joint and/or related chewing muscles along with lack of mobility. Limitation in jaw movement when opening the mouth or a history of locking open or closed may be apparent. Range of opening is typically around 40 millimeters from edge of upper and lower teeth while at maximum opening. Limited opening is evident at 25 millimeters and below. Jaw deviation while opening is a sign of internal joint derangement. Poor dental alignment or missing teeth may be obvious as well. Unusual sounds such as popping or clicking or grinding may be noted in the jaw joint. There may be evidence of hearing problems. Records of recent dental procedures may be reviewed. Tests: Laboratory or imaging studies are generally not necessary unless an infection or fracture are suspected. |
Source: Medical Disability Advisor
| The individual will be advised to avoid overusing the jaw. Gum chewing is eliminated. Jaw clenching or grinding is avoided. If grinding of the teeth is done during sleep, a mouth device that keeps the upper and lower teeth from touching may be recommended. Local application of heat may be recommended. Drug therapy may be employed to decrease joint inflammation and pain (either prescription or OTC nonsteroidal anti-inflammatory drugs [NSAIDs]). Muscle relaxants such as benzodiazepines may help relieve muscle tension.
The temporomandibular joints may be repaired in some individuals using arthroscopic surgery (arthroscopy), a minimally invasive procedure that allows visualization of the joint being repaired. A small telescoping tube with lenses at each end is inserted into the TMJ through a tiny incision below the jaw. It is attached to a fiberoptic light system that allows the surgeon to look directly through the lenses of the arthroscope into the joint; or, more commonly, an image of the joint interior can be transmitted through a small video camera to a TV monitor. Computer-assisted arthroscopic technique may be used with imaging modalities such as standard x-ray, CT scanning, or magnetic resonance imaging (MRI) to allow a detailed view of the anatomy and electronically track the procedure. The repair procedure itself is performed with other small instruments inserted through a tiny incision into the join space. Either fluid or gas is infused into the joint to expand the space and help clear debris.
Stress may be a contributing factor to the pain; in this case, counseling and/or medication to deal with stress may be recommended. In some cases, referral to a physical therapist for treatment such as massage may be given. |
Source: Medical Disability Advisor
| Most individuals with TMJ disorders respond well to conservative medical treatment and self-care, including over-the-counter analgesics and warm compresses on the affected muscles. Even if untreated, symptoms generally ease within 2 to 3 years, but treatment will generally make the individual more comfortable sooner and help prevent the development of dental complications. |
Source: Medical Disability Advisor
| Complications might include chronic facial pain, and wearing, cracking, or misalignment of the teeth (malocclusion). |
Source: Medical Disability Advisor
| In jobs requiring extensive verbal communication, such as a tour guide or corporate trainer, work accommodations and/or modifications may be necessary. Since stress is generally implicated in TMJ syndrome, transfer to a less stressful position may be appropriate. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has diagnosis of TMJ syndrome been confirmed?
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Have other conditions with similar symptoms been ruled out?
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Does individual have a coexisting condition that may impact recovery?
Regarding treatment:
- Is individual refraining from gum chewing?
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Is individual using a mouthguard at night?
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Has appropriate medication been provided?
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Has medication been effective in relieving symptoms?
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Is individual under continued psychological stress?
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Is individual receiving instruction in stress-reduction techniques?
Regarding prognosis:
- Do symptoms persist despite treatment?
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Would individual benefit from consultation with a specialist (dentist, oral surgeon, otorhinolaryngologist)?
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Is stress a contributing factor to the pain?
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Is individual under continued psychological stress?
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Is individual receiving instruction in stress-reduction techniques?
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Would individual benefit from physical therapy?
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Source: Medical Disability Advisor
| Heffer, Steven M. "Temporomandibular Joint Syndrome." eMedicine. Eds. Jerome F.X. Naradzay, et al. 30 Jun. 2004. Medscape. 18 Oct. 2004 <http://emedicine.com/emerg/topic569.htm>. |
Source: Medical Disability Advisor