Understanding and treating TMJ disorders

By: Dr. Jerry Gordon

TMJ is the abbreviation for temporomandibular joint, a small "ball and socket" joint located slightly in front of the ear. The joint allows movement between the lower jaw and the skull, and is cushioned by a disc. Ligaments and muscles help stabilize the joint and disc during eating, speaking, and other common functions.

An estimated 10 million Americans suffer from TMJ disorders (also TMD), which can cause a wide variety of symptoms. These symptoms include pain in the TMJ area when opening or closing the mouth (sometimes accompanied by loud clicking and popping), difficulty opening widely, headaches, and soreness of the muscles around the jaw when awakening.


TMJ disorders are often caused by a stressful situation, which can cause clenching of the teeth during the day, or grinding of the teeth while sleeping (bruxism). Other causes include a traumatic injury to the chin, jaw, or TMJ itself, missing back teeth and/or poor alignment of the jaws, arthritis, or poor dental treatment that forces the jaws to be more opened or closed than normal. Recent research has shown that the common venereal disease Chlamydia, if left untreated, may lead to reactive arthritis that affects the TMJ.

Your family dentist or an oral surgeon is most qualified to diagnose TMJ disorders. The dentist will ask you about your symptoms, habits, and your medical history. A clinical (hands-on) examination is required to determine jaw mobility, muscle soreness of the head and neck, and to evaluate the condition of the teeth, especially recent dental treatment. In some cases, an infected tooth towards the back of the mouth can cause referred (phantom) pain to the ear and TMJ area. A physician is sometimes needed to rule out an inner ear infection (otitis media) that can also mimic TMJ disorder. A panoramic or TMJ x-ray examination is also needed to evaluate potential damage, including fractures, and displacement or arthritic changes of the TMJ. In some cases, an MRI, CT scan or an arthrogram is needed to better evaluate the condition of the TMJ and surrounding muscles and ligaments.

People with TMJ disorder should see their dentist as soon as possible. In most cases, conservative therapy can resolve the problem. The dentist can identify and correct dental problems that may be related to the disorder. If the patient suffers from bruxism, a custom acrylic splint may be fabricated to wear at night or during the day. Pain should resolve in a few weeks. If these measures fail, a consultation with an oral surgeon may needed. In a minority of cases, a minor surgical procedure such as arthroplasty may be indicated, where cartilage or scar tissue is repaired and irritants are flushed out of the TMJ. Rarely, a more involved open joint surgery may be required to repair the bony aspect of the joint, ligaments or the disk.

During treatment for TMJ disorder, there are several measures that you can take to help speed up recovery. You should keep your jaw relaxed; try repeating the phrase "lips together, teeth apart" to yourself to avoid clenching during the day. Reduction in emotional stress is also beneficial in limiting both clenching and grinding that contributes to TMJ disorder. Try to temporarily eliminate hard foods and use moist heat packs to soothe sore muscles. If the TMJ is injured in an accident, an ice pack can be used (20 minutes on, 20 minutes off) for the first 24 hours. Over the counter medication such as ibuprofen (Advil, Motrin) or naproxen sodium (Aleve) are very effective in reducing inflammation associated with TMJ disorders. Your dentist may also prescribe muscle relaxants and apply physical therapy to relieve muscle pain associated with TMJ disorder.

Most dentists have not had training in treating TMJ disorders. You should find out if your dentist has had experience and training in treating these disorders before beginning any TMJ therapy.