Temporomandibular (jaw) joint disorder  

  • Overview

Introduction 

Although not a serious condition, temporomandibular joint disorders can make a significant impact on quality of life 

Temporomandibular joint disorders (TJDs) are problems that affect the joint between the lower jaw and the base of the skull.

A TJD is not usually a serious condition, but symptoms can impact significantly on quality of life. Doctors sometimes also refer to the condition as myofascial pain disorder.

It has been estimated that approximately 20-30% of the adult population will experience a TJD at some point. Symptoms usually last for a few months before getting better.

What are the symptoms?

TJDs can cause:

  • clicking, popping or grating noises as you chew or move your mouth
  • muscle spasms around the jaw
  • pain in front of the ear that may spread to the cheek, ear and temple
  • difficulty opening the mouth  the jaw may feel tight, as if it is stuck, making eating difficult
  • headache or earache

What are the causes?

The main causes of TJD are:

  • clenching your jaw or grinding your teeth during sleep, which overworks the jaw muscles and puts pressure on the joint (often caused by stress)
  • wear and tear of the inside of the jaw joint, usually caused by osteoarthritis 
  • a disease causing inflammation of the jaw joint, such as rheumatoid arthritis or gout
  • injury to the jaw joint, for example after a blow to the face or surgery

You can click on the above links for more information on these conditions.

How are TJDs treated?

If your TJD is severe, you may need to see more than one medical professional, such as a dentist, oral and maxillofacial surgeon, GP, or ear, nose and throat (ENT) specialist.

Generally, non-surgical treatments such as lifestyle changes are tried first.

Lifestyle changes

There are a number of self-help measures that can help improve TJD, including:

  • resting the joint by eating soft food and avoiding chewing gum
  • holding a warm or cold flannel to the jaw after doing a few gentle jaw-stretching exercises
  • avoiding opening the joint too wide
  • massaging the muscles around the joint
  • relaxation exercises to relieve stress (people tend to clench their jaw when stressed)
  • not resting your chin on your hand

Mouth guards

Mouth guards (plastic mouthpieces that fit over your teeth) may be helpful if you grind your teeth. These cover the teeth at night to reduce jaw clenching and teeth grinding, and can be made to measure by your dentist.

Read more about treatments for teeth grinding.

Medication

Paracetamol, ibuprofen or codeine can help relieve pain. If these are not strong enough, ask your GP if they can prescribe you a muscle relaxant or tricyclic antidepressant, which may be more effective at relieving the pain.

Steroid injections

If your TJD is caused by a disease such as arthritis, you may benefit from a steroid injection into the jaw joint.

A steroid injection can help reduce pain and swelling in a joint or the surrounding soft tissue. Most people report feeling less pain within the first 24 hours to one week. You may find that your pain improves for a period of a few weeks to several months, and in some cases the injection resolves the pain completely.

Read more about corticosteroids (steroids).

Surgery

If the above measures do not help, you may wish to consider a surgical treatment such as:

  • arthrocentesis  needles are inserted into your upper jaw cavity and a solution is injected to help loosen up the joint and flush out any microscopic particles.
  • arthroscopy a small incision is made in front of your ear and a small thin instrument is inserted that allows your surgeon to examine the area and remove any inflamed tissue, or realign the jaw.
  • open joint surgery  the entire area around the jaw joint is opened up so the surgeon can get a better view and full access. This may be needed if the bony structures are deteriorating or if there are tumours around the joint. It has a longer healing time than arthroscopy, as well as a greater chance of scarring and nerve injury.

There is always a risk that surgical procedures may lead to more serious symptoms. You should discuss these risks with your surgeon.

Joint replacement

People with TJD who experience severe disability may wish to try an artificial temporomandibular joint replacement. Patients have reported finding it much easier to speak, sing and kiss with an artifical jaw.

The medical name for this procedure is total prosthetic replacement of the temporomandibular joint.

Under a general anaesthetic, a cut is made in front of the ear and behind or below the lower jaw. The diseased parts of the jaw are replaced with artificial joints, which can be made from various materials.

The benefits of joint replacement can be significant for some patients.

Possible risks include:

  • weakness in the face muscles caused by nerve damage
  • nerve pain
  • failure of the joint (the joint parts coming loose, dislodging, breaking or getting infected)
  • your immune system reacting to the joint

You should discuss these risks with your surgeon.

The National Institute for Health and Clinical Excellence (NICE) has produced guidelines on this procedure. Read the NICE 2009 guidelines on artificial total temporomandibular joint replacement.

Outlook

Most TJDs improve over time and do not get worse, and most people will not need surgery.

In the meantime, symptoms can often be improved with the treatments mentioned above.

Page last reviewed: 10/08/2012

Next review due: 10/08/2014

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Comments

The 12 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Jessica_97 said on 26 April 2014

I'm 17 and have been suffering with TMJD for about 4 months now. I saw my dentist about it about 2 months ago who referred me to a maxillofacial specialist. I saw the specialist about a month ago now who couldn't work out the cause of my problems other than the bone had bunched up at the front of the joint, causing the clicking/popping, and that there was
A slight lack of fluid around the joint. I was put on a soft food diet for 2 weeks and given a mouth splint to wear at night. Neither of these treatments improved my symptoms or subsided the pain in the slightest so I went to my GP last week who didn't bother examining the joint at all and prescribed me 400mg ibuprofen tablet which seem be causing me headaches and tiredness. I was not impressed by my last visit and wanted to ask people's opinion on what I should do next to try and get this sorted.

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Indiarae said on 14 April 2014

I have Ménière's disease as well as TMJ. The teeth grinding aggravates the Menieres. I am waiting to see a maxiofacial surgeon for what looks like is going to be my third op to remove debris from the jaw. The pain is awful and I am so depressed. Painkillers don't touch it. A med called Maxalit was mentioned on this thread but I can't find any info on it?? Any idea gratefully received.
Thanks for reading this x

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sonya1234 said on 06 April 2014

I have been suffering with severe pain that starts by the inside of my right ear for 2 years. I was always fobbed off with painkillers which never worked. I have also used a upper mouth shield for 2 years with no joy. I have used maxallt 10mg for the pain which would stay around for 3 days. I recently played a visit to my dentist who was concerned about the constant strange feeling to my back teeth and took a x ray and discovered that the disc between my skull and jaw bone is missing. After another bad bout of pain in the week I have now been given an appt with the Max facial tomorrow. Anyone else had this problem as I'm totally wiped out physically and mentally. Thanks sonya

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JJ69 said on 22 March 2014

I would just like to offer some advice for those out there suffering with this debilitating problem.

Following a fall, I have had major problems with my left jaw joint for almost 10 years. A dentist is useful for mouth guards, but frankly I found them of no further help dealing with my condition.

I would recommend asking your GP to book an appointment with a maxillo facial surgeon which can now be done very easily under the 'choose and book' system. This will get you the specialist treatment you need, and therefore hopefully avoid this becoming a chronic problem. You have the right to be referred to a consultant at a hospital of your choice, so please do not allow your GP to fob you off!!

I subsequently had a left jaw replacement, and although it will never be as good as it was, can now open my mouth, eat properly, and am almost pain free.

Good luck!!

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DataRascal UK said on 11 March 2014

Hello, Today, 11/03/2014 I attended an appointment at Birmingham's huge, Queen Elizabeth Hospital to see a Maxillofacial Surgeon. I underwent a face X-ray using a specialised X-ray for that purpose. I was diagnosed with TMJ Dysfunction Syndrome. I have found using ice-packs or freezer-sprays, used on the left side of my face, to be hugely beneficial with this affliction. However, though nobody believes me on this, I believe I have an affliction on the left side of my brain and it is that, that is causing this TMJ Dysfunction to originate down the left side of my face. It's up to yourself to try the ice-packs and freezer sprays. They work very well for me! Thank you.

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wendy nolan said on 27 February 2014

today I had surgery for my jaw joint, which was clicking and grinding, then locked shut for the last 6 months. I had an arthrocentesis. afterwards I found my jaw ached a little bit, but I didn't feel any different to when I went in. I am meant to do light exercises but I honestly don't think it has worked, I still cant open my mouth as far as I used to be able to before it locked shut. I have to go back in 6 weeks for a check up but I am pretty sure I know what they are going to say.

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Hcae said on 24 February 2014

Mine has been aggrivated by having a back tooth out. I had to have general anasthetic (Due to a phobia of dentists) .the dentist knew I had a clicky jaw...this is now worse since having the tooth removed as it now hurts.


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student128 said on 19 February 2014

It would be good if more people here post about their tmj experience so that we can all help each other. Has anyone tried a steroid injection and if so what was your experience? Thanks

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PrincessRainycorn said on 06 January 2014

@bird on a wire
Have you tried a dental outreach clinic? They are run by universities for students about to sit their exams, I know this sounds daunting but I have been using one for years and have never had a problem, it is all free, even mouthguards! This was a blessing to my mother after she took allergic reactions to all of her crowns and fillings and couldn't afford the £3000 to have it fixed by the NHS dental hospital, have a look in your local area and you should find some answers :)

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Bird On The Wire said on 14 October 2013

I pretty much know I have TMJ Dysfunction in the right side of my jaw joint, which is causing some tinnitus and wax to build up in my right ear too. TMJ can effect your ear, and it can be painful, mine is getting painful. When I wake up in the morning sometimes my jaw locks and it takes me a good 15 minutes to get it unlocked.
The problem is I cannot afford a dentist, not even and NHS dentist if it was possible for me to actually get one. I am on benefits, but I cannot claim anything income related as my husband works. The problem is, due to me having Asperger's Syndrome, and him being suspected of being on the spectrum, there are no laws that say he must hand over part of his wages to me to pay for dental care, he insists in keeping all finances separate and cannot get his head around the idea that we are married and it shouldn't work like that, so in reality I live only on my ESA and a small bit of DLA. Because my ESA is not 'income related' I cannot apply for free dental care.

My problem could be so easy to fix, at worst requiring I have a small operation, but it seems TMJ is dealt with by dentists, which are currently out of my reach.

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Bashir_R said on 23 September 2013

This information relating to Temporomandibular joint disorders (TJDs) is very helpful and saves me time to visit my GP or NHS...after reading through I quickly find the course of my joint disorder. Which was what I do most of the time....."resting chin on your hand". Thanks NHS for this update.

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Banane said on 09 December 2012

My local GP told me that the only choices I had for my deteriorating jaw condition were either the Tricyclics or corticosteroid injections. Now I see that there are other choices available, as I do not wish to have medication that messes with my head or the steroids. I've been down those paths before, and both have horrible side effects neither I want to try again.

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