Temporomandibular disorder (TMD) is a term that encompasses a wide range of conditions that are associated with the temporomandibular (jaw) joint (TMJ) or the muscles of mastication (jaw muscles), leading to pain or other clinical problems.
Signs and symptoms of TMD
Signs and symptoms of TMD include pain around the joint (ears) and jaw areas that can extend to the scalp or down towards the neck, which are tender when palpated; pain that worsens during speaking, eating or yawning; limited mouth opening; and headaches.
Joint sounds, such as clicking, popping or grating sounds may be associated with TMD if there is also concomitant pain; otherwise, these sounds may be normal.
Causes of TMD are generally related to the jaw muscles or the jaw joint.
The jaw muscles can become fatigued, tense and undergo spasm. Common risk factors for this include clenching, grinding, and psychosocial issues such as stress and anxiety.
The jaw joint can be subjected to trauma, osteoarthritis, and other joint issues involving the bones at the jaw joint.
The aim of treatment of TMD is to relieve symptoms, rather than treat the cause. Up to 40% of patients with TMD have symptoms that spontaneously resolve without treatment, and the majority of patients’ TMD symptoms resolve with conservative treatment.
Conservative treatments
Conservative treatments include patient education and reassurance, resting the jaw and avoiding large movements, massaging and placing warm packs to the joint and muscles, and regular stretching and jaw exercised with the help of a physiotherapist.
Behavioural modifications to reduce stress, anxiety and therefore clenching and grinding can help.
Dental splints are an effective treatment option for those who clench or grind during sleep.
Medications can be used short-term to alleviate symptoms – these include nonsteroidal inflammatory drugs (NSAIDs) and muscle relaxants, among others, can be considered.
If conservative treatments are unsuccessful, referral to an oral medicine specialist or oral maxillofacial surgeon may be required.
Minimally invasive treatments
Minimally invasive treatment options include short-term use of botox for symptom relief via weakening of muscles, sodium hyaluronate and corticosteroid injections to treat symptoms of osteoarthritis, or arthrocentesis, and arthroscopy.
Arthrocentesis is a procedure whereby fluid is drained from the joint and the joint is then flushed with a sterile solution to remove debris and inflammatory molecules from the site.
Arthroscopy refers to a surgical procedure where a small telescope is inserted into the joint area for inspection, as well as release any fibrous adhesions within the joint that may prevent normal joint movements and washing out of the site.
Invasive treatments
Invasive procedures include open joint surgery and total joint replacement. These tend to be used as the final treatment options where more conservative treatment options have failed – in 5% of patients with TMD.
Overall, there are many treatment options for TMD which are provided in an order from most to least conservative. If any of the symptoms described resonate with you, you can visit your dentist to discuss your condition. Your dentist can help to provide you with information about TMD, deliver conservative treatment options, and direct you in the right direction to receive further treatment as required.
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Therapeutic Guidelines Limited. Oral Dental Expert Group. (2019). Therapeutic guidelines. Oral and dental (Version 3.. ed.). North Melbourne: Therapeutic Guidelines Limited.