Temporomandibular disorder (TMD) is a painful condition of the joint in the jaw. The temporomandibular joints are the small joints in front of each ear. They attach the lower jaw (mandible) to the skull. The disorder may affect the joint in the jaw or the muscles surrounding it. The disorder can include: Damage to the joint surface or intra-articular discDisplacement or complete dislocation of jaw bonesMuscle spasm
The Temporomandibular Joint
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The exact cause of TMD is often unclear. Possible causes include: Injury of the jaw or faceExcess tension in the jaw musclesFaulty alignment between the upper and lower teethDisturbed movement of the jaw jointDisplacement or abnormal position of the jaw joint or cartilage disc inside the jaw jointArthritis or similar inflammatory process in the jointExcess or limited motion of the joint
TMD is more common in women aged 30-50 years old. Other factors that increase your chance of TMD include: Clenching or grinding of teethStressArthritisPoorly fitting dentures or crownsFibromyalgia
TMD may cause: Pain in the temporomandibular joint, jaw, or facePain may be worse with chewing, yawning, or opening the mouthClicking, popping, or grating sounds with movement of the jawA sensation of the jaw catching or locking briefly, while attempting to open or close the mouth, or while chewingDifficulty opening the mouth completelyA bite that feels off, uncomfortable, or as though it is frequently changingHeadacheEaracheNeck pain
You will be asked about your symptoms and medical history. A physical exam will be done. The physical exam may include: Range of motion of the jaw testsListening for sounds of popping or clicking in the temporomandibular jointsVisual inspection of your teeth, temporomandibular joints, and muscles of your face and head Palpation of the joints and the muscles of the face and head
Images may be needed of your jaw to check for abnormalities causing TMD. This can be done with: X-raysArthrography—jaw movements videotaped with x-rays taken after dye is injected into the jointMRI scanCT scan
Usually, the least invasive measures will be tried first.
The area will need time to heal: Rest the jaw with a soft dietRestrict movement with smaller bites, avoiding wide yawning, and gum chewingApply ice or heat
packs for pain reliefGentle jaw stretching and exercises
The most commonly used medications include: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofenMuscle relaxantsAntidepressants
Some medication may be injected into the jaw such as: Pain relievers, such as
or lidocaineBotulinum toxin
(Botox)—may offer temporary relief if pain or clicking are major symptoms
To help reduce pain and allow muscles to relax:
or stretching exercises
Gentle strengthening exercises or muscle balance exercises to retain alignmentTranscutaneous electrical nerve stimulation (TENS)
A splint or mouth guard can be made to relax the jaw muscles, and prevent clenching and grinding of the teeth. The guard is usually worn at night. Unfortunately, there is not a lot of proof it works.
Correction of bite abnormalities by a dentist or orthodontist is sometimes needed.
Surgical correction is a last resort. Many of the available procedures have not been well-studied for their effectiveness.
There are no current guidelines to prevent TMD.
National Institute of Dental and Craniofacial Research website. Available at:
http://www.nidcr.nih.gov/oralhealth/topics/tmj. Updated July 10, 2014. Accessed May 16, 2016.
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http://www.ebscohost.com/dynamed: Turner JA, Mancl L, Aaron LA. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial
Last reviewed May 2016 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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