|Temporomandibular Joint Dysfunction
The temporomandibular joints (TMJ) connect the lower jaw, or mandible, to the
temporal bones at the sides of the head. These joints are flexible, allowing the
jaw to move smoothly up and down and side to side, and enabling us to talk,
chew, and yawn. TMJ dysfunction involves face pain, clicking sounds in the TMJ,
and limited movement of the jaw. About 33 percent of the population has TMJ
dysfunction, and as many as 75 percent have some symptoms.
|Signs and Symptoms|
TMJ dysfunction is often accompanied by the following signs and
- Pain, particularly in the chewing muscles and/or jaw joint
- Limited movement or locking of the jaw
- Radiating pain in the face, neck, or shoulders
- Painful clicking, popping, or grating sounds in the jaw joint when
opening or closing the mouth
- A sudden, major change in the way the upper and lower teeth fit
- Also, sometimes headaches, earaches, dizziness, and hearing
|What Causes It?|
The only definitive cause of TMJ dysfunction is a severe injury, such as a
heavy blow, to the jaw or temporomandibular joint. Other possible causes include
- A bad bite (malocclusion)
- Orthodontic treatment, such as braces and the use of
- Jaw clicking, which is more likely the sign of a displaced disk
- Stress, which may cause or aggravate TMJ dysfunction. People with TMJ
dysfunction often clench or grind their teeth at night, which can tire the jaw
muscles and lead to pain.
|Who's Most At Risk?|
The following risk factors are associated with TMJ
- Gender—women seek treatment two times more
- Age—people 30 to 50 years of age are most
- Nutritional or metabolic disorders
- Grinding teeth, clenching jaw
- Malocclusion (bad bite)
- High stress levels
|What to Expect at Your Provider's Office|
If you are experiencing symptoms associated with TMJ dysfunction, you should
see your health care provider. He or she can help make a diagnosis and guide you
in determining which treatment or combination of therapies will work best for
Your provider will check muscles in the area of the TMJ, look for asymmetry
or inflammation in your face, listen for joint clicking or scraping sounds, test
your mandibular range of motion, and look for evidence of jaw clenching or teeth
grinding. If you're experiencing any neurological symptoms, such as numbness,
your provider will give you a neurological examination. Imaging techniques may
be used if there is evidence of degenerative disease or disk
Reducing stress and keeping yourself from grinding your teeth or clenching
your jaw may help prevent TMJ dysfunction or lessen the
Some health care providers consider TMJ dysfunction a medical condition while
others consider it a dental problem.
Your provider may prescribe the following medications.
- Analgesics—aspirin or nonsteroidal
- Minor tranquilizers or muscle relaxants at bedtime to reduce spasms
- Injections of a local anesthetic
- Antidepressants—for pain that
- Cortisone injections, in cases where no other treatment
|Surgical and Other Procedures|
When all other measures have failed, surgery may be
|Complementary and Alternative Therapies|
A comprehensive treatment plan for TMJ dysfunction may include a range of
complementary and alternative therapies.
The following nutritional tips may help prevent or reduce symptoms of TMJ
- Eat soft foods high in flavonoids to provide antioxidants to decrease
- Avoid saturated fats, fried foods, and caffeine, all of which increase
- Avoid chewing gum.
Potentially beneficial nutrient supplements include the
- Essential fatty acids (omega-3 and omega-6) to decrease
- St. John's wort (Hypericum perforatum) may improve serotonin
levels affected in TMJ dysfunction. Oil may be applied to the skin over the
joint. Oral dose is 250 mg three times a day.
- Cramp bark (Viburnum opulus) and lobelia (Lobelia
inflata) are antispasmodic. Rub 5 drops tincture of each herb into joint. Do
not apply to broken skin.
An experienced homeopath could prescribe a regimen for treating TMJ
dysfunction that is designed especially for you. Some of the most common acute
remedies are listed below.
- Causticum for burning pains
- Hypericum perforatum for sharp shooting pains
- Ignatia for tension in the jaw
- Kalmia for face pain especially with other joint pains or
- Magnesia phosphorica for muscle cramps
- Rhus toxicodendron for pains that feel better in the morning
and in dry weather, and worse after movement or in wet weather
- Ruta graveolens for pains from overuse or
Acute dose is three to five pellets of 12X to 30C every one to four hours
until symptoms are relieved.
Contrast hydrotherapy—alternating hot- and
cold-water applications—may decrease inflammation,
provide pain relief, and enhance healing. Use hot packs and ice wrapped in a
washcloth and apply to area. Alternate three minutes hot with one minute cold
and repeat three times for one set. Do two to five sets per
Very good evidence exists for acupuncture as an alternative treatment for TMJ
dysfunction. A number of well-designed trials found that acupuncture can help
provide long-term pain relief for this condition. In treating TMJ dysfunction,
acupuncturists often find a deficiency of qi in the liver meridian and a
relative excess in the gallbladder meridian. In addition to the primary
treatment on the liver and the supporting kidney meridians, moxibustion (a
technique in which the herb mugwort is burned over specific acupuncture points)
may also be used to enhance the needling therapy.
No well-designed studies have evaluated the effect of chiropractic on
individuals with TMJ dysfunction, but chiropractors report that manipulation of
the TMJ and adjacent areas in the upper spine may improve symptoms of the
condition in some individuals. It is believed, in these cases, that manipulation
restores movement to the TMJ.
Certain types of massage techniques and chiropractic manipulation may help
decrease muscle spasms, provide pain relief, and prevent recurrence of
TMJ dysfunction is treated successfully in 75 percent of patients who follow
a multifaceted treatment plan. In rare cases, prolonged teeth clenching or
grinding, trauma, infection, or connective tissue disease may result in
degenerative joint disease or arthritis. If you experience severe grinding, you
may benefit from nighttime use of a bite guard worn inside your
You may need to see your provider regularly to ensure the prescribed
therapies are working for you.
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|Review Date: March 2000|
|Reviewed By: Participants in the review process include: Gary Guebert, DC, DACBR,
(Chiropractic section October 2001) Login Chiropractic College, Maryland
Heights, MO; Anne McClenon, ND, Compass Family Health Center, Plymouth, MA;
Joseph Trainor, DC, (Chiropractic section October 2001) Integrative
Therapeutics, Inc., Natick, MA; Marcellus Walker, MD, LAc, (Acupuncture section
October 2001) St. Vincent's Catholic Medical Center, New York, NY; Terry Yochum,
DC, Rocky Mountain Chiropractic Center, Arvada, CO; Ira Zunin, MD, MPH, MBA,
(Acupuncture section October 2001) President and Chairman, Hawaii State
Consortium for Integrative Medicine, Honolulu,
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