TMJ / TMD

TMJ/TMD Overview

Pain and dysfunction of the jaw joint and controlling muscles comprise the conditions known as temporomandibular disorders (TMDs). These conditions affect the jaw joints, chewing muscles, or headache areas related to the jaw. Although the joint is called the TMJ, the term TMD refers specifically to disorders of this joint and its surrounding tissues.

Each TMJ exists in front of the ear to join the lower jaw with the skull structure. The TMJ’s design allows people to perform intricate eating functions, vocalize words, and open their mouths for yawns and swallowing. A cartilage disc cushions the bones for smooth movement. TMD symptoms can be unrelated to the jaw because the TMJ joints are close to the ear and their associated nerves.

Untreated TMJ/TMD leads to multiple problems, such as persistent jaw pain, joint damage, recurrent headaches, and sleep disorders. Tooth wear and eventual tooth loss become possible when someone experiences strain. Long-term pain exposure causes mental health conditions, which raise the likelihood of depression and anxiety.

While untreated TMD can persist or worsen in some patients, many experience gradual improvement or stabilization without invasive intervention. Nevertheless, persistent symptoms warrant professional evaluation to prevent chronic dysfunction.

Underlying Factors

A combination of biochemical changes, structural issues, muscle problems, trauma, genetics, hormones, systemic diseases, and other factors leads to TMD development. Arthritis, together with jaw injuries, stress, and teeth grinding (bruxism), are contributing factors to TMD development. The diagnostic process for TMD becomes complicated because it demands a detailed review of health and lifestyle factors.

TMJ symptoms/severity vary. Mild temporary discomfort responds well to self-care treatments, including rest, ice or heat applications, gentle exercises, and stress management practices. People with severe and long-lasting pain need medical intervention for their condition.

Causes and Contributing Factors of TMJ Disorder

Primary Causes   

1. Clenching/Grinding Teeth (Bruxism)

The jaw-muscle movement known as bruxism is the primary reason behind TMD development. The unconscious movement takes place both during daytime and nighttime hours. The repeated application of force against the jaw muscles through teeth clenching leads to muscle pain and stiffness and fatigue of the jaw, neck, and facial muscles.

The TMJ becomes inflamed when subjected to constant pressure, which could lead to hearing clicking/popping sounds and result in permanent tissue damage, such as misalignment and disc deterioration. Bruxism exposes the TMJ to repeated biomechanical stress, making it a major contributor to TMD.

2. Arthritis of the TMJ

Arthritis in the temporomandibular joint (TMJ) is a major cause of TMD. It leads to joint pain, inflammation, and restricted movement. Several types of arthritis can affect the TMJ:

• Osteoarthritis (OA). Cartilage degeneration in the TMJ causes stiffness, pain, and grating sounds (crepitus). OA typically affects individuals over 50 and often involves both joints.
• Rheumatoid Arthritis (RA). This autoimmune disease attacks the joint lining, resulting in inflammation, pain, swelling, and limited movement. RA may also alter bite alignment.
• Infectious Arthritis. Bacterial infections that spread to the TMJ can cause intense inflammation, pain, and impaired jaw function.
• Traumatic Arthritis. Acute injuries to the jaw can lead to inflammation, tenderness, and restricted movement.
• Secondary Degenerative Arthritis. Often seen in women aged 20–40 with prior trauma or muscle pain, this condition causes limited jaw opening, one-sided pain, tenderness, and crepitus.

3. Bad Bite (Malocclusion)

The condition known as malocclusion results in a misalignment of teeth during jaw closure, which affects TMJ function. The uneven distribution of biting and chewing forces on misaligned teeth leads to TMJ and stress on muscles/ligaments. This strain results from inflammatory processes, muscle fatigue, discomfort, and TMJ pain/symptoms. Specific types linked to pain:

• The front teeth of the upper jaw overlap the lower teeth beyond what is considered normal
• The jaw position fails to connect the back teeth properly
• Anterior open bite: Gap between front teeth when closed
• Back teeth display an improper alignment that affects one side of the mouth in unilateral posterior crossbite

4. Muscle Spasms or Pain

Muscle spasms/pain around the TMJ cause TMD. The condition of disc displacement occurs alongside overused chewing muscles and spasms. Movement requires the articular disc as a cushion, which becomes dysfunctional when displacement happens through trauma, excessive movement, or abnormalities, resulting in pain and movement difficulties. Strain develops from overworking the chewing muscles (masseter, temporalis, and pterygoids), which occurs when people respond to pain/altered mechanics while bruxism/stress worsens the condition.

The continual strain on muscles leads to the formation of trigger points that cause referred pain and also results in spasms, which limit movement through painful muscle contractions. This cycle perpetuates pain/dysfunction.

Other Contributing Factors  

1. Gum Chewing

Chewing gum might trigger adverse effects on TMD symptoms for specific individuals. The TMJ, together with muscles, activates when jaw movements repeat. People with TMD or predisposition to the condition should avoid regular gum chewing since it intensifies their symptoms. Extended gum chewing leads to muscle fatigue, producing jaw tension, tooth discomfort, and jaw joint pain.

Constant jaw movement can worsen TMJ inflammation, increase stiffness, and produce more joint noises. Gum chewing has the potential to worsen bruxism, which frequently occurs in people with TMD. Uneven chewing creates imbalances. TMD patients need to restrict their gum-chewing activities to prevent symptom worsening.

2. Traumatic Injury to the Facial Area or Jaw

Facial/jaw injuries contribute to TMD. Joints and structures receive damage from direct contact incidents such as sporting activities and accidents. The alignment of the head and neck suffers when someone experiences indirect trauma (whiplash), which creates jaw problems. The TMJ experiences additional stress from particular dental procedures that involve it.

Trauma leads to joint disc displacement while also resulting in ligament tears and joint inflammation. A “bad bite” results from misalignment instability, which forces muscles to work harder, thus causing fatigue and strain and leading to jaw, facial, neck, and shoulder pain. Symptoms may appear months/years later. The risk of developing TMD increases when someone has experienced past traumatic events.

3. Stress-Induced Muscle Tension and Clenching

Muscle tension develops in all body areas, including the jaw region, because of stress. The human body exhibits bruxism through tooth clenching and jaw muscle tightening during the day and nighttime for those under stress. The excessive tension in the TMJ leads to jaw pain and stiffness, which becomes most prominent during the morning.

The combination of long-term stress and teeth clenching leads to TMD through tissue inflammation, joint misalignment, and reduced joint movement. The existing symptoms of patients become worse when stress is present, thus establishing a cycle between pain and tension.

Stress management practices, which include mindfulness, breathing, yoga, and hobbies, help protect people from developing TMJ symptoms caused by stress while easing existing symptoms.

4. Poor Posture

The correct alignment of body structures depends on proper posture, which includes the TMJ. When people sit with slouched postures or their heads are forward from the screen, the spine-skeleton alignment becomes disrupted, creating stress for neck, facial, and jaw muscles. When the head moves forward, jaw muscles must compensate excessively, creating imbalances and mismatched muscle tension and strength.

The ongoing strain from this condition progressively worsens the symptoms of TMD, which include pain, stiffness, and problems with opening and closing. A proper alignment of the head with the spine reduces physical tension. Combining ergonomics with mindful posture and core/back exercises helps posture and TMJ health.

Signs and Symptoms of TMJ Disorder

Primary Signs and Indicators  

• Jaw, Face, Neck, and Shoulder Pain. TMD often causes pain or tenderness in the jaw joint, facial muscles, neck, and shoulders. This pain can range from a mild ache to sharp, intense discomfort and may radiate to nearby areas.
• Tenderness When Touching the Jaw. Discomfort typically worsens with touch or pressure on the jaw muscles or joints, indicating localized inflammation or irritation.
• Clicking, Popping, or Grating Sounds. Audible jaw noises during movement, like clicking, popping, or grating, are common. Occasional, painless sounds are harmless, but frequent or painful noises may signal joint dysfunction or degeneration.
• Restricted Jaw Movement or Lockjaw. Difficulty opening or closing the mouth, known as lockjaw, can result from muscle spasms, disc displacement, or structural issues. Limited mobility that interferes with daily activities requires professional evaluation.

Secondary Symptoms and Associated Issues 

• Earache and Tinnitus

The proximity of the TMJ to the ear canal leads to earache as a secondary symptom of TMD. The condition known as tinnitus exists due to TMD. These highlight TMJ’s connection to nearby structures/nerves.

• Headaches, Migraines, and Muscle Spasms

Patients with temporomandibular disorders (TMD) often experience tension headaches and migraines due to the close relationship between the jaw muscles, TMJ, and head and neck nerves. Jaw muscle tension and TMJ dysfunction can trigger nerve irritation, sending pain signals to the head and worsening headache symptoms.

Muscle spasms and involuntary contractions in the face, neck, and shoulders may develop as a protective response. Swelling or lump formation in the jaw or temple area can indicate tissue inflammation or, less commonly, a ganglion cyst. A professional medical evaluation is essential to identify the cause and rule out more serious conditions.

• Dizziness and General Facial Discomfort

Some with TMD experience dizziness/vertigo. The relationship between TMJ and dizziness remains unclear, although the inner ear (balance) lies nearby. TMJ dysfunction can disrupt brain signals that monitor body position. TMD produces dizziness and discomfort throughout the face, including pain, stiffness, and pressure. The wide-ranging effects of TMD become evident through its uncommon symptoms.

Risk Factors for TMJ Disorder

Pre-Existing Medical Conditions 

Arthritis at any stage, including RA or OA, is a significant factor that increases the risk of developing TMD. Joint inflammation from arthritis affects TMJ tissue, which leads to pain while reducing motion and joint stiffness. Inflammatory polyarthropathies increase risk. People with arthritis must recognize that their joints may affect the temporomandibular joint.

Previous injuries to the jaw that included fractures, dislocations, or whiplash and facial blows elevate the risk of developing TMD. Trauma causes damage to the TMJ structure, producing misalignment and inflammation and disrupting the joint’s movement. The symptoms can develop immediately or emerge after several months to years. The occurrence of traumatic experiences in someone’s history significantly raises their chances of developing TMD.

Behavioral and Physiological Factors 

Bruxism that occurs repeatedly is one of the most significant behavioral factors that contribute to disease risks. The unconscious act of bruxism creates excessive force on both the TMJ and muscles. The combination of tension results in inflammatory changes that produce pain alongside fatigue and the potential for joint damage. Stress triggers bruxism. People who clench or grind their teeth continuously experience increased susceptibility to TMD. The implementation of stress management techniques combined with night guards effectively minimizes the chances of bruxism development.

Conditions affecting connective tissues

The risk of developing TMD increases when connective tissues such as ligaments, tendons, and cartilage experience any type of condition. These tissues stabilize joints. Ehlers-Danlos, Marfan, and lupus conditions impair tissue integrity and elasticity. The high joint laxity of TMJ makes this joint vulnerable to problems with stability and dysfunction. The structural changes to tissue properties make it difficult for TMJ to manage stress, which leads to symptoms of pain. People with connective tissue disorders need to recognize their increased risk of developing TMD.

Diagnosis of TMJ Disorder

Clinical Evaluation

The initial step for diagnosing TMD begins with evaluating dental and physical aspects. A trained professional measures pain symptoms by locating the discomfort and determining its intensity and duration before feeling the tenderness of the jaw joint and jaw muscles through physical touch. The professional listens for joint sounds, which include clicking, popping, and grating when the patient moves their jaw. The physical examination offers the first indications for diagnosis.

The examination phase examines the bite alignment and the functionality of facial muscles. A dentist examines tooth alignment during observation to detect any misalignment of teeth (malocclusion). The professional examines jaw muscle functionality by testing their range of motion for opening, closing, side-to-side, and forward motions while searching for structural or balancing problems through movement assessment.

Diagnostic Testing

Dental X-rays combined with TMJ imaging reveal the structures of the jaw bones and TMJ to exclude bone-related or fracture problems. CT scans (detailed bony structure). The MRI diagnostic tool reveals disc displacement, inflammation, and abnormalities in soft tissues, including discs, ligaments, and muscles. Medical imaging choices depend on patient symptoms and findings since MRI is required for soft tissue examination.

Treatment Options for TMJ Disorder

Non-Surgical Treatments

OTC pain relievers (ibuprofen and acetaminophen) help manage symptoms of mild and moderate TMJ pain. Prescription pain relievers/NSAIDs for severe pain. Muscle relaxants ease pain/spasms (esp. bruxism). Low-dose antidepressants/anti-anxiety meds for chronic pain, bruxism, and sleep issues. The medicines help reduce symptoms but do not address the underlying problem.

Non-Medical Therapies  

Dental splints or night guards

Teeth guards from the drugstore help decrease bruxism by stabilizing the jaw and potentially reshaping the bite. Many find them helpful for bruxism-related TMD. 

Physical therapy

Specific exercises help patients regain jaw flexibility while building muscle strength and easing pain or stiffness. The treatment includes specific exercises for jaw muscles and stretching combined with joint mobilization, massage techniques, and proper posture education.

The portable device TENS delivers low electrical currents through skin electrodes, which help block signals and relax muscles to relieve pain. This treatment serves as an additional method to other therapies for momentary pain reduction.

Surgical Procedures for Severe Cases 

Surgical intervention is reserved for TMD unresponsive to conservative care.

Arthroscopy uses small incisions to insert a camera and instruments, allowing removal of inflamed tissue, lysis of adhesions, and disc repositioning with minimal pain and rapid recovery. Arthrocentesis employs two needles to irrigate the joint with saline, flushing debris, and reducing mild disc displacement to prevent locking episodes, typically under local anesthesia in an outpatient setting.

In advanced cases featuring severe degeneration, osteophytes, ankylosis, or tumors, open-joint surgery offers direct access to reshape or excise pathological bone and soft tissue and reconstruct the joint, though it requires a longer rehabilitation.

Find the Right Dental Help Near Me

Temporomandibular joint (TMJ) disorders affect the jaw joint and surrounding muscles, leading to pain, limited movement, and reduced quality of life. Because the TMJ plays a vital role in everyday functions like speaking and chewing, early diagnosis and treatment are essential to prevent long-term complications.

Common causes include bruxism, arthritis, bite misalignment, trauma, and stress. Key symptoms are jaw pain, clicking or popping sounds, and difficulty opening or closing the mouth. If you notice these signs, seek professional evaluation promptly.

Calabasas Smiles Advanced Dentistry offers expert care for TMJ/TMD through comprehensive evaluations and personalized treatment plans. If you are experiencing persistent jaw discomfort or mobility issues, contact our team at 818-878-7300 for a consultation.