The most frequently used joint in the human body is not those joints we think about daily such as our knees, elbows, shoulders, hips, wrists or ankles. While those joints can take some “time off” during the day, there is a joint that’s constantly working during our waking hours: the temporomandibular joint (TMJ).

The TMJ, according to the American Association of Oral and Maxillofacial Surgeon (AAOMS), is a small hinge and gliding joint located in front of the ear that allows the lower jaw to move and function.

While small, the TMJ has a large role as it is used for essential functions such as speaking, eating, swallowing, and facial expressions. Even when we are not actively moving our jaw, the TMJ is engaged in maintaining the position of the lower jaw.

TMJ is Prone to Disorders and Discomfort

Unfortunately, due to its frequent use, the TMJ is also prone to disorders and discomfort, which can significantly impact daily life.

 “TMJ disorders are common, and symptoms can include earaches, headaches or a limited ability to open the mouth,” says AAOMS.

The good news is that in August 2024 the AAOMS announced that it has developed evidence-based guidance for evaluating, diagnosing and treating patients with TMJ disorders and the pain that originates from the joint, called intra-articular pain and dysfunction (IPD)

"Significant advances in our understanding of the pathophysiology of TMJ pain and inflammation, along with the application of established principles underlying joint disease, have enabled IPD to be better diagnosed and treated. The well-documented success of nonsurgical treatment as well as minimally invasive surgical options provides the patient and surgeon with sound treatment choices," said Dr. Gary F. Bouloux, chair of the AAOMS Special Committee on Temporomandibular Joint Care and professor and chief of the Division of Oral and Maxillofacial Surgery at Emory University School of Medicine in Atlanta.

Let’s look closer at TMJ disorder causes, symptoms and when to see a professional.

Causes of TMJ Disorders

While TMJ Syndrome has become a popular term for disorders and pain associated with the head, neck and jaw, the AAOMS refers to Temporomandibular Disease (TMD) as a collective term that describes clinical problems involving the function of the masticatory muscles (which are attached to the jaw) and the jaw joint.

Causes of masticatory muscle disorders and TMJ disorders include:

Masticatory muscle disorders may result from:

• Abnormal parafunctional habits such as bruxism and clenching of teeth in response to stress
• Referred pain patterns of the cervical spine
• Systemic muscle disorders such as dyskinesia, fibromyalgia, and myositis
  
  

TMJ disorders can be the result of:

• Internal derangement (articular disc in the jaw is displaced)
• Degenerative joint disease
• Rheumatoid arthritis
• Infectious arthritis
• Mandibular dislocation (dislocated jaw)
• Neoplasia (abnormal growth of cells or tissues)
• Ankylosis (stiffness of a joint due to abnormal adhesion and rigidity of the bones)
• Condylar hypoplasia (condition that causes the jawbone to grow too large)
• Condylar osteolysis (breakdown and loss of bone tissue in the lower jawbone)
• Fractures
  
  

Other risk factors for TMJ disorders are stress, anxiety, depression, sleep disturbances, and smoking.

It's important to note that TMJ disorders often result from a combination of these factors rather than a single cause. The interplay between physical, biological, and psychological elements can make diagnosis and treatment complex.

TMJ Disorders Symptoms

TMJ disorders (temporomandibular joint disorders) can present with a variety of symptoms affecting the jaw, face, and surrounding areas. The most common symptoms include:

Pain and discomfort

• Jaw pain and tenderness, especially in the joint area
• Pain spreading to the face, neck, or shoulders
• Earaches or pain around the ear
• Headaches, particularly around the temples
• Facial pain
  
  

Movement Issues

• Limited jaw movement or difficulty opening the mouth fully
• Jaw stiffness
• Locking of the jaw in an open or closed position
• Difficulty or discomfort while chewing or biting
  
  

Sounds and Sensations

• Clicking, popping, or grating sounds when opening or closing the mouth
• A change in how the upper or lower teeth fit together (called malocclusion)
  
  

Others Symptoms

• Tinnitus (ringing in the ears)
• Dizziness or vertigo
• Muscle fatigue in the face
• Swelling on the side of the face
  
  

It's important to note that while clicking or popping sounds in the jaw are common, they are not necessarily indicative of a TMJ disorder if they occur without pain.

“Symptoms are usually reported by adults between the ages of 20 and 40 and tend to affect females more frequently than males,” says AAOMS.

When to Consult an Oral and Maxillofacial Surgeon

AAOMS says that when symptoms of TMJ trouble appear, consult an oral and maxillofacial surgeon (OMS).

“A specialist in the areas of the mouth, teeth and jaws, your OMS has the expertise to correctly diagnose the problem,” says AAOMS. “TMJ disorders can be complex and may require different diagnostic procedures. Special imaging studies of the joints may be ordered, and appropriate referral to other dental or medical specialists or a physical therapist may be made.”

The good news is that while TMJ disorders are widespread, AAOMS says that only 5 to 10 percent of people require surgical treatment for their symptoms.

The treatment protocol released by AAOMS in August 2024 calls for:

• Conducting a thorough history, screening, and physical examination.
• Obtaining the proper diagnostic imaging which can include x-rays, CT scans, MRIs, or ultrasounds.
• Diagnosis after the history, screening, physical examination, and imaging.
• Initiating the least invasive, evidence-based nonsurgical or surgical treatment.
  
  

“Treatment may range from dental and medical care to complex surgery,” says the AAOMS.

Least invasive nonsurgical treatments for managing TMJ disorders may include rest, heat, ice, nonsteroidal anti-inflammatory drugs, muscle relaxants, physical therapy, stress management counseling, and orthotics.

“Arthroplasty – surgery to restore the joint – or total joint replacement are surgical options that should be reserved for patients in whom minimally invasive procedures have not been successful,” the AAOMS advises.

If you are experiencing TMJ related pain or problems, reach out to the board-certified surgeons at Northwest Oral & Maxillofacial Surgery who specialize in diagnosing and treating diseases and injuries of the face, mouth, dentition, jaws, and neck.