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Temporomandibular joint disorders

The temporomandibular joints, located on either side of the face in front of your ears, connect your lower jaw to your skull. They act like hinges, allowing you to open and close your mouth and move your lower jaw forward and from side to side.

Signs of temporomandibular joint disorders (TMDs) are tenderness or pain when moving the jaw or at rest, similar to an earache. These anomalies may be accompanied by:

  • difficulty in opening or closing your mouth
  • clicking, crunching or grinding noises when the joints move
  • stiffness in the muscles involved in the chewing process (face, neck or shoulders)
  • headaches similar to migraines

Causes of TMDs

TMDs often originate with a combination of factors, although no specific cause has yet been pinpointed.

Some possible causes:
  • jaw injuries or anomalies, joint disease
  • tooth clenching or grinding (bruxism) and head or neck muscle tension
  • stress, although it is not clear whether stress causes TMDs or is a result of them

There is no scientific evidence of a link between misaligned teeth or jaws and TMDs.

Main symptoms

  • sharp pain in front of your ear
  • tender jaw muscles
  • stiff jaw, reduced jaw movement
  • grinding or crunching noises when you open your mouth or chew, accompanied by pain
  • headaches

Treatment

Many people with this kind of difficulties and pain get better on their own, by resting their jaw muscles, applying compresses or taking anti-inflammatories.

More specialized treatment is required in some cases, e.g.:

  • if TMDs cause persistent muscle pain
  • if they are accompanied by internal displacement of ligaments and cartilage, arthritis, a jaw lesion or reduced or excessive joint mobility
  • if there are deviations and gradual anomalies in jaw development

If symptoms persist, it is important to see a dentist.

Medications and physiotherapy are good ways of treating TMDs caused by joint inflammation. Often an occlusal splint, or night guard, can ease joint and muscle pain and reduce wear on teeth. Your dentist can monitor your condition and recommend appropriate treatment.

Recognized dental standards state that dentists must adopt a prudent and conservative approach when treating temporomandibular joint disorders. All treatment options are to be considered before resorting to interventions affecting the joint and teeth.

Generally speaking, grinding down your teeth, replacing missing teeth and orthodontic treatments will not correct TMDs, although they will improve the condition of your teeth and mouth.

Dental treatments that could affect the anatomical structures of the joint must be used with caution, since they are irreversible and could aggravate joint problems rather than solving them.

Prevention

  • Avoid hard or sticky foods that make you chew hard or open your mouth wide; also avoid chewing gum.
  • Try to relax your jaw muscles.
  • Gently massage and work your jaw muscles to relax them.
  • Try not to yawn too widely.
  • Apply the principle of “lips closed, teeth apart.” When you are relaxed:
    • your teeth should be slightly apart;
    • your tongue should be resting on the roof of your mouth;
    • your lips should be lightly touching or slightly apart.
  • Your teeth should be in contact only when chewing or swallowing.

If you grind or clench your teeth at night (bruxism), talk to your dentist about wearing an occlusal splint, or night guard.