Jaw Pain: Is This Temporomandibular Disorder (Tmd)? By Dr. Khawaja Shehryar Nasir

Temporomandibular disorders (TMD) are a collective term that is used to describe by doctors, disorders that affect the jaw muscles and the jaw joint. According to the NHS, TMD is not serious in most cases and goes away on its own. Sometimes it is incorrectly referred to as “TMJ”. This term stands for temporomandibular joint. It is not a disorder but name of the jaw joint. TMJ is a small sliding hinge like structure present on either side of your face, which connects your jawbone to your skull. TMD is majorly characterized by jaw pain. Below, we answer some questions about TMD.

How common are TMD?                            

These disorders are fairly common. It is estimated that TMD affects nearly 10-30 % of the population. It can affect both males and females, of all ages. However, it is most common in adult females between ages 20 to 50 years.

What are common signs and symptoms of TMD?

The most common symptom associated with TMD is pain or ache in the area of jaw, temples, and in or around ears, on either or both sides. Pain tends to last for hours to days.  It may worsen during or after chewing, and is often accompanied by limited mouth opening, and stiffness or tightness in the region.

Sometimes there may be episodes of “clicking”, “popping” or “snapping” present in the jaw or the ear. They are often worse in morning, while yawning, and during or after chewing. Similarly, there may be occasional episodes of jaw “locking” or “catching” such that it may result in inability to open or close the jaw.

Other symptoms include swelling on either side of the face, nerve damage, migraines, Eustachian tube dysfunction (ETD), and even TMJ dislocation occasionally.

How Do Doctors Diagnose TMD?

Doctors look for the symptoms discussed above by doing a physical examination and collecting the patient’s medical history. Because there is no particular test to specify TMD in a patient, a general physician might recommend the patient to an otolaryngologist (ENT specialist), a maxillofacial specialist, or a dental surgeon to corroborate the diagnosis. Doctors can order an MRI of TMJ as well to rule out other issues.

What are different types of TMD?

Based on the structures that are affected, TMD can be subdivided into two broad categories. These are masticatory muscle disorders and TMJ disorders. Masticatory muscle disorders are conditions that affect the muscles of the jaw and head region. Most common type of masticatory muscle disorder is myalgia or myofascial pain. Similarly TMJ disorders refer to disorders that affect the TMJ and its supporting structures. Most common type of TMJ disorders includes arthralgia and disc displacement disorders.

What causes TMD?

The exact causes of TMD are not fully understood. However, genetics and environments factors appear to play an important role. These include trauma to the head and neck region, clenching or grinding of teeth, stress, depression, arthritis, and presence of an existing pain condition, such as migraine headache or fibromyalgia.

Is there a treatment for TMD?

There are numerous treatments available that may help in the management of TMD. Treatment depends on various factors, including your age, overall health and medical history, and the sub-type of TMD. Different treatment options include medicines, injections, night guard devices, behavioral exercises, and physical therapy. Very rarely, you might require a surgery.

Most symptoms of TMD can be resolved with home remedies. Some of these are: ice packs to the affected area; over-the-counter anti-inflammatory medicine; eating softer edibles and avoid chewing gum; massaging or stretching the muscles around TMJ (seek assistance from a doctor); stress relief and management; certain essential oils like chamomile might provide some relief from the pain.

If self-treatment does not work, medical help might be required. These procedures might still not resolve TMD, but they can induce short- or long-term relief from the pain. These include: cognitive behavioral therapy (CBT) might help lessen the pain; jaw exercises can help in improving flexibility and strengthening muscles.

If the aforementioned treatment options fail to provide comfort, surgery might become necessary. This can include: TMJ arthrocentesis which is a simple surgery and requires only a week’s recovery time; in some cases a complete joint replacement can become necessary which requires in-hospital stay for a week and a month’s recovery time.

Not everyone responds to these treatment options in the same way. However, together with your doctor you should be able to find ways to manage your TMD.

When should I see a doctor for this?

In approximately 40 % cases TMD is self-limiting. Discuss with a doctor if your condition is very bothersome for you, causing intense jaw pain,  debilitation, or resulting in difficulty in chewing, or opening or closing of your jaw.

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