TMJ Disorder

TMJ stands for temporal-mandibular joint — where the jaw (mandible) connects with the temporal bone (front-side of the skull), allowing us to open & close our mouths.  This is a hard topic, because there’s very little good evidence about the condition, regarding the cause, symptoms, treatment, or even what it consists of.  People say they “have TMJ,” which doesn’t really make sense, because all animals have two TMJs, one on each side.  The right term is TMD for Temporal-Mandibular Disorder, meaning something wrong in that general area.  But here we’ll say “TMJ.”

Personally, I prefer to diagnose “headache” or “facial pain,” because in most cases there’s no true disease of the actual joint.ย  The latter may rarely occur among people with rheumatoid arthritis.ย  But most people with “TMJ” have normal joints.

We make the diagnosis by ruling out other causes of pain in that area.ย  Patients should see a dentist at least once to make sure there’s no tooth disease (actually, it’s good to see a dental hygienist twice a year, and dentists occasionally, no matter what).ย  The dentist may order a “Panorex” (panorama x-ray of the entire mouth).ย  Otherwise, we don’t order CT scans or MRIs unless we suspect tumors, like if there’s an abnormality on physical exam (something more than just popping noises), or if there’s severe pain on just one side.ย 

There are many options for therapy, none of which have been proved to truly help.ย  Dentists may make custom splints (the main downside is cost).ย  A variety of pain medications exist, some taken as needed to calm pain, others to prevent it (we avoid anything addicting).ย  “TMJ Specialists” offer a variety of specialized physical therapies, biofeedback, and more, but again, it’s hard to say if results are worth the cost.ย  Certainly, if any anxiety or depression is present, it should be treated.

This may sound pessimistic, but that’s true for any chronic condition for which cause is unknown and definition is imprecise.ย  Fortunately, discomfort can be controlled, and there are no serious complications that occur. As such, I recommend that my patients avoid any sort of treatment which may be either expensive or potentially risky.

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