TMJ (Jaw Joint) Disorders

The jaw joint (temporomandibular joint, or TMJ) sits just in front of the ear, where the lower jaw connects to the skull. There is one on each side and the two work together. It moves constantly as you talk, chew, yawn and swallow.

Between the rounded end of the lower jaw and the skull bone there is a small cartilage disc that lets the two glide without rubbing. The ligaments around the joint and the chewing muscles control this movement. When there is a problem with the bone, the disc, the ligaments or the muscles, a jaw joint disorder develops. These conditions are also known collectively as temporomandibular disorders.

• Pain in the jaw, in front of the ear, at the temple or in the cheek, especially when chewing or in the morning
• A click, pop or grating sound when opening and closing the mouth
• Not being able to open the mouth fully, the jaw shifting to one side when opening, or locking
• Tired chewing muscles, a tight jaw on waking
• Headaches, a feeling of fullness or ringing in the ear (when no ear problem is found)
• Worn or chipped teeth, tooth marks on the tongue and inside the cheeks (signs of clenching)

A clicking sound on its own, without pain or restriction, does not always need treatment; however, it is worth having it assessed and monitored.

In most patients there is not a single cause but a combination of several factors:

• Teeth clenching and grinding (bruxism): Puts constant extra load on the joint and muscles.
• Stress and muscle tension: Makes the chewing muscles tighten without you noticing.
• Disc displacement: A common cause of clicking and some types of locking.
• Trauma: A blow to the jaw or procedures that keep the mouth open for a long time.
• Joint wear and inflammatory conditions: Including rheumatic diseases.
• Bite and jaw structure problems: Missing teeth or jaws that do not match can contribute in some patients.

Clenching is pressing the teeth together or grinding them without being aware of it. Most people do it during sleep and do not know until someone next to them hears the noise or wear on the teeth is noticed. Some people also catch themselves clenching during the day. Stress is among the most important factors.

Long-term clenching can lead to worn and cracked teeth, broken fillings and crowns, jaw and facial pain, jaw joint problems and morning headaches. Early assessment is important to prevent permanent damage. The aim of treatment is to protect the teeth and the joint and to relax the muscles: a custom night guard (splint), advice on reducing stress and, in suitable patients, Botox in the chewing muscle are used.

At the examination, how far and in which direction the jaw opens is measured, sounds from the joints are listened to, the chewing muscles and joint area are checked by hand for tenderness, and the bite and any tooth wear are examined. When the symptoms started, stress, sleep and clenching habits are discussed.

Imaging is done if needed: a panoramic X-ray or a 3D CT scan to assess the bone, and an MRI to see the position of the disc in the joint. If an ear, nerve or rheumatic cause is suspected, we work together with the relevant doctor.

Treatment is done in steps: non-surgical treatments are tried first, and in most patients symptoms ease markedly with them.

Non-surgical treatments

• Custom splint (night guard): A clear, removable appliance worn over the teeth. It spreads the load on the joint and muscles, prevents clenching from damaging the teeth and helps the muscles relax. Whether it is worn at night or during the day is decided according to your symptoms.
• Self-care: Soft foods, avoiding chewing gum and hard foods, not opening the mouth too wide, warm compresses, and getting into the habit of keeping the teeth apart during the day.
• Jaw exercises and physiotherapy: Help the muscles relax and improve jaw movement.
• Medication: Short-term painkillers and muscle relaxants.
• Stress management: Stress and sleep directly affect symptoms; getting support in this area when needed is part of the treatment.

Botox

For muscle-related pain and clenching, Botox injected into the chewing muscle (masseter) can reduce excessive muscle contraction. The effect is not permanent; it usually lasts a few months and is repeated when needed. It is not used on its own but considered together with a splint and other measures.

Arthrocentesis

A small, short procedure used for pain and locking that do not respond to non-surgical treatments. Under local anaesthesia, fine needles are placed into the joint and the joint space is rinsed with sterile fluid. This washes out inflammatory substances in the joint and can make jaw movement easier. If needed, medication can be placed in the joint at the end. No incision is made; most patients return to daily life the same day.

Surgery

In selected cases that do not improve with other treatments, such as advanced joint damage, long-standing locking or structural problems, arthroscopy (a camera-guided procedure inside the joint) or open joint surgery is considered. Only a small proportion of patients with jaw joint disorders need surgery.

The risks of non-surgical treatments are low; still, there are things to know:

• Splint: In the first days you may feel pressure on the teeth or produce more saliva; poorly fitting splints used without check-ups can affect the bite. That is why they are custom-made and monitored at check-ups.
• Botox: Temporary tenderness or bruising at the injection site, temporary weakness when chewing; rarely, a temporary change in facial expression.
• Arthrocentesis: Temporary swelling and tenderness around the joint; rarely, a temporary change in facial sensation or movement, or infection.
• Surgery: Carries more risk depending on its extent; in that case the risks are discussed separately and in detail.

Even when symptoms ease with treatment, they can come back with stress, clenching or overloading the jaw. This is why part of the treatment is changing habits and attending regular check-ups.

• First days (splint and initial advice). Getting used to the splint may take a few days. A soft diet, warm compresses and jaw exercises are started.
• First weeks. In most patients pain and muscle tension start to ease. The splint is adjusted at the check-up.
• 2–3 months. Progress is assessed. If there is not enough improvement, the next step, such as Botox or arthrocentesis, is discussed.
• After arthrocentesis. There may be tenderness and mild swelling over the joint for the first 1–2 days; follow-up is with a soft diet and the recommended exercises.