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Temporomandibular joint disorders (TMD) are common in the general population.  About two thirds of people will experience some TMD in their lifetime, but only about one in 20 patients with TMD will a significant headache or require treatment.

The temporomandibular joint or jaw joints are located just in front of the year and are thought to be a common cause of headaches. 
You can locate this joint by putting your finger on the piece of cartilaginous  structure in front of your ear. Then move your finger just slightly toward your nose and press down while you open your jaw all the way and shut it.  You can do this on both sides at once, for comparison.  The motion you feel is the TMJ.     These maneuvers can cause considerable pain for  patient who is having TMJ trouble. 

 The joint has a small, cartilaginous disc between the jaw and the fossa or pocket in which the jaw rotates.  Changes in the disc mechanics or the surfaces of the joint may progress to frank arthritis of the joints.  As joint abnormalities develop, there is usually an associated musculoskeletal changes that occur in the "muscles of mastication", that is the muscles in work on the mandible or jaw.  Alternatively, patients can put an excessive load on the temporomandibular joint by clenching or grinding their teeth during the daytime or nighttime, consciously or unconsciously.  Grinding one's teeth, also called bruxism, causes chips in the teeth, wear of the biting surface, and cracks of the teeth.  When the grinding motion often occurs in the lateral direction, flattening the edges of the teeth occur and pain in the TMJ area can develop.   Pain along the muscles of mastication will frequently be felt in the joint or there may be in a sensation of pain "in the ear".  In fact, in most ENT office practices, when patients present with ear pain, but have no discoverable ear disease, temporomandibular joint pain is the most common cause the ear pain. 

Symptoms of TMJ disorders are:

1. Clicking, popping or grating sounds in the jaw joint
2. Jaw pain or tightness in your jaw muscles
3. Ear pain
4. Teeth grinding or clenching, which may be loud enough to wake your sleep partner
5. Dull morning headache
6. Teeth that are worn down, flattened or chipped
7. Increased tooth sensitivity
8. Being unable to open the mouth comfortably
9. Locking of the jaw in an open position, when attempting to open the mouth
10. A bite that feels uncomfortable or “off”
11. Swelling over the TM joint

The clicking or popping in the joint arises from arthritis, cartilaginous changes, disk changes, and scarring in the joint that is often associated with abnormal joint movement.  Ear pain arises becomes the nerve endings in the joint share a common pathway with the nerve endings in the ear.  Limited range of motion on opening the jaw can occur.   Normal motion of the jaw canbe measured with a ruler and ranges from 35 to 55 mm for adults.  Patients with TMJ will often have limited opening motion as well as deviation of the mandible to the left or right as the mouth opens.  Jaw and temple pain arise over the masseter muscle (in front of them below the ear) and over the temporalis muscle (above and in front of the year) as the muscle becomes sensitive excessive activity or abnormal motion.  As the pain of the joints and muscles becomes more severe, the joint may feel swollen, and unilateral or bilateral headaches can be a prominent symptom.

Several factors can contribute to or can cause temporomandibular joint pain.  These include:

1. Clenching, grinding, or bruxism (one the most common causes)
2. Gum Chewing
3. Blunt or surgical trauma to the joint.
4. Irritation of the joint from excessive mouth opening (ie, in the dentist chair)
5. Habitual motion of the jaw
6. Poor dental occlusion
7. Rheumatoid arthritis
8. Other autoimmune diseases/arthritides
9. Fractures near the joint
10. Myofascial pain
11. Direct effect of tumors near the joint.

What are the treatments for TMJ disorders? 
Management of TMJ disorders is directed at removing the underlying cause, if possible.  Cessation of daytime clenching and nocturnal bruxism is critical.  Behavioral changes are often helpful, because stress is a frequent cause of clenching and nocturnal bruxism.  Basically, today's busy lifestyle places many people at risk of bruxism.  Our "go-go lifestyle" and busy schedule keep many people at a heightened level of activity up until the moment they lie down to sleep.  Although our exhausted body may quickly become non-responsive, our brains take longer to relax.  As a result, patients may clench or grind their teeth at night because their brain has not been an able to wind-down prior to bedtime.  Many dentists recommend 30 to 60 minutes of relaxation prior to bed time, to let body and brain relax prior to the onset of sleep.  This relaxation does not include reading work-related materials, he answering e-mails, watching an intense television show, or performing high level tasks of any sort, but rather should be something on the order of  pleasure reading, listening to music, or other low-key activity.   Some patients that are prone to bruxism place warm compresses or microwaveable “rice bag” compresses on their jaws for 20-30 minutes prior to bedtime, particularly when they are experiencing higher levels of stress. 

Other behavioral treatments for patients with problematic TMJ include:  absolute cessation of gum chewing or eathing very dense or chewy materials, avoidance of excessive wide opening of the mouth, and reduction of daily stressors.

The most commonly used class of drugs for controlling TMJ pain are the inflammatory drugs (NSAIDs) such as ibuprofen, naproxen,  alleve or others.  Occasionally muscle reluctance, tricyclic antidepressants, or the occasional and very judicious use of narcotics can also be helpful, particularly for very acute exacerbations (i.e., trauma)

A small percentage of patients with problematic TMJ pain resulting from bruxism benefit from an oral appliance or a bite plate. A bite plate is usually fashioned by a dentist and resembles a football or athletic mouthguard.  The bite block prevents normal occlusion of the teeth, and greatly reduces the amount of bruxism at night.  In some cases, it's used regularly, while other patients use it intermittently during periods of stress or symptomatic pain.

When behavioral therapy, appliances, and stress reduction KL and the patient's TMJ symptoms are significant, surgery may be indicated.  This is generally for a very small percentage of patients with TMJ disorders.  TMJ arthroscopy can be performed to remove it lesions and damaged cartilage from the joint, similar to the arthroscopic surgery in many ways.  Occasionally, open joint surgery may be indicated.