Temporomandibular Joint Dysfunction (TMD)

Temporomandibular joint(TMJ)dysfunction can mimic many other diseases, and therefore is often misdiagnosed or overlooked. Common symptoms include dull aching pain around the ear, often radiating into the face, neck, back of the head, and shoulders.

  • certain types of headaches, sometimes of migraine proportions.
  • ringing in the ears, hearing loss, "plugged" ears, ear pain.
  • tenderness of the jaw muscles.
  • clicking or popping noises when opening or closing the mouth.
  • difficulty opening the mouth or chewing, locking of jaws open or closed.

The temporomandibular joints are the hinges located on either side of the face that connect the lower jaw to the skull. Each temporomandibular joint has two sections that permit the hinge and gliding actions needed to open the mouth widely.

The joints work in concert with the facial bones and five pairs of muscles to allow opening and closing of the mouth and forward, backward, and side-to-side movements of the lower jaw. Any disturbance of this facial symphony can trigger the cycle characteristic of TMJ dysfunctions: muscles and joints not working together correctly, causing muscle spasm, resulting in pain, muscle tenderness, and tissue damage.

One of our dentists, Patrick Grossmann, has a special interest in treating patients with cranio-facial pain and jaw joint dysfunction. For more information, please contact reception.


What causes temporomandibular joint dysfunction (TMD)?

TMD has many causative factors the more common of which are malocclusion or problems in the way the teeth fit together, a blow to the jaw or head, clenching or grinding of the teeth, arthritis of the jaw, poorly fitting dentures, yawning for prolonged periods with the mouth open too wide, recent dental work, accidents that damage facial bones or the jaw, extraction of teeth or missing back teeth, birth trauma due to delivery complications, and traction involving the head, jaws, and neck.

The most common TMJ dysfunction originates in the jaw muscles and is called myofascial pain dysfunction (MPD). It often results from a tendency to deal with tension and stress by clenching or grinding the teeth. These habits can tire the muscles and trigger spasms, producing pain, more spasms and, eventually, a TMJ dysfunction. MPD sufferers may or may not have problems with their bite.

Because this dysfunction mimics so many other conditions, diagnosis may be complicated. Many people may spend a great deal of time and money searching for the source of their symptoms. If your physician cannot find any underlying conditions, he could consider the possibility of TMJ dysfunction and recommend that you consult a dentist with a special interest in the diagnosis and treatment of TMJ dysfunctions.


'Do I have TMD?'

Here is a checklist of symptoms associated with TMD. If you answer yes to 12 or more of these questions, you may have some form of TMJ problem. Please get in touch with our reception to arrange an appointment with Patrick Grossmann.

  • Do you have a grating, clicking or popping sound in either or both jaw joints when you chew or open or close your mouth?
  • Do you have sensations of stuffiness, pressure or blockage in your ears or excess wax?
  • Do you ever have a ringing, roaring, hissing or buzzing sound in your ears?
  • Do you ever feel dizzy or faint?
  • Is your jaw painful or locked when you get up in the morning? Does it get stuck?
  • Are you ever nauseous for no apparent reason?
  • Do you fatigue easily or consider yourself chronically fatigued?
  • Are there imprints of your teeth on the sides of your tongue?
  • Is it difficult or impossible to swallow quickly five times in a row with the last swallow being as easy as the first swallow?
  • Does your tongue go between your teeth when you swallow?
  • Do you have pain or soreness in any of the following areas: jaw joints, upper jaw or teeth, lower jaw or teeth, side of neck, back of head, forehead, behind eyes, temples, tongue or chewing muscles?
  • Is it hard to move your jaw from side to side or forward and backward?
  • Do you have difficulty in chewing your food?
  • Do you gulp your food, swallowing it whole or almost whole?
  • Do you have any missing back teeth?
  • Have you had extensive dental crowns and bridgework that were painful afterwards?
  • Do you clench your teeth during the day?
  • Do you grind your teeth at night? (Ask your family)
  • Do you ever awaken with a headache?
  • Have you ever had a whiplash injury?
  • Have you ever worn a cervical collar or had neck traction?
  • Have you ever experienced a blow to the chin, face or head?
  • Have you reached the point where drugs no longer relieve your symptoms?
  • Does chewing gum start or worsen your symptoms?
  • Is it painful, or is there soreness when you press your jaw joints or the cheek just below them?
  • Is it painful to stick your "pinky" fingers into your ears with your mouth open wide and then close your mouth while pressing forward with your "pinky" fingers?
  • Does your jaw deviate to the left or right when you open wide? (Look in a mirror.)
  • Are you unable to insert your first three fingers vertically into your mouth when it is opened wide?
  • Is your face crooked and not symmetrical?


What Causes Craniomandibular Dysfunction?

The structures that make it possible to open and close your mouth include the bones, joints, muscles and ligaments. All these elements must work together whenever you chew, speak or swallow. The lower jaw is connected to the facial skeleton via the tm joints by muscles and ligaments. Any problem which prevents the complex system of muscles, bones and joints from working together in harmony may lead to TMJ dysfunction.

Each jaw joint is a ball and socket joint. When functioning properly, the ball and socket do not actually touch because a thin disc of cartilage rides between them. The disc acts as a cushion and allows the joint to move smoothly. Each disc is held in place and guided by muscle. If your bite is not right, the joint is pulled out of alignment. Typically the disc is pulled forward. Since it no longer serves as a cushion, the joint itself now rubs against the bony socket and presses on pain fibers. Mild displacements cause a clicking or popping sound in the jaw joint; more severe displacements can be very painful and eventually lead to permanent joint damage associated with arthritis and a grinding noise known as crepitus.

Disc in place:

Disc in place

Disc out of place

Disc out of place