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Temporomandibular disorders (TMDs)

Temporomandibular disorders (TMDs) are known by several different names, including ‘facial arthromyalgia’. The temporomandibular joint is the hinge joint in the jaw. Within the joint is a small disc that moves with the lower jaw. Most people with TMDs have problems with the muscles in their jaw rather than the joint itself. It can be helpful to think of TMDs as cramp in the muscles.

What are the symptoms of TMDs?

The main symptoms of TMDs are:

  • pain, discomfort and tenderness around the ear and surrounding muscles, either on one side or both
  • dull, aching pain (but sometimes the pain is sudden and sharp)
  • jaw locking when you open your mouth and reduced opening of your mouth, though this is less common
  • clicking noises coming from one or both joints in the jaw when you open or close your mouth. (These noises are because the way the disc moves is altered. They do not necessarily mean that the jaw bone is damaged.)

Other symptoms include:

  • earache, buzzing in the ear or a blocked sensation in the ear
  • headache and migraine
  • neck ache
  • pain in other parts of the body (for example, backache)
  • disturbed sleep.

What causes TMDs?

Different causes for TMDs have been suggested. These include hereditary factors, genetic increased sensitivity to pain and previous injuries to the jaw joint and muscles. Except for people with arthritis in the jaw (which is rare and often not painful), it is unusual for there to be damage to the bone in the temporomandibular joint. Stress does not cause TMDs but it can increase the levels of pain people experience.

Experiencing pain and stiffness in the jaw can be worrying. Some people might worry that their jaw is damaged, that the pain will worsen or that their jaw might lock. It is important to know that TMDs are rarely the result of serious disease.

What are the treatments for TMDs?

Dentists often recommend that people use splints at night. Splints are devices that cover some or all of the teeth and might be helpful for people who clench or grind their teeth to such an extent they begin to damage them. However, there is not enough evidence to suggest that they are essential for people with TMDs. Splints might cause distress and poor sleep because they can be bulky.

People with TMDs might experience a few days or weeks with severe pain and difficulty opening their mouths. During this time, there are a number of things that can help people with managing their pain.

  • Eat a soft food diet and use both sides of the mouth at the same time, or alternate sides, when eating. Try to return to a normal diet when the pain improves. Staying on a soft food diet will mean that you are not using the muscles in your jaw which can result in more stiffness and pain.
  • Chew with the back teeth rather than biting with the front teeth.
  • Avoid opening the mouth widely (for example, to yawn or to have dental treatment) until the pain has settled. Once the pain has settled, you can return to opening your mouth widely as you would do normally.
  • Avoid habits that put strain on the jaw muscles and joints (for example, chewing objects or clenching the jaw).
  • Apply a warm or cold face towel (whichever feels better) for 10-20 minutes, three or four times a day.
  • Keep the tongue in the roof of the mouth and the top and bottom teeth apart. This keeps the jaw muscles in a relaxed position.
  • Take pain relief medication (as long as there is no medical reason to avoid it).
  • Learn and regularly practise relaxation techniques (for example abdominal breathing or mindfulness).

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