The temporomandibular joint (jaw joint) is located in front of the ear where the skull and the lower jaw meet.
The joint allows the lower jaw (mandible) to move and function. The joint itself is made up of two bones that are separated by a disc of cartilage. Ligaments and muscles surround the joint. Problems with the jaw joint are very common but typically only last a few months before getting better. In some instances, only the muscles are affected (myofacial pain dysfunction) whereas in others the cartilages and ligaments may also be at fault (internal derangement of temporomandibular joint).
The TMJ, unlike other joints slides backwards and forwards through the complicated coordination of bone, muscles, cartilage and ligaments.
- Joint noise – such as clicking, cracking, crunching, grating or popping.
- Pain – usually a dull ache in and around the ear. The pain may radiate, i.e. move forwards along the cheekbone or downwards into the neck.
- Limited mouth opening.
The cartilage in the jaw joint is thought to slip forwards because of over-use of the muscles surrounding the jaw. This over-use commonly produces tightening of the muscles and may occur as a result of chewing habits, such as grinding or clenching the teeth when under stress or at night. Nail-biting or holding things between the teeth can also cause jaw joint problems. Less commonly missing back teeth, an uneven bite or an injury to the jaw can lead to the problem. Often no obvious cause is found. Most jaw joint problems are made worse by chewing and are aggravated at times of stress.
What happens if there’s no improvement?
Surgery is only carried out in selected cases. This can involve manipulation of the joint whilst you are asleep, washing out the joint (arthrocentesis) or open surgery to the joint in order to operate on the bones, cartilages and ligaments.
Are jaw joint problems anything to worry about?
It is important to realise that jaw joint problems, although a nuisance, are not sinister and usually respond to relatively simple measures over a period of time. Patients themselves can manage most of these treatments. Occasionally jaw joint problems may return after several years. It is very rare for jaw joint problems to progress to arthritis.
Why have I got jaw joint problems?
Pain is caused by the muscles in and around the jaw joint tightening up. Joint noise occurs if the disc of cartilage moves out of its normal position between the bones of the jaw joint. Most commonly the cartilage slips forwards and a noise is made when it returns to its normal position in between the bones of the jaw joint. The noise sounds louder to some patients than others because the joint is just in front of the ear. The ligaments and muscles surrounding the joint can in turn go into spasm, producing pain and limited mouth opening.
Are my problems anything to worry about?
Jaw joint problems are usually not serious and do not lead onto other problems eg arthritis of the jaw joint. They are however a nuisance. Fortunately, jaw joint problems usually respond to simple treatments.
What are the treatments?
Treatments vary depending on whether you are suffering from myofacial pain dysfunction, internal derangement of the temporomandibular joint or a combination of both. On the whole, treatment is aimed at trying to reduce the workload of the muscles so allowing the disc of cartilage to return to a normal position in the joint.
- A soft diet that requires little chewing – this allows over-worked muscles to rest.
- Painkillers – anti-inflammatory medication (eg Nurofen) is good and can be taken as either tables or applied as a gel on the outside of the joint.
- Heat – eg warm water in a hot water bottle (avoid boiling water) wrapped in a towel applied to the side of the face.
- Identifying and stopping any habits, such as clenching or grinding. Remember that these may be “subconscious”, ie you may not be aware of them.
- Relaxation therapy and learning techniques to control tension and stress.
- Jaw joint relaxation manoeuvres – I will discuss the movements that are best for you. Please remember to carry them out as instructed.
- Resting the joint as much as possible – eg avoiding yawning
The disc of cartilage which lies in your jaw joint has moved out of its normal position between the bones.
How will I feel after the operation?
The area in and around the jaw joint is often uncomfortable for a day or two after the procedure.
You may find it necessary to take simple painkillers (eg Ibuprofen) during this time.
There will also be some swelling in front of your ear.
You may also find it difficult to open your jaw for a few weeks.
Will I need another appointment?
You will need to return a few weeks after surgery to have your jaw joint checked by me. Arthrocentesis is not always successful and even in those people who have an improvement following the procedure it can take several months for this to occur. Repeat procedure in the future may be necessary.
What is a jaw joint arthrocentesis?
An arthrocentesis is a procedure during which the jaw joint is washed out with sterile fluid. It aims to return the disc of cartilage to its normal position within the joint.
What does the treatment involve?
An arthrocentesis usually takes place under a general anaesthetic, ie you will be put to sleep completely. While you are asleep two small needles will be inserted into the jaw joint. One of these needles allows sterile fluid to be pumped into the joint under pressure. The second needle allows fluid to be drained out of the joint.
Will anything else be done at the same time?
While you are asleep your lower jaw will often be manipulated in an attempt to encourage the disc of cartilage back into its normal position.
This procedure is suitable if you have…
- Jaw joint pain that has not responded to simple treatments
- Limited mouth opening
- Difficulty eating