Temporomandibular Joint Disorders

young woman with a toothache

Up to 12% of Americans suffer from jaw joint and muscle problems.

The jaw joints and muscles are some of the most utilized in the body. When they are not working properly, it can lead to significant pain and difficulty eating or speaking.

Our providers are some of the most experienced in western North Carolina in treating children, teens, and adults with jaw joint and muscle problems. Our goal is to understand your unique needs and provide care based on the latest scientific evidence and proven surgical and nonsurgical techniques.

What causes jaw joint problems?

The jaw joints – also called the temporomandibular joints – are located on the right and left sides of the face in front of the ear. The temporomandibular joints are made up of the lower jaw and the base of the skull separated by a cartilage disc. This cartilage disc allows the jaw to rotate and slide against the base of the skull – letting us speak and chew normally. The joints are held together by the surrounding ligaments and muscles.

Trouble with the jaw joints and muscles typically begins with injury. This may be a direct injury to the joints, as occurs in a car accident, fall, or physical assault. More commonly, it is caused by small, repeated injuries to the joints that build over time, as occurs with clenching or grinding of the teeth. In rare cases, the joints are injured by the immune system mistakenly attacking the joint tissues, as occurs in rheumatoid or psoriatic arthritis.

When the damage caused by injury is greater than our bodies ability to heal or adapt – disease will result.

The temporomandibular joints

What are common symptoms of jaw joint problems?

  • Jaw joint pain
  • Joint clicking, popping, or grinding sounds
  • Restricted mouth opening
  • Jaw locking open or closed
  • Jaw muscle stiffness or soreness
  • Earaches or ringing in the ears
  • Headache or neck pain
  • Diet limited to soft foods
Temporomandibular Joint Disorders consultation

How are jaw joint and muscle problems treated?

Determining the source of your jaw joint and muscle symptoms requires careful evaluation. At your initial consultation our providers will get to know you, understand your concerns, and determine how to best achieve your goals for treatment. You should expect to discuss your medical history, any medications you take, and undergo a brief health review. Your provider will perform a physical exam and obtain any necessary x-rays. We take time to help you understand your condition, any necessary treatment, and answer any questions you may have.

We emphasize a team approach with patients with jaw joint and muscle problems. Our providers work closely with local physical therapists, dentists, physicians, chronic pain specialists, and psychiatrists to provide a treatment plan specific to your needs and ensure the best possible outcome.

Treatment of your jaw joint and muscle symptoms can take time. No single treatment will work for every patient. Our providers will strive to find the right treatment for your particular needs.

dental consultation

Nonsurgical Treatment

Around 70% of patients with jaw joint disease can be managed successfully without surgery. Nonsurgical therapies can help reduce symptoms, limit further joint damage, and improve diet and quality of life.

Treatments can include:

Self-care, including:

  • A soft diet. Avoid hard, chewing, sticky foods. No chewing gum, ice, or nuts.
  • Stress reduction and changes in behavior
  • Jaw muscle and neck stretches
  • Moist heat or cold packs to the jaw

Medications, including:

  • Anti-inflammatory pain medications
  • Muscle relaxants

Bite splint therapy

Bite splint therapy can greatly help patients who grind or clench their teeth. A small plastic mouth guard is custom-made to fit over your upper teeth at night. Bite splint therapy will help support the jaw, reduce stress on the joints, and protects your teeth from damage that occurs when grinding.

Physical therapy

Physical therapists can help improve neck posture, strengthen jaw muscles, and improve range of motion. Treatments may include manual therapy, jaw exercises, therapeutic ultrasound, dry needling, or low-level laser therapy.

Botulinum muscle injections (Botox®)

Botox® is a medication that when injected into the jaw muscles causes relaxation – helping reduce pain, muscle spasms, or tightness.

Surgical Treatment

A small number of patients may eventually require surgery. Most surgical treatments are minimally invasive and are completed in the office or at Mission Hospital under anesthesia.

Arthrocentesis and Arthroscopy

Arthrocentesis is a minimally invasive procedure to improve joint mobility and reduce inflammation. Two hypodermic needles are placed into the joint allowing for the joint to be washed. This helps remove inflammatory debris and any adhesions that limit normal movement of the joint. Arthroscopy uses a camera to be able to visualize conditions inside the joint after the joint is washed.

Arthrocentesis is usually considered in patients with a sudden, severe restriction in mouth opening or for degenerative inflammatory conditions of the joint that are not responding to nonsurgical therapies.

Intraoral vertical ramus osteotomy

Intraoral vertical ramus osteotomy is a procedure to help reposition the lower jaw into a more natural position within the joint. This creates additional space within the joint – improving movement of the meniscus and reducing joint pain and sounds.

Open Joint Surgery

Open joint surgery is rare and is typically reserved for patients with limited mouth opening, joint dislocation, or significant degeneration of the joint.