Temporomandibular Disorder (TMD)

Medically Reviewed by Greg Grillo, D.D.S.

Are you suffering from chronic jaw pain, clicking, or discomfort? These may be symptoms of temporomandibular disorder (TMD).

TMD is a chronic condition affecting the temporomandibular joints, jaw muscles, and nerves. Patients sometimes refer to these conditions as “TMJ,” but that term refers to the temporomandibular joint itself. The chronic nature of the condition and symptoms often leads to diagnosis of TMD because sufferers are forced to seek professional care. Once a diagnosis is confirmed, TMD treatment options may be discussed.

The temporomandibular joint (TMJ), commonly recognized as one of the most complex joints in the body, is integral to jaw movement and functionality. There are a variety of muscles, ligaments, and bones working together in TMJ functionality. Essentially a disc fitted between a ball and a socket, the TMJ cushions against the force generated by jaw movement on both sides of the skull. When this functionality is disturbed, TMD is a likely outcome. Grinding or clenching of the teeth, known as bruxism, is one of the most common causes of TMD problems.

Common Symptoms of TMD

Jaw pain usually drives patients to seek professional care. This jaw pain is often more pronounced early and late in the day. Although other symptoms may occur prior to the onset of pain, they are typically less intense and/or noticeable than the jaw pain – often described as a chronic dull aching of one or both sides of the face. Although TMD symptoms affects the joint itself, it may radiate to other areas such as the ears, neck, and shoulders.

Although pain is the most common TMD symptom, it is not always experienced. Some of the other common TMD symptoms include:

  • Jaw popping or clicking (when opening/closing your mouth)
  • Facial swelling
  • Bite changes/irregularities (malocclusion)
  • Tooth sensitivity
  • Headaches (tension headaches or early morning headaches)
  • Earache

If you experience one or more of these symptoms over an extended period, you should seek medical assistance to determine whether you may be suffering from TMD.

Diagnosing TMJ Disorder

In most cases, your dentist can diagnose and treat TMJ disorder. Diagnosing TMD prior to treatment is essential, even though currently there is no universal standard test to identify all TMD conditions.

The diagnosis of TMJ disorder begins with a comprehensive oral health examination consisting of an assessment of joint and muscle tenderness, clicking and popping, and ease of movement. Your dentist also may perform a “clench test” in order to understand the nature of your pain. X-rays and impressions of your upper and lower teeth also are taken so that cast models can be made to study the jaw-to-bite relationship and the position/condition of your temporomandibular joint.

Your dentist can measure forces on the teeth, proper balance of the bite and timing of the bite using a specialized computer bite analysis test (T-scan). This test can help to determine if a structural disorder exists within the joint itself, or if interferences in the bite are affecting the joint’s ability to close properly.

Diagnosing TMD

In most cases, your dentist can diagnose and treat TMD. Diagnosing TMD prior to treatment is essential, even though currently there is no universal standard test to identify all TMD conditions. In fact, there are at least twenty different subcategories of TMD depending on the symptoms and clinical findings.

The diagnosis of TMD begins with a thorough history and a comprehensive oral health examination. The exams involves an assessment of joint and muscle tenderness, clicking and popping, and ease of movement. Your dentist also may perform a “clench test” in order to understand the nature of your pain. X-rays and impressions of your upper and lower teeth also are taken so that cast models can be made to study the jaw-to-bite relationship and the position/condition of your temporomandibular joint.

Your dentist can measure forces on the teeth, proper balance of the bite and timing of the bite using a specialized computer bite analysis test (T-scan). This test can help to determine if a structural disorder exists within the joint itself or if interferences in the bite are affecting the joint’s ability to close properly.

TMJ Treatments

There are a wide variety of TMD treatments available to help manage the pain and discomfort associated with the chronic condition. Obtaining a TMD diagnosis with your dentist is the first step towards developing a TMD treatment plan designed to restore normal jaw functionality.

Jaw-to-bite relationship is fully evaluated to determine the extent of your TMD, after which a treatment plan can be created. Regardless of your specific temporomandibular issue, a conservative approach to treatment will be advised. Many TMD treatments are simple in nature and can be performed at home. TMD surgery is an extreme option that should only be considered once all other options have been evaluated in full.

  • Traditional TMD Treatments: Traditional TMD treatments revolve around bite correction. This can be performed through basic orthodontics (dental braces, retainers), tooth restorations (bridgesveneersimplants, and dentures), occlusal equilibration, or appliance therapy. Regardless of your specific treatment modality, it’s important to maintain regular dental visits so that progress and overall oral health can be fully evaluated.
  • Alternative TMD Treatments: Beyond the traditional treatments used to combat TMD, there are some alternative treatment options available for consideration. Alternative TMD treatment modalities may include things like transcutaneous electrical stimulation, ultrasound, trigger-point injections, radio wave therapy, and even Botox injections. Botox TMD treatment is particularly interesting because it is routinely associated with cosmetics. Botox is injected into the jaw muscle, essentially blocking nerve signals associated with pain, discomfort, and other TMD symptoms.

What’s the Cost of TMD Treatment?

TMJ treatment costs are difficult to approximate because of the many factors and the wide range of disorders involved. For example, the cost of TMD treatment can be impacted based on the type of medical professional providing treatment (dentist, primary care physician, chiropractor, etc.), and the number of professionals involved. If your dentist is the primary treatment provider, but a chiropractor and ear nose and throat specialist are consulted, treatment will cost more than if the dentist performed treatment alone. Your first evaluation should be with a dentist since the TMJ, muscles, and chewing system is their area of expertise.

The cost of treating TMD also can be affected based on whether or not you have dental insurance coverage, or whether an occlusal appliance is prescribed. An occlusal device could cost between $400 and $700 as part of treatment. Similarly, if Botox is involved as part of your treatment plan, your costs will be greater; but even Botox costs will vary. If braces are recommended as part of your TMD treatment, the cost could be significant. Consult with your dentist to determine the most appropriate treatment considerations for your circumstances.