Temporomandibular joint (TMJ) syndrome is a disorder involving the two joints (one on each side) that attach the lower jaw to the skull. These two joints open and close the mouth, and are located directly in front of each of the ears. In TMJ syndrome, the area around the temporomandibular joints becomes chronically tender and inflamed. Symptoms include the following:
- Pain in the temporomandibular joint
- Popping, clicking, or grating in the temporomandibular joint while eating and/or drinking
- A sensation of the jaw “catching” or “locking” briefly, while attempting to open or close the mouth, or while chewing
- Difficulty opening the mouth completely
- Pain in the jaw
- Facial pain
- Muscle pain and/or spasm in the area of the temporomandibular joint
- Ear pain
- Neck and/or shoulder pain
TMJ syndrome often occurs in people who have had accidents or injuries involving their jaw, but many others have had no such incident. It is believed that grinding the teeth or clenching the jaw in response to stress may trigger the condition in many cases. Other possible causes include arthritis of the temporomandibular joint, facial bone defects, and misalignments of the jaw or of the bite.
The underlying cause of TMJ syndrome is not known. In most cases, the joint appears to be healthy, suggesting that it is the soft tissue around the joint rather than the joint itself that has the problem. However, some cases of TMJ syndrome may be caused by TMJ arthritis, TMJ dislocation, or other forms of true joint injury.
Treatment of TMJ includes stress management, avoidance of certain foods that trigger discomfort (such as gum or beef jerky), and anti-inflammatory medications. The older antidepressant drug amitriptyline, taken in low doses,
as well as the muscle relaxant cyclobenzaprine
may help as well.
According to a few controlled trials, some people with more severe forms of TMJ may benefit from the use of a dental appliance.
Finally, on rare occasions, surgery may be necessary.
Proposed Natural Treatments
, taken alone or in combination with
, has shown considerable promise for the treatment of
. Because osteoarthritis of the temporomandibular joint can play a role in some cases of TMJ syndrome, researchers have begun to investigate the potential role of these supplements in treating the condition. Promising results were seen in a
that compared glucosamine to ibuprofen in the treatment of 45 people with TMJ arthritis.
Over the 3-month study period, the supplement proved equal in effectiveness to the drug. However, because this study lacked a placebo group, it cannot be taken as fully reliable. Another double-blind study, this one involving glucosamine without chondroitin, did have a placebo group, but too many participants dropped out to allow meaningful conclusions to be drawn.
EMG biofeedback is a form of
therapy that involves teaching a person to gain conscious control of muscle tension. A meta-analysis (formal statistical review) of published studies suggests that EMG biofeedback might be helpful for TMJ pain.
However, the reviewers noted that the evidence is as yet incomplete, and more (and better quality) research is needed.
A small randomized trial involving 39 women with TMJ found hypnosis to be more effective in reducing pain than relaxation.
Similarly, while preliminary controlled trials suggest that
may be helpful for TMJ syndrome, more research is needed.
10, 12, 14
A preliminary study compared
Traditional Chinese Medicine
(TCM incorporates acupuncture among other treatments) and
(NM) against care given by clinic staffed by TMJ specialists. Researchers found that both TCM and NM provided greater benefit among 128 women.
Although subjects were randomized into the different groups, there was no blinding and practitioners were permitted to treat each subject in any way they saw fit.
A cream made from
and other hot peppers (capsaicin cream) has shown promise for a variety of painful conditions. However, one study failed to find capsaicin cream more effective than placebo cream for TMJ syndrome.
Other treatments sometimes recommended for TMJ, but that lack reliable scientific support, include