• Reference Number: HEY-134/2023
• Departments: Oral Surgery, Dentistry and Max Fax
• Last Updated: 31 July 2023

Introduction

This leaflet has been produced to give you general information about your condition.  Most of your questions should have been answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What are Jaw Joint Problems?

The jaw joint (temporo-mandibular joint or TMJ) 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 most common symptoms are:

• 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.
• Headache – if the ache radiates upwards to the temple.
• Limited mouth opening – usually as a result of muscle spasm but sometimes occurs as locking, requiring manipulation of the jaw to allow free movement.
• Some patients experience a feeling of numbness of the skin of the cheek.

Most symptoms are made worse by chewing and are aggravated at times of stress, speaking or by cold weather.

For many patients the cause is overloading of the joint, which commonly produces pain, tightening of the muscles and clicking of the disc within the joint. This may occur of a result of habits, such as grinding or clenching the teeth at night, stress or chronic pain. Nail biting or holding things between the teeth can also cause these problems. Less commonly missing back teeth, and uneven bite, or an injury to the jaw can lead to the problem. Often no obvious cause is found.

Why do I need treatment?

It is important to realise that jaw joint problems, although a nuisance, are common and usually respond to relatively simple measures over a period of time. Patients themselves can manage most of these treatments, supported by their dentist. Occasionally problems may return after several years. It is very rare to progress to arthritis.

How do I prepare for the treatment?

Treatments vary depending on whether you are suffering from myofacial pain dysfunction, internal derangement of the joint or a combination of both.  On the whole treatment is aimed at trying to reduce the workload of the muscles, or to allow the disc of cartilage to move freely inside the joint.

A soft diet that requires little chewing – this allows over-worked muscles to rest.

Pain relief medication – anti-inflammatory medication (e.g. Ibuprofen) is good and can be taken as either tablets or applied as a gel on the outside of the joint.

• Heat – e.g. warm water in a hot water bottle (avoid boiling water) wrapped in a towel applied to the side of the face (no more than 20 minutes).
• Identifying and stopping any habits, such as clenching or grinding. Talking a lot or chewing gum.

Remember that these may be “subconscious”, i.e. you may not be aware of them. Your teeth should not be together if you are not chewing food.

• Relaxation therapy and learning techniques to control tension and stress.
• Jaw joint exercises – exercises that may be helpful may have been discussed by the doctor seeing you.
• Resting the joint as much as possible – e.g. avoiding opening the mouth wide when yawning.
• Provision of a clear plastic splint that fits over the teeth and is worn usually all the time except meal-times. This helps prevent over-loading the joint and surrounding muscles. This is normally provided by your own dentist.
• Physiotherapy
• Replacing missing teeth to balance the bite or replacing worn dentures – if this is appropriate it will have been discussed with you.

What will happen?

Jaw joint problems are usually not serious and do not lead onto other problems e.g. arthritis of the jaw joint. They are however a nuisance. Fortunately jaw joint problems usually respond to simple treatments.

Pain is caused by the muscles tightening up, or through inflammation within the joint.

Joint noise occurs if the disc of cartilage sticks or 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 between the bones of the jaw joint. A painless click is usually nothing to worry about and usually doesn’t warrant intervention.

Locking occurs if the disc gets in the way when the jaw moves, or occasionally if there are some loose bodies of cartilage inside the joint.

What happens afterwards?

Surgery is only required in a small number of cases. This can involve merely washing out of the joint under local anaesthetic with sedation, or surgery carried out with a mini telescope. As a last resort it may be necessary to open the joint and operate on the bones, cartilage and ligaments.

Should you require further advice, please do not hesitate to contact the Maxillofacial Department (01482) 463218

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.