The temporomandibular joints (TMJ) connect the lower jaw, or mandible, to the temporal bones at the sides of the head. These joints are flexible, allowing the jaw to move smoothly up and down and side to side, and enabling us to talk, chew, and yawn. TMJ dysfunction involves face pain, clicking sounds in the TMJ, and limited movement of the jaw. About 33 percent of the population has TMJ dysfunction, and as many as 75 percent have some symptoms.

TMJ dysfunction is often accompanied by the following signs and symptoms.

• Pain, particularly in the chewing muscles and/or jaw joint
• Limited movement or locking of the jaw
• Radiating pain in the face, neck, or shoulders
• Painful clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth
• A sudden, major change in the way the upper and lower teeth fit together
• Also, sometimes headaches, earaches, dizziness, and hearing problems

The only definitive cause of TMJ dysfunction is a severe injury, such as a heavy blow, to the jaw or temporomandibular joint. Other possible causes include the following.

• A bad bite (malocclusion)
• Orthodontic treatment, such as braces and the use of headgear
• Jaw clicking, which is more likely the sign of a displaced disk
• Stress, which may cause or aggravate TMJ dysfunction. People with TMJ dysfunction often clench or grind their teeth at night, which can tire the jaw muscles and lead to pain.

The following risk factors are associated with TMJ dysfunction.

• Gender—women seek treatment two times more than men
• Age—people 30 to 50 years of age are most often affected
• Nutritional or metabolic disorders
• Grinding teeth, clenching jaw
• Malocclusion (bad bite)
• High stress levels

If you are experiencing symptoms associated with TMJ dysfunction, you should see your health care provider. He or she can help make a diagnosis and guide you in determining which treatment or combination of therapies will work best for you.

Your provider will check muscles in the area of the TMJ, look for asymmetry or inflammation in your face, listen for joint clicking or scraping sounds, test your mandibular range of motion, and look for evidence of jaw clenching or teeth grinding. If you're experiencing any neurological symptoms, such as numbness, your provider will give you a neurological examination. Imaging techniques may be used if there is evidence of degenerative disease or disk problems.

Reducing stress and keeping yourself from grinding your teeth or clenching your jaw may help prevent TMJ dysfunction or lessen the symptoms.

Some health care providers consider TMJ dysfunction a medical condition while others consider it a dental problem.

Your provider may prescribe the following medications.

• Analgesics—aspirin or nonsteroidal anti-inflammatory drugs
• Minor tranquilizers or muscle relaxants at bedtime to reduce spasms and pain
• Injections of a local anesthetic
• Antidepressants—for pain that persists
• Cortisone injections, in cases where no other treatment works

When all other measures have failed, surgery may be necessary.

A comprehensive treatment plan for TMJ dysfunction may include a range of complementary and alternative therapies.

The following nutritional tips may help prevent or reduce symptoms of TMJ dysfunction.

• Eat soft foods high in flavonoids to provide antioxidants to decrease joint pain.
• Avoid saturated fats, fried foods, and caffeine, all of which increase inflammation.
• Avoid chewing gum.

Potentially beneficial nutrient supplements include the following.

• Essential fatty acids (omega-3 and omega-6) to decrease inflammation

• St. John's wort (Hypericum perforatum) may improve serotonin levels affected in TMJ dysfunction. Oil may be applied to the skin over the joint. Oral dose is 250 mg three times a day.
• Cramp bark (Viburnum opulus) and lobelia (Lobelia inflata) are antispasmodic. Rub 5 drops tincture of each herb into joint. Do not apply to broken skin.

An experienced homeopath could prescribe a regimen for treating TMJ dysfunction that is designed especially for you. Some of the most common acute remedies are listed below.

• Causticum for burning pains
• Hypericum perforatum for sharp shooting pains
• Ignatia for tension in the jaw
• Kalmia for face pain especially with other joint pains or arthritis
• Magnesia phosphorica for muscle cramps
• Rhus toxicodendron for pains that feel better in the morning and in dry weather, and worse after movement or in wet weather
• Ruta graveolens for pains from overuse or injury

Acute dose is three to five pellets of 12X to 30C every one to four hours until symptoms are relieved.

Contrast hydrotherapy—alternating hot- and cold-water applications—may decrease inflammation, provide pain relief, and enhance healing. Use hot packs and ice wrapped in a washcloth and apply to area. Alternate three minutes hot with one minute cold and repeat three times for one set. Do two to five sets per day.

Very good evidence exists for acupuncture as an alternative treatment for TMJ dysfunction. A number of well-designed trials found that acupuncture can help provide long-term pain relief for this condition. In treating TMJ dysfunction, acupuncturists often find a deficiency of qi in the liver meridian and a relative excess in the gallbladder meridian. In addition to the primary treatment on the liver and the supporting kidney meridians, moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) may also be used to enhance the needling therapy.

No well-designed studies have evaluated the effect of chiropractic on individuals with TMJ dysfunction, but chiropractors report that manipulation of the TMJ and adjacent areas in the upper spine may improve symptoms of the condition in some individuals. It is believed, in these cases, that manipulation restores movement to the TMJ.

Certain types of massage techniques and chiropractic manipulation may help decrease muscle spasms, provide pain relief, and prevent recurrence of symptoms.

TMJ dysfunction is treated successfully in 75 percent of patients who follow a multifaceted treatment plan. In rare cases, prolonged teeth clenching or grinding, trauma, infection, or connective tissue disease may result in degenerative joint disease or arthritis. If you experience severe grinding, you may benefit from nighttime use of a bite guard worn inside your mouth.

You may need to see your provider regularly to ensure the prescribed therapies are working for you.

Challem J. TMJ pain may be aggravated by free radicals, relieved partly by anti-oxidants. The Nutr Reporter. 1998.

Chinappi AS Jr, Getzoff H. The dental-chiropractic cotreatment of structural disorders of the jaw and temporomandibular joint dysfunction. J Manipulative Physiol Ther. 1995;18(7):476-481.

Crider AB, Glaros AG. A meta-analysis of EMG biofeedback treatment of temporomandibular disorders. J of Orofacial Pain. 1999;13(1):29-37.

Dambro MR. Griffith's 5-Minute Clinical Consult. 1999 ed. Baltimore, Md: Lippincott Williams & Wilkins, Inc.; 1999.

Ernberg M, Hedenberg-Magnusson B, et al. Pai, allodynia and serum serotonin level in orofacial pain of muscular origin. J Orofacial Pain. 1999; Winter 13(1):56-62.

Ernst E. Acupuncture as a treatment for temporomandibular joint dysfunction. Arch Otolaryngol Head Neck Surg. 1999;125:269-272.

Goroll A, ed. Primary Care Medicine. 3rd ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1995.

Jagger RG, Bates JF, Kopp S. Temporomandibular Joint Dysfunction. Oxford, England: Wright; 1994.

Johansson A, Wenneberg B, Wagersten C, Haraldson T. Acupuncture in treatment of facial muscular pain. Acta Odontol Scand. 1991;49:153-158.

Koopman WJ, ed. Arthritis and Allied Conditions. 13th ed. Baltimore, Md: Williams & Wilkins, Inc.; 1997.

List T, Helkimo M. Acupuncture and occlusal splint therapy in the treatment of craniomandibular disorders. Acta Odontol Scand. 1992;50:375-385.

List T, Helkimo M. Andersson S, Carlsson GE. Acupuncture and occlusal splint therapy in the treatment of craniomandibular disorders. Swed Dent J. 1992;16:125-141.

List T, Helkimo M, Karlsson R. Pressure pain thresholds in patients with craniomandibular disorders before and after treatment with acupuncture and occlusal splint therapy: a controlled clinical study. J Orofac Pain. 1993;7:275-282.

Marbach JJ. Temporomandibular Pain and Dysfunction Syndrome. Rheum Dis Clin North Am. 1996;22(3).

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:111-114, 185-186, 187-189, 208-209, 237, 324-325, 329-330.

Roberts J, Hedges J, ed. Clinical Procedures in Emergency Medicine. 3rd ed. Philadelphia, Pa: W.B. Saunders; 1998.

Rosen P, ed. Emergency Medicine: Concepts and Clinical Management. 4th ed. St. Louis, Mo: Mosby-Year Book; 1998.

Rosted R. Practical recommendations for the use of acupuncture in the treatment of temporomandibular disorders based on the outcome of published controlled studies. Oral Dis. 2000;7:109-115.