What are the Signs and Symptoms of Temporomandibular Disorders (TMDs)?

 Welcome to my fourth post in an ongoing series on temporomandibular disorders (TMDs). To read the previous posts, click the titles below.

1. Temporomandibular Joint Anatomy and Function

2. Epidemiology of Temporomandibular Disorders

3. Etiology (Causes) of Temporomandibular Disorders (TMDs)
   

Today’s focus is on the signs and symptoms of temporomandibular disorders.

What are the Signs and Symptoms of Temporomandibular Disorders (TMDs)?

TMD is not a specific diagnosis. It is an umbrella term for various conditions affecting the jaws, muscles, and associated structures. (I’ll discuss the different disorders collectively known as TMDs in a subsequent post.)

Patients diagnosed with a temporomandibular disorder may experience some of the following signs and symptoms:

1.     Pain involving one or both joints:

Pain is perceived in front of the ear (at the site of the TMJ) or inside the ear on the affected side. The pain is typically exacerbated by jaw activity such as talking, chewing, eating, yawning, swallowing, or opening the mouth wide. The pain may impact the quality of life by making these everyday activities challenging to perform.

2.     Muscle pain, stiffness, tiredness, or pressure

involving the muscles of mastication (chewing muscles) or even the neck and shoulder muscles. These symptoms are also exacerbated by jaw movements involved with talking, yawing, chewing, and opening wide. Patients with overuse habits who clench or grind their teeth at night may experience tension and stiffness of the facial muscles and jaw on awakening.

3.     Limited mouth opening, which may be secondary to:

• Muscle dysfunction. Patients may subconsciously guard against opening their mouths due to muscle pain, stiffness, or weakness. This protective mechanism aims to avoid exacerbating the discomfort or pain associated with muscle dysfunction.

• Dysfunction within the temporomandibular joint (TMJ) itself. This may include inflammation or structural problems within the joint resulting from disc displacement without reduction (closed lock), degenerative joint disease (arthritis), or adhesions. These conditions, if present, can restrict the range of motion of the TMJ.

4.     Joint sounds: clicking, popping, cracking, or grinding sounds.

• Clicking or popping sounds associated with TMJ articular disc displacement with reduction.

Each TMJ has a disc that separates the bones of the joint (the condyle and articular eminence) and prevents them from rubbing against each other during function. Displacement of this disc can occur due to various factors, such as trauma, excessive jaw movement, or structural abnormalities.

 In people with TMJ articular dis displacement with reduction, the disc is displaced in a closed mouth position.

When the mouth is fully opened, clicking, popping, or snapping sounds occur as the condyle gets past the posterior aspect of the displaced disc, and the disc returns to its normal position between the condyle and articular eminence of the TMJs. A second pop or click, known as a reciprocal click, may occur just before the open jaw returns to a fully closed position. As mentioned, this condition is known as disc displacement with reduction.

Clicking or popping sounds in the TMJs do not always indicate the presence of significant joint dysfunction. These sounds may often be benign and not associated with pain or other symptoms.

Image depicting a combination of anterior disc displacement and degenrative changes of the TMJ

• Grinding or cracking sounds occur secondary to degenerative or arthritic changes of the bones within the TMJs that lead to alterations in the joint structures. These changes can result in irregular movement of the joint components, leading to cracking or grinding sounds.

5.     Jaw locking closed or open.

• Closed lock refers to limited mouth opening secondary to TMJ articular disc displacement without reduction or protective guarding of the muscles of mastication due to pain.
  

• Open locks occur when the articular disc and condyle become positioned anterior to the articular eminence of the temporal bone when the mouth is open. When this occurs, the jaw gets stuck wide open and cannot return to a closed position without a maneuver by the patient or the help of a clinician. The duration of the open lock may be momentary or prolonged.

6.     Deviation or deflection of the jaw on opening or closing

• Deviation is the shifting of the jaw midline during opening, which disappears with the full opening of the mouth. It is usually associated with disc displacement with reduction and coincides with the click that occurs when the condyle gets past the displaced disc during mouth opening.
  

• Deflection is a shift of the midline to one side that does not disappear but becomes greater with full mouth opening. It can occur due to lateral pterygoid muscle spasms or structural restrictions within the joint from disc displacement without reduction or adhesions.

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7.     Bite changes:

Noticeable changes in how the upper and lower teeth fit together, with teeth not meshing together, leading to an uneven bite. This can occur secondary to inflammation and effusion within the joint, arthritic changes that alter the joint structure, or as a consequence of spasms of the muscles of mastication, typically the lateral pterygoids.

8. Recurrent headaches:

Tension headaches, migraines, or pain around the temples or forehead.

• Myofascial trigger points, which are hyperirritable spots in the muscles of the face, neck, and shoulders, can refer pain to the head, resulting in headaches.

• In patients with a history of migraine headaches, this can trigger migraines. Chronic TMD symptoms can also make the nervous system become hypersensitive to pain signals. This phenomenon, known as central sensitization, lowers the threshold for migraine triggers and increases the severity of migraine attacks.

• TMD symptoms can also disrupt the quality and quantity of sleep, leading to tension headaches upon waking or throughout the day.

Headaches are typically worsened with jaw movement and function and feel better when the jaw is rested.

9.     Ear symptoms:

The anatomical location of the temporomandibular joint (TMJ) is closely related to the ear. The TMJ and the ears also share a common nerve supply - the auriculotemporal nerve. Therefore, dysfunction of the joint and or masticatory system can sometimes lead to otalgia (ear pain), tinnitus (ringing), vertigo, and sensation of ear fullness.

10.  Toothaches

Heightened sensitivity or pain in the teeth can occur secondary to clenching or grinding habits or as a result of trigger points in masticatory (chewing) muscles that refer pain to teeth. To read more on toothaches of muscular origin, click HERE to be directed to an earlier post I wrote on this topic.

 Conclusion

It's important to note that not all individuals with TMD experience the same symptoms. These symptoms can vary in severity and may come and go over time.

If you're experiencing moderate to severe TMD symptoms and reside in the Philadelphia, PA, metropolitan region, you can contact me for a comprehensive evaluation and management plan that will be based on your specific diagnosis, signs, and symptoms.

Join me next time as I discuss the different conditions classified as TMDs (Temporomandibular Disorders).

Until next time…

Dr. Chizobam Idahosa

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© What are the Signs and Symptoms of Temporomandibular Disorders (TMDs)?

Dr. Chizobam Idahosa.

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