Patients most often seek treatment for TMJ related disorders during the second and third decade of life, (average age of 33.8 years), with females accounting for 85% of those seeking treatment. Females with TMD pain seek care more often than males at all ages but the probability for someone seeking care for TMD correlates more strongly with an increase in the frequency and intensity of facial pain, regardless of age or sex.

While the history and examination protocol is essentially the same for all age groups, the treatment recommendations vary depending upon the patient's age as well as the duration of the signs and symptoms. In the younger age group the opportunity to intervene and prevent progression may be a key factor in recommending treatment. For older individuals the treatment focus may shift to creating homeostasis and stabilization of the condition rather than resolution.

            

Select Your Age Range

Under Age of 20 Years

TMD pain and dysfunction in children increases with age in both boys and girls, with females accounting for 89% of those seeking treatment. Trauma as an etiology is more common under the age of twenty. Motor vehicle collisions (55.1%), assault (14.5%), and falls (8.6%) were the most common mechanisms for facial injury in all pediatric age groups. Falls were the most common mechanism (23.4%) among infants and toddlers (0-4 years). Bicycle-related collisions and pedestrians struck by motor vehicles were the most common mechanism for school-aged children (5-14 years). For older teenagers (15-18 years), the most common mechanism was a fight or an assault (21. 7%). The male sex predominated through all age groups and for all types of injuries.

Removal of wisdom teeth occurs most often in the late teens, and there is evidence that there is increased risk for developing TMJ dysfunction in those who have recently had their wisdom teeth extracted. No association has been found between orthodontic therapy and the onset of TMJ disorders when symptoms frequency of orthodontically-treated patients is compared to patients of the same age that have not undergone orthodontic therapy. read more

Fingernail biting is a surprisingly common habit, with nail-biting acknowledged by 28% of students aged 15 to 19 years. While fingernail biting is not likely to trigger a TMJ-related problem, it can certainly aggravate the condition.

Tooth abrasion caused by tooth grinding or bruxism may be a contributing factor to jaw joint and muscle pain. Bruxism can also occur in association with medications used for mood and anxiety disorders, attention-deficit/hyperactivity disorder and in those with pervasive developmental disorders an autism spectrum disorder. While dentists will often advise patients that there is no need for an intraoral appliance or nightguard when only the primary teeth are present, an appliance may be indicated if the child is also experiencing jaw pain or dysfunction.

Between Ages of 20 - 60 Years

Most patients who seek treatment for TMJ pain and dysfunction are in this age range of 20 to 60 years. There are a variety of causes for jaw problems with one of those being life stressors, which peak in the second and third decade related to relationships, raising children, career patients and financial obligations. Parafunctional clenching and grinding of the teeth, known as bruxism, is a contributing factor for many patients, and this activity is more pronounced if the patient has poor quality of sleep.

Cyclic hormonal variations in women, including during pregnancy, contribute to the onset of jaw dysfunction and pain, which help explain the predominance of young women in a TMJ population.

Over Age of 60 Years

One explanation for why few older people seek treatment for TMJ disorders is that they have developed better coping skills as part of their life experience. The loss of teeth associated with aging is more often a contributing factor in those over the age of 60 years than it is in younger individuals. Sleep patterns change as we age and there appears to be less frequent tooth grinding in older individuals.

Nearly all of our joints eventually are affected by age-related wear and tear and as is true of our hips and knees, the TMJ also undergoes degenerative joint disease in the elderly. However, while the treatment-seeking behavior goes up after the age of 50 years, treatment seeking fo TMJ related problems goes down after the age of 50 years.

Treatments for TMJ disorders can be divided into 6 general treatment types:

1. Physical medicine treatments

2. Intraoral orthopedic appliances

3. Pharmacological therapy

4. Behavioral and psychological therapy

5. Temporomandibular joint surgery and arthrocentesis

6. Dental occlusal treatments

The goal in managing a TMJ disorders is to identify the cause of the problem and then engage in those treatments that address the underlying causes, as well as manage the signs and symptoms. In making the decision to undergo treatment, the patient should ask if a specific treatment will most effectively reduce TMJ pain and dysfunction as compared to other options or as compared to no treatment at all? Will the treatment provide only symptomatic relief, resulting in future recurrences and need for additional therapy? Paralleling treatments may be needed to resolve muscle, joint, and dental occlusal involvement. Not all signs and symptoms can be resolved, but they can be managed. Understanding the following categorizations of signs and symptoms will facilitate the patient in self-management of their problem,which may be as important as the care they may receive from a provider.

The material in the TMJ Anatomy section and the pamphlets in the Education Materials section in the Patient Resources section of this website provide additional information.

Select the Symptoms You Are Experiencing

TMJ Pain, Facial Pain, Headaches

Words ending in "algia" indicate specific kinds and locations of pain, as in arthralgia (joint pain), cephalgia (headache), myalgia (muscle pain), otalgia (ear pain), cervicalgia (neck pain), fibromyalgia, neuralgia, etc. Given the anatomic location of the temporomandibular joints in the middle of the head and adjacent to the ears, it is not surprising that many TMJ-disorder patients seek treatment for ear problems and headaches, not realizing that their jaw dysfunction may be contributing to these symptoms. The same is true for neck pain, in that the neck (cervical) muscles and the jaw (masticatory) muscles are both involved in positioning the head and maintaining balance and equilibrium. In addition to this overlapping anatomy, two small muscles within the ear have a shared innervation with the trigeminal nerve, the source of innervation to the muscles of mastication and the teeth. Ringing in the ears (tinnitus) and the experience of fullness of the ears will frequently improve in patients being treated for TMJ disorders.

TMJ Sounds

Sounds associated with temporomandibular joint movement are not normal, but they are common. In adults, 30-40% of the population experience TMJ sounds. One needs to be familiar with the anatomy of the temporomandibular joints, the role of ligaments and joint capsular tissue and the activity of the muscles before the mechanical TMJ dysfunction that creates the joint sounds can be understood. A very complete explanation is available in the TMJ Anatomy section in the Patient Resources section of this website.

The mere presence of TMJ sounds does not necessarily indicate that there is a need for treatment. However, any treatment of a TMJ disorder should take into account the nature of the joint sounds, the etiology or cause of the joint sounds, and the likelihood that the mechanism producing the sounds will progress to catching or locking of the jaw joint. A recent change in joint sounds can be a barometer of instability in the joints or in the supporting dental occlusion. When TMJ sounds have been present, but abruptly stop, this is not necessarily a favorable change. It may indicate that the fibrous articular disc in the TMJ has become more deformed or displaced. A change from clicking and popping to a grinding or gravely sound also usually indicates a progression of the condition. Grinding or gravely sounds from the TMJ in a young person is uncommon and should create concern, whereas the same sounds over the age of 70 years are common and not usually accompanied by pain. read more

Imaging, such as a panoramic view, a CT (CBCT) scan, or an MRI can provide definitive information regarding joint sounds. However, if after completing a thorough history and examination of the masticatory system, the nature of the joint sound is understood and the contributing factors can be identified, then it is usually not indicated to obtain sophisticated imaging such as CT (CBCT) or MRI. If a TMJ surgical procedure is being considered, then almost without exception, a CT (CBCT) or MRI is indicated.

Limitation of Jaw Use

While it is very straight forward to measure the mouth opening (range of motion) and to categorize it as limited, normal, or excessive, it is not always easy to identify the cause of an abnormal range of motion. The range of mouth opening is related to body stature and thus children open less wide than adults and in general, men open wider than women. In adults the normal range is 40 mm - 50 mm, which is usually equivalent to the width of the middle three fingers placed vertically between the incisal edges.

Arthrokenetics means the motion of a joint, and not only the degree of opening but also the ability to move the lower jaw side to side and forward. These other movements are also important and can provide further information about the ability of the jaw to move "within normal limits". Any deviations, deflections, or pain while making these jaw movements can be important diagnostic clues as to the function of the jaw joints.

Excessive mouth opening or hypermobility (greater than 55 mm) can be related to repetitive overuse activities, such as singing. However a more common cause is systemic ligament laxity, a connective tissue disorder. Patients who have this genetic condition typically report that they are "double jointed" and often have a history of problems with other joints. They often excel at dance or gymnastics because of their increased flexibility, but unfortunately they are more prone to joint injuries from these activities, as well as from contact sports. If you can bend your thumb to your wrist without pain or you  can bend your fingers backward nearly 90 degrees, and are having a lot of different joint involvement, you may want to discuss systemic ligament laxity with your physician. A patient with TMJ clicking related to ligament laxity needs to focus on controlling the degree of mouth opening, such as with yawning or when eating foods that require wide opening (apples, large sandwiches, etc.). There may be other contributing factors such as bruxism, but the dental occlusion seldom contributes to TMJ hypermobility dysfunction.