Temporomandibular Joint Disorders (TMD)

What is the temporomandibular joint?

The temporomandibular joint (TMJ) is located at the spot where the lower jaw meets the base of the skull. The muscles and ligaments surrounding the joint work together to allow it to move. The health of those surrounding muscles and ligaments—and the health and position of your child’s teeth—all contribute to the proper alignment and functioning of the TMJ. 

TMD can arise because of over-exertion of your child’s TMJ. Some examples of conditions that can cause this over-exertion are high levels of stress or anxiety, grinding or clenching of the teeth, or trauma to the jaw. 

This is a common problem, and it can often be treated at home. More severe cases of TMD may require physical therapy, dental treatments or surgery. 

Who develops TMD?

Children and adolescents are more likely to develop TMD as a result of stress or trauma to the jaw. In younger children, congenital jaw deformities can lead to TMD.

Causes 

TMD can be caused by several factors:

• teeth clenching or grinding
• stress or anxiety
• trauma to the jaw or the joint
• muscle spasms
• misalignment of the jaw (malocclusion)
• arthritis

Signs and symptoms 

If your child has any of the following symptoms, you may want to check with a doctor: 

• Difficulty opening the mouth
• Difficulty closing the mouth
• Jaw pain
• Jaw fatigue
• Ear aches or ringing in the ear
• Unexplained headaches
• Popping or clicking of the joint, along with pain
• Locking of the jaw
• Asymmetrical jaw opening
• Uneven vertical or lateral movements of the jaw
• Pain when touching the TMJ
• Swelling around the TMJ
• Jaw asymmetry or malocclusion

What sort of treatment will my child need?

Treatment depends on the severity of your child’s condition. It ranges from range-of-motion jaw exercises and medications to physical therapy, joint injections and/or surgery. 

Long-term outlook

If your child’s symptoms are mild, home care and anti-inflammatory medications can help. If the condition is more severe, physical therapy, dental treatments or joint surgery may be needed.

Tests

While there is no standard test to identify TMD, your child’s symptoms and a physical exam will be adequate for diagnosis. 

The physical examination includes:

• Feeling your child's jaw joints and surrounding muscles for discomfort
• Listening for clicking, popping or grinding sounds
• Examining your child’s jaw movement
• Examining your child’s mouth and teeth 

The doctor will also review your child’s dental and medical history before making a diagnosis and starting treatment. If more information is needed, your child’s doctor may order any of the following tests: 

• Panoramic X-ray: this X-ray uses small doses of radiation to produce an image of your child’s mouth, teeth and jaws
• MRI (magnetic resonance imaging): a radiographic exam that uses a large magnet, radio waves and a computer to produce two- and three-dimensional images of your child's jaw, muscles and mouth
• CT scan (computed tomography): a radiographic exam that uses X-ray equipment and powerful computers to create detailed, cross-sectional images of your jaw and mouth. 

After we complete all necessary tests, Boston Children’s experts from Oral and Maxillofacial Surgery, Dentistry or Otolaryngology (ear, nose and throat) will review the results and decide on the best course of treatment for your child.

At Boston Children's, we consider you and your child integral parts of the care team. You and your care team—which can include pediatric dentists, otolaryngologists (ear, nose and throat doctors) and oral surgeons—will work together to customize a plan of care for your child. 

What makes Boston Children's different?

Physicians and researchers in Children's Oral and Maxillofacial Surgery Program combine a tradition of surgical excellence with innovative research. Our multidisciplinary team works in conjunction with dentists and physical therapists to treat children with TMD. 

How is TMD treated?

There is a range of options for how your child's doctor may choose to treat his TMD based on how severe his symptoms are. For many children, self care will be enough to manage TMD; for others, physical therapy, dental treatments and joint surgery may be needed. 

Self-care

Many minor TMJ problems can often be cared for at home with no other treatment needed. Here are some tips that may reduce the discomfort from TMD: 

• Have your child rest the jaw joint when it becomes tender.
• Avoid hard or chewy food that can strain muscles of the face.
• Use moist heat to help relax muscles of the face.
• Teach your child to perform range-of-motion jaw exercises.
• Monitor your child's stress and anxiety levels.
• Ask your child's dentist to evaluate him for grinding or clenching of teeth. 

Medications

Your child's surgeon may prescribe anti-inflammatory medications and/or muscle relaxants to help alleviate jaw pain and encourage easier jaw movement. 

Physical therapy

If home care isn't enough, a physical therapist can help your child with stretching and strengthening,. There are a variety of possible treatments, including: 

• Jaw exercises
• Posture training
• Electrical stimulation: low-level electrical currents can help relax your child's jaw joint and facial muscles
• Ultrasound: deep heat can be applied to a sore or immobile joint
• Biofeedback: a type of relaxation therapy that uses electronic instruments to give your child immediate feedback about what effect the relaxation exercises are having on his jaw joint and facial muscles 

Dental treatment/splint therapy

If your child is clenching or grinding his or her teeth, his doctor may suggest that a dentist make a night guard or splint to protect your child's teeth and jaw. 

Surgery

If your child needs surgery, physicians in our Oral and Maxillofacial Surgery Program can help her get better, faster. Here are the different kinds of surgery used to treat severe TMD:

• Arthrocentesis — This is a procedure where two needles are inserted into the temporomandibular joint space. The surgeon then injects sterile fluid to clean the joints.
  • Medications to lubricate the joint may be added at the end of the procedure to help reduce inflammation or pain.
     
• Arthroscopy — An endoscope (a small flexible tube with a camera attached to it) is inserted into the joint in order to see where the problems are. The endoscope may be used to remove cartilage fragments and scar tissue.
   
• Open joint surgery — In this surgery, the surgeon makes an incision and then removes, reshapes or repositions parts of the joint to reduce pain and improve its function.
   
• Joint replacement — If your child's TMJ is so damaged that it needs to be replaced, the surgeon can reconstruct the joint.
   
• Orthognathic (jaw) surgery — If your child's pain is a result of misalignment of the jaw (malocclusion), the doctor may recommend jaw surgery to correct the problem.

Coping and support 

On our For Patients and Families site, you can read all you need to know about: 

• Getting to Children's
• Accommodations
• Navigating the hospital experience
• Resources that are available for your family 

Outside resources:

• The American Association of Oral and Maxillofacial Surgeons offers an informative page about the TMJ.

Research & Innovation

Physicians and researchers in Boston Children’s Hospital’s Oral and Maxillofacial Surgery Program combine a tradition of surgical excellence with innovative research. 

Current research projects include: 

• Shelly Abramowicz, DMD, MPH, is using MRI to study TMD in children with arthritis in order to diagnose the condition as early as possible. Read more on this study here.
  
  Dr. Abramowicz has also researched and compared different TMJ reconstruction systems.