The temporomandibular joint (TMJ) connects your lower jaw to the temporal bone of your skull, located just in front of each ear. This joint enables movements like chewing, speaking, and yawning. TMJ arthritis occurs when this joint becomes inflamed or degenerates.
Recognizing the Symptoms
Individuals experiencing TMJ arthritis often report localized pain in the jaw, face, or ear region. This discomfort can manifest as a dull, persistent ache or as a sharp, sudden pain, especially when moving the jaw. Joint stiffness is another common symptom, which can be particularly noticeable upon waking in the morning.
Beyond pain and stiffness, the jaw joint may produce various sounds during movement. These can include clicking or popping noises, or a grating sensation known as crepitus, indicating friction within the joint. Functional difficulties also arise, such as a limited range of motion, making it challenging to open the mouth fully. Chewing can become difficult or painful, and some individuals may experience their jaw locking in either an open or closed position.
Underlying Types of Arthritis in the Jaw
TMJ arthritis stems from specific medical conditions affecting the joint. Osteoarthritis is the most common form, often described as “wear-and-tear” arthritis. It develops as the protective cartilage cushioning the joint surfaces gradually breaks down over time, leading to bone-on-bone contact.
This degenerative process in the TMJ can result in changes such as flattening, lipping, or erosion of the mandibular condyle, which is the rounded end of the jawbone that articulates with the skull. Although it is frequently observed in individuals over 50 years old, it can also affect younger people following a jaw injury or due to prolonged overuse.
Rheumatoid arthritis represents an autoimmune condition where the body’s immune system mistakenly attacks the lining of its own joints, including the TMJ. This systemic inflammatory disorder often affects multiple joints symmetrically throughout the body, though the TMJ is typically involved later in the disease progression. Clinical signs in the jaw may include swelling, pain, and restricted movement.
Psoriatic arthritis is another autoimmune disease that can affect the TMJ, commonly seen in individuals with the skin condition psoriasis. This form of arthritis can inflame the jaw joint, leading to pain, swelling, and reduced mobility. If left unaddressed, psoriatic arthritis can lead to irreversible damage within the temporomandibular joint.
The Diagnostic Process
Diagnosing TMJ arthritis begins with a consultation where a healthcare professional gathers medical history, including symptoms, pain patterns, and past treatments. A physical examination follows, during which the doctor carefully assesses jaw movement, listening for any joint sounds like clicking or crepitus. During this examination, the practitioner will also gently press on areas around the jaw to identify sites of pain or tenderness in the joint and surrounding muscles.
If TMJ arthritis is suspected, imaging tests are ordered to view the joint’s internal structures, confirm the diagnosis, and assess damage. X-rays are an initial imaging step, offering a general overview of bony structures and identifying signs of degeneration. For more detailed images of the bones, such as condylar flattening, lipping, or erosions, a Computed Tomography (CT) scan may be performed. To visualize soft tissues like the articular disc and cartilage, Magnetic Resonance Imaging (MRI) is a standard method.
Management and Treatment Approaches
Managing TMJ arthritis often begins with conservative, at-home care to reduce jaw strain. This includes making lifestyle adjustments such as consuming soft foods, applying either heat or ice packs to the affected area, and consciously avoiding extreme jaw movements like wide yawning or chewing gum. Practicing good resting jaw posture, where the tongue rests gently on the roof of the mouth with teeth slightly apart, can also provide relief.
When self-care measures are insufficient, medical therapies may be recommended. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen alleviate pain and reduce inflammation. For more severe symptoms, prescription muscle relaxants can help with jaw spasms, and low-dose tricyclic antidepressants may be prescribed to help manage chronic pain and improve sleep quality.
Physical therapy improves jaw function, focusing on exercises that stretch and strengthen jaw muscles. Specific exercises, such as chin tucks, tongue lifts, and resisted jaw movements, are designed to enhance mobility and reduce tension in the joint. Oral appliances, like custom-made splints or mouth guards, are another treatment option. These devices fit over the teeth to stabilize the jaw, reduce strain on the joint, and prevent clenching or grinding, which can worsen symptoms.
In cases where conservative and medical treatments do not provide sufficient relief, various procedures or surgical options may be considered, typically progressing from least to most invasive. Arthrocentesis is a minimally invasive procedure involving the insertion of small needles into the joint to flush out inflammatory substances and debris. TMJ arthroscopy, a “keyhole surgery,” allows a surgeon to view the inside of the joint with a small camera and address issues like reshaping bone or removing scar tissue. For severe structural problems that are unresponsive to other interventions, open-joint surgery may be necessary to repair or even replace the joint.