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Costen's Syndrome - Temporomandibular Joint Disorders


Overview, Causes, & Risk Factors

Temporomandibular joint disorder, which is also known as TMJ, is a painful condition that affects the joint connecting the jawbone to the skull. TMJ may also involve the surrounding muscles and soft tissues.

What is going on in the body?

Temporomandibular joint disorders are poorly understood. They are thought to involve a disturbance of the joint that connects the back of the jaw to the skull. This joint is located just in front of the ear and can be felt when the jaw opens and closes.

What are the causes and risks of the condition?

The exact causes of temporomandibular joint disorders are still a subject of debate. Ninety percent of the people with TMJ are women in their childbearing years. Many times, TMJ is linked to inappropriate activities, such as:

  • activities that cause the head to be held in an abnormal position, such as cradling a telephone on the shoulder
  • clenching or grinding of the teeth
  • oral habits, such as yawning with the mouth wide open or eating chewy foods often
  • overuse of, or trauma to, the muscles used in chewing
  • poor posture, such as sitting improperly at a desk or computer station
  • Other causes of TMJ are as follows:

  • abnormal sensitivity to pain in the area of the joint or muscles used for chewing
  • abnormal structure of the joint, present at birth
  • dental procedures, such as root canals and tooth extractions
  • diseases affecting the muscles, such as fibromyalgia
  • injury, such as a motor vehicle accident or sports injury
  • joint diseases, such as osteoarthritis
  • medical procedures, such as endotracheal intubation used to deliver general anesthesia during surgery
  • poor alignment of the jaw or teeth
  • stress

  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    Temporomandibular joint disorders may cause a wide variety of complaints, such as:

  • a clicking or snapping noise heard in the joint when the jaw is opened and closed
  • headaches
  • jaw pain
  • joint locking open or shut
  • limited ability to open the mouth
  • pain behind the eye
  • pain that spreads to the shoulders, neck, and back
  • spasm or pain in the muscles used for chewing
  • Certain other symptoms are often seen in people who have temporomandibular joint disorders. These symptoms may be part of the TMJ. Sometimes they may be caused by another condition that is also occurring at the same time. These symptoms include:

  • dizziness
  • ear pain
  • hearing impairment
  • ringing in the ears, also known as tinnitus
  • vertigo, which is a sense of the room spinning around that is worsened by sudden movement or turning
  • visual impairments, such as blurred vision

  • Diagnosis & Tests

    How is the condition diagnosed?

    The results of a medical history and physical exam often cause a healthcare provider to suspect a temporomandibular disorder. Blood tests and X-rays are often used to make sure more serious diseases are not causing the symptoms. No single test can confirm the diagnosis. Dental X-rays can sometimes help make the diagnosis.


    Prevention & Expectations

    What can be done to prevent the condition?

    Prevention of temporomandibular joint disorders is not always possible. However, these measures may be helpful in avoiding or minimizing TMJ:

  • Avoid postural problems by setting up work areas ergonomically and using a telephone headset.
  • Correct oral habits such as teeth grinding and yawning widely.
  • Seek effective treatment for diseases such as osteoarthritis and fibromyalgia.
  • Use dental devices to correct abnormalities of the joint or help prevent teeth grinding.
  • What are the long-term effects of the condition?

    Prolonged temporomandibular joint disorders may result in deformity of the joint. Poor alignment of the jaw or teeth can also result. The main long-term effect is frustration from the symptoms. For many people with TMJ, there are no long-term effects.

    What are the risks to others?

    Temporomandibular joint disorders are not contagious. They pose no risk to others.


    Treatment & Monitoring

    What are the treatments for the condition?

    Initial treatment of temporomandibular joint disorders involves identifying actions that cause symptoms to get worse, such as clenching or grinding the teeth. Many people may not realize they are doing these things.

    Some other measures used to treat TMJ are as follows:

  • application of heat or cold
  • massage
  • medicines to relax the muscles
  • pain medicines
  • physical therapy, which may involve mild jaw exercises
  • relaxation therapy
  • a soft diet that avoids chewy foods
  • stress management
  • If these treatments fail, referral to a dentist who treats TMJ may be needed. Special bite appliances may be used. In severe cases of TMJ that do not respond to other treatments, surgery to realign the jaw is sometimes helpful. Joint replacement or a joint implant may be considered.

    What are the side effects of the treatments?

    Pain medicines may cause stomach upset and allergic reactions. Medicines to relax the muscles may cause drowsiness or allergic reactions. Other side effects depend on the drug used. Surgery may cause bleeding, infection, or allergic reaction to anesthesia. Surgery does not always cure TMJ.

    What happens after treatment for the condition?

    If symptoms go away, no further treatment is generally needed for the temporomandibular joint disorders. The person should take care to avoid factors that may cause another episode of TMJ, such as teeth grinding.

    How is the condition monitored?

    Symptoms and a physical exam are used to monitor temporomandibular joint disorders. Sometimes, X-rays may be used to monitor the condition. Any new or worsening symptoms should be reported to the healthcare provider.


    Attribution

    Author:Adam Brochert, MD
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:08/20/01
    Reviewer:Eileen McLaughlin, RN, BSN
    Date Reviewed:08/20/01

    Sources

    Otolaryngology Head and Neck Surgery, 1998, Cummings et al.

    Emergency Medicine, 1998, Rosen et al.


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