Disease Description (Causes and Symptoms)
- Definition summary: A collective term for various disorders affecting the temporomandibular joints (jaw joints) and masticatory muscles. Common symptoms include joint sounds (clicking or popping), jaw pain, difficulty opening or closing the mouth (opening/closing dysfunction), headaches, and referred pain (to the ear, temple, cheek, etc.).
- Main causes: Trauma (bruising or impact), chronic teeth grinding or clenching (bruxism), excessive chewing of hard or chewy foods, and psychological stress are major triggers.
- Pathophysiology summary: Abnormalities of the joint cartilage or disc (articular disc), excessive tension in the muscles around the joint, and degenerative changes or inflammation of the joint surfaces cause pain, restricted movement, and joint sounds. In the early stages, muscular pain and functional abnormalities are the main manifestations; as the condition progresses, structural changes in the joint (arthritis, anterior displacement of the articular disc, etc.) may occur.
Treatment Methods
- Principle: Conservative (non-surgical) treatment is prioritized. Depending on the severity of symptoms and functional impairment, treatment progresses stepwise through medication, physical therapy, dental appliances, injections/procedures, and surgery.
- Non-pharmacological and non-invasive treatment
- Lifestyle measures: Avoiding hard or chewy foods, avoiding excessive mouth opening, managing stress, and reducing the habit of clenching the teeth (relaxation training), etc.
- Physical therapy: Warm compresses, ultrasound and laser therapy, muscle and joint stretching and strengthening exercises, manual therapy, etc.
- Behavioral therapy/psychotherapy: Managing stress and anxiety, and training related to teeth grinding (bruxism).
- Occlusal appliance (splint): A stabilization occlusal appliance (worn at night) to relieve muscle tension and protect the joint.
- Medication
- Analgesics/anti-inflammatory drugs (NSAIDs) to control pain and inflammation.
- Short-term muscle relaxants to relieve muscle tension.
- For chronic pain only, pain-relieving medications such as low-dose tricyclic antidepressants may be considered.
- Injections and procedures
- Intra-articular injection: Hyaluronic acid or steroids (selectively, depending on the symptoms and diagnosis); effectiveness is limited.
- Arthrocentesis or arthroscopy: Used when conservative treatment fails, for the purpose of relieving joint adhesions and controlling inflammation.
- Surgery
- Open surgery (joint reconstruction, articular disc surgery, etc.) is considered in cases of structural abnormalities (severe articular disc deformity, tumors, or severe degenerative changes) or when other treatments have failed.
- Precautions and self-care
- Do not force the mouth open wide or engage in activities that place excessive strain on the joint.
- If left untreated for a long time, arthritis, limited mouth opening (측폐), jaw asymmetry, and eating disorders (digestive problems) may occur; early medical evaluation is recommended if symptoms worsen.
Outpatient Visit Checklist (Including Example Questions)
- Items to bring/preparations
- List of medications currently being taken (including prescription drugs, OTC medications, and supplements)
- Bring previous test results, if available (dental records, radiographs, MRI results, etc.)
- Symptom record: onset, pain intensity (pain scale 0–10), aggravating/relieving factors, joint sounds (when they occur, frequency, and sound characteristics), and whether mouth opening/closing is restricted (maximum mouth-opening distance, e.g., number of fingers)
- Relevant medical history: recent jaw injury, dental treatment (extraction, orthodontic treatment, etc.), sleep-related teeth grinding, and stress level
- Information to tell the doctor in advance during the outpatient visit (examples)
- When the symptoms first started and how they have progressed (acute vs. chronic)
- Times of day when the pain is most severe or triggering activities (eating, talking, yawning, etc.)
- Whether there has been brief “locking” along with the sound (a phenomenon in which the mouth cannot be opened or closed)
Examples of General Questions to Ask the Doctor
- How long does it usually take for these symptoms to improve (prognosis)?
- What are the side effects and duration of use of the medication you plan to prescribe?
- Would an occlusal appliance (splint) help in my situation? How long should it be worn, and how should it be maintained?
- What physical therapy or exercises should I do, and for how long, for them to be effective?
- In what cases is surgery necessary, and what are the risks of surgery?
Examples of Condition-Specific Questions
- In my case (the combination of joint sounds, pain, and limited mouth opening/closing), is an MRI necessary to examine internal joint structures (such as disc damage)?
- I grind or clench my teeth at night; what behavioral therapy should be combined with an occlusal appliance (nighttime splint) for the best results?