TMJ Disorders

Mostly everyone has soreness or tightness in the jaw from time to time. Usually, these symptoms go away within a few days and are not cause for alarm.

But sometimes, the pain can linger and get worse — becoming so intense that chewing, smiling, and even breathing is difficult. When kids have symptoms like these, they're likely to have developed a TMJ disorder, which may require treatment.

About TMJ Disorders

TMJ disorders are medical problems related to the temporomandibular joint (TMJ), the joint that connects the lower jaw to the skull. You can feel your TM joints and their movement by placing your fingers directly in front of your ears and opening your mouth. What you're feeling are the rounded ends of the lower jaw as they glide along the joint socket of the temporal bone, which is the part of the skull that contains the inner ear and the temple.

TMJ disorders (also called temporomandibular disorders, or TMD) can cause pain in the head, neck, jaw or face; problems chewing or biting; popping or clicking sounds when opening and closing the mouth; and, occasionally, a jaw that can be locked open or locked shut.

TMJ disorders can affect kids of any age, but are much more common in teens, especially girls.

Causes

It's often not clear what causes TMJ disorders, but many things can contribute to them.

Bruxism (jaw clenching or teeth grinding) can make a TMJ disorder more likely. It overworks the TMJ, which can lead to a disc in the joint wearing down or move out of place. Grinding and clenching also can change the alignment of the bite (the way that top and bottom teeth line up) and can affect muscles used for chewing. Sometimes people don't even realize that they're clenching or grinding and might even do it during sleep.

Stress can influence TMJ symptoms by making kids more likely to grind their teeth, clench their jaw, or tighten their jaw muscles.

TMJ disorders also are more common in those with other dental problems (like a bad bite), joint problems (like arthritis), muscle problems, or a history of trauma to the jaw or face.

Signs and Symptoms

Many symptoms can indicate a problem with the TM joint. Some of the most common are:

• pain in the facial muscles, jaw joints, or around the ear, and sometimes in the neck and shoulders. Some people have pain when they talk, chew, or yawn; a few might notice muscle spasms.
• popping, clicking, or grating sounds when opening or closing the mouth (some kids hear these noises but don't have other symptoms, and might not need any treatment)
• difficulty chewing or biting
• headaches, dizziness, ear pain, hearing loss, and ringing in the ears (tinnitus)
• jaw locking (the jaw might lock wide open or lock shut)

When to See a Dentist

If your child has symptoms of a TMJ disorder, let your dentist know. The earlier a TMJ disorder is diagnosed and treated, the better.

The dentist will ask questions, examine your child, and might order imaging tests (like X-rays, a CT scan, or an MRI) to confirm a TMJ disorder.

If your child's jaw is locked open or locked shut, see an oral surgeon or go to the emergency room.

Treatment

For some kids with TMJ disorders, treatment can be as simple as resting the jaw for a few days.

Offer your child soft foods and make sure he or she avoids any habits that can aggravate the TM joint or the muscles of the face (such as chewing gum, clenching or grinding the teeth, or opening the mouth extra-wide while yawning). Apply ice packs or heat to the side of the face to help your child feel more comfortable.

Depending on the specific diagnosis of a TMJ disorder, more treatment might be needed. A child whose jaw is locked will need to have the jaw manipulated until it can be opened or closed. Sometimes this is done under sedation.

If pain is caused by clenching the jaw or grinding the teeth, the dentist may fit your child with a splint or biteplate to wear at night to help reduce clenching and grinding. Medicine also can be prescribed to help relieve the pain or relax the muscles.

And if the dentist finds that a problem with your child's bite is contributing to the TMJ disorder, he or she may recommend braces or other dental work to correct it.

Occasionally, when the symptoms do not respond to other treatments, a child might need surgery to repair damaged tissue in the joint. But most kids won't need surgery.

Prevention

Lots of kids develop TMJ disorders or joint pain as a result of unconsciously grinding the teeth or clenching the jaw repeatedly. You can help a child control these habits by making him or her aware of the activity.

Teach kids to notice these behaviors when they happen (for example, during a test at school, when angry or upset, etc.) so that they can be consciously stopped. If the behavior is a result of stress, have your child get plenty of exercise to release nervous energy. Breathing exercises also can help kids relax. 

Ask your dentist for more tips on avoiding TMJ disorders.