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Navigating unknown waters

20 March 2020

As you will likely know, temporomandibular disorders (TMDs) are a selection of conditions that impact the temporomandibular joint (TMJ), masticatory muscles and associated structures of the face and neck. The conditions are estimated to affect around 25-33% of the population, , though a much smaller percentage of people will experience severe enough symptoms to report the problem. Symptoms can range from pain around the jaw, ear and temple to clicking or grinding sounds upon jaw movement, headaches, restricted jaw motion and jaw locking.

In terms of unmodifiable risk factors, incidence of TMDs is reportedly higher in females than males. Interestingly, one review of the literature found that most symptoms presented in patients aged between 20 and 50-years-old. The wide age range affected may well contradict the traditional view that TMDs are degenerative conditions.

Possible causes

TMDs have a multifactorial aetiology, although the exact mechanisms of disorder onset and development are not well understood. In turn, this makes diagnosis and management difficult for healthcare professionals.

There are several potential causes of TMDs, which include bruxism. Some studies have found a strong relationship between bruxism and TMDs, with one associating the sheer force placed on the TMJ – especially during sustained clenching – with the development of TMDs. This is logical when you consider the stress placed on the TMJ and masticatory muscles. Another paper linked parafunction and its influence on joint loading with osteoarthritis of the TMJ. However, as found in a 2008 review, the lack of a universal definition for ‘bruxism’ makes it difficult to definitively confirm a causal relationship between this and TMDs.

Another potential cause of TMDs is an injury to the face or neck. For example, a heavy blow to the face could result in a broken or fractured TMJ and lead to a TMD. There is also some evidence to suggest that whiplash can lead to TMDs, with one American study concluding that one in every three people who experience whiplash are at risk of delayed TMD symptoms. However, other authors have highlighted some conflicting results in this particular area of study and so more research is needed.

Malocclusion is an alternative possible culprit. Indeed, much of the patient-facing literature – including the NHS websiteiii – lists an uneven bite as a potential cause of TMDs. Many clinical papers also elude to the association between malocclusion and the development of TMDs. However, it has more recently been postulated that malocclusion is secondary to joint or muscle disorders. This highlights the importance of a thorough investigation into potential TMD signs and symptoms before any treatment that could adjust the patient’s occlusion is delivered. This could include orthodontics, as well as the provision of restorations and prosthetics within a comprehensive treatment plan.

Finally, specific diseases have been found to increase the chance of TMD development. For instance, rheumatoid arthritis has been associated with a high risk of TMDs, making regular TMJ assessments an essential part of on-going care for individuals with the condition. Patients with fibromyalgia may also be predisposed to TMJ problems. In addition, some evidence exists linking TMDs with chronic diseases such as asthma, osteoarthritis and thyroid dysfunction.


Due to the unspecified aetiology of TMDs, treatment of symptoms can be wide ranging. GDPs should look to implement solutions in order of invasiveness so patients are not submitted to major procedures unnecessarily. In cases of minor TMDs, resolution of symptoms may be provided through simple exercises that the patient can perform at home. These can help to stretch and mobilise the TMJ, improving mobility and reducing discomfort. Botulinum toxin injections have also been shown to provide long-term relief.

Furthermore, a product like the OraStretch Press Jaw Motion Rehab System, available in the UK from Incito Medtech, may improve the patient’s condition. It is an easy-to-use, hand-operated device that gently stretches the TMJ, improves jaw and joint function, and reduces pain and swelling. With diligent use, a patient could gain up to 1-2mm in range of motion per week.

Where TMDs are more serious, complex treatments might be indicated. For any cases beyond the remit of the GDP, patients should be referred to the local maxillofacial surgeon who provides TMJ-related therapies.

A holistic approach to quality of life

Despite the uncertainty that exists around the causes and development of TMDs, even among the healthcare profession, it’s essential to keep the patient’s best interests at heart. Facial and jaw pain that can result from TMDs have a significant impact on someone’s quality of life. Therefore, finding a safe and effective solution is essential.

For more information please email or visit or call 07796 058128


  • Sambrook J. Temporomandibular joint dysfunction and pain syndromes. Patient. Professional Articles. Orthopaedics and Sports Medicine. May 2016.
  • Wright EF, North SL. Management and treatment of temporomandibular disorders: A clinical perspective. J Man Manip Ther. 2009; 17(4): 247–254. doi: 10.1179/106698109791352184
  • NHS. Health A-Z. Temporomandibular disorder (TMD). [Accessed December 2019]
  • Solberg WK, Woo MW, Houston JB. Prevalence of mandibular dysfunction in young adults. J Am Dent Assoc. 1979 Jan;98(1):25-34.
  • Gonçalves DA, Dal Fabbro AL, Campos JA, Bigal ME, Speciali JG. Symptoms of temporomandibular disorders in the population: an epidemiological study. J Orofac Pain. 2010 Summer;24(3):270-8.
  • Murphy MK, MacBarb RF, Wong ME, Athanasiou KA. Temporomandibular Joint Disorders: A Review of Etiology, Clinical Management, and Tissue Engineering Strategies. Int J Oral Maxillofac Implants. 2013 Nov-Dec; 28(6): e393–e414. doi: 10.11607/jomi.te20
  • Chisnoiu AM, Picos AM, Popa S, Chisnoiu PD, Lascu L, Picos A, Chisnoiu R. factors involved in the etiology of temporomandibular disorders – a literature review. Clujul Med. 2015; 88(4): 473–478. Published online 2015 Nov 15. doi: 10.15386/cjmed-485
  • Commisso MS, Martínez-Reina J, Mayo J. A study of the temporomandibular joint during bruxism. Int J Oral Sci. 2014;6(2):116–123. doi:10.1038/ijos.2014.4
  • Israel HA, Diamond B, Saed-Nejad F, Ratcliffe A. The relationship between parafunctional masticatory activity and arthroscopically diagnosed temporomandibular joint pathology. J Oral Maxillofac Surg. 1999 Sep;57(9):1034-9.
  • Barbosa TdeS, Miyakoda LS, Pocztaruk RdeL, Rocha CP, Gavião MB. Temporomandibular disorders and bruxism in childhood and adolescence: review of the literature. Int J Pediatr Otorhinolaryngol. 2008 Mar;72(3):299-314. doi: 10.1016/j.ijporl.2007.11.006. Epub 2008 Jan 3.
  • Salé H, Isberg A. Delayed temporomandibular joint pain and dysfunction induced by whiplash trauma: a controlled prospective study. J Am Dent Assoc. 2007 Aug; 138(8):1084-91.
  • Fernandez CE, Amiri A, Jaime J, Delaney P, The relationship of whiplash injury and temporomandibular disorders: a narrative literature review. J Chiropr Med. 2009 Dec; 8(4): 171–186. doi: 10.1016/j.jcm.2009.07.006
  • Chokalingham S, Felicita AS. Malocclusion and TMJ disease – A review of the literature. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 13, Issue 1 Ver. X. (Feb. 2014), PP 71-73
  • Caldas W, Conti ACCF, Janson G, Rodrigues CPC. Occlusal secondary to temporomandibular joint conditions: a critical review and implications for clinical practice. J Appl Oral Sci. 2016 Jul-Aug; 24(4): 411–419. doi: 10.1590/1678-775720150295
  • Witulski S, Vogl TJ, Rehart S, Ottl P. Evaluation of the TMJ by means of clinical TMD examination and MRI diagnostics in patients with Rheumatoid Arthritis. BioMed Research International, vol. 2014, Article ID 328560, 9 pages, 2014.
  • Gui MS, Garden MP, Rizzatti-Barbosa CM. Temporomandibular disorders in fibromyalgia syndrome: a short communication. Brazilian Journal of Rheumatology (English Edition), Volume 55, Issue 2, March – April 2015, Pages 189-194
  • Song HS, Shin JS, Lee J, et al. Association between temporomandibular disorders, chronic diseases, and ophthalmologic and otolaryngologic disorders in Korean adults: A cross-sectional study. PLoS One. 2018;13(1):e0191336. Published 2018 Jan 31. doi:10.1371/journal.pone.0191336
  • Mor N, Tang C, Blitzer A. Temporomandibular Myofacial Pain Treated with Botulinum Toxin Injection. Toxins (Basel). 2015;7(8):2791–2800. Published 2015 Jul 24. doi:10.3390/toxins7082791


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