TMJ: The Great Impostor

By Gary Iskol, DDS

Mary is a 43-year old account executive. For the last six months she has suffered from severe, debilitating headaches associated with pain around the ears, sinus problems and a strange clicking sound when opening her mouth wide.

Mary’s physician referred her to an Ear, Nose and Throat Specialist (ENT) and a neurologist. After discussing their findings, they referred Mary to another office— a dentist’s office. The diagnosis: “Temporomandibular Joint Dysfunction Syndrome”, or TMJ/TMD syndrome.

The temporomandibular joint is just in front of the ear and hinges to the skull to open and close the lower jaw. TMJ syndrome may develop when the following three factors are present:

1.) A predisposition (genetic or acquired) to the syndrome.
2.) A tissue alteration of the jaws, such as malaligned upper and lower jaws, malaligned teeth or arthritic changes in the joint.
3.) A degree of psychological stress sufficient to cause muscle tension, clenching or grinding of teeth and gritting teeth.

The many symptoms of TMJ/TMD are seemingly unrelated, making diagnosis extremely difficult. This is why TMJ/TMD syndrome has been nicknamed “The Great Impostor”.

Symptoms usually begin with soreness in the muscle around the jaws. As the disease progresses, any combination of symptoms may develop. (See symptoms list on this page.)

TMJ/TMD symptoms usually begin due to malalignment of the jaws and/or teeth. This causes clenching, grinding or gritting of teeth. Many patients are totally unaware of these actions because they may occur during sleep. Psychological stress (ex., loss of loved one, financial/family pressures) increases muscular tension also causing clenching, gritting and grinding. Some patients might also exhibit the habits during the day during exercise, driving or even at work.

Non-surgical therapy usually involves placement of a clear plastic “splint” over the upper OR lower teeth. This separates the teeth and allows the lower jaw to position itself in an anatomically correct position. The muscles and ligaments can then relax, allowing symptoms to subside.

When the patient is comfortable, the malalignment of the teeth and jaws can then be analyzed and corrected. Correction might involve surgery (although this is rarely needed), orthodontics or occlusal equilibration.

In an attempt to reduce stress, stress reduction or biofeedback programs may be recommended. In severe cases of stress, referral to a psychologist may be appropriate. Physical therapy may also be suggested.

TMJ/TMD syndrome is complex and often debilitating. If you or anyone you know are plagued by these symptoms, call us.

*Both Dr. Iskol and Dr. Fisk have extensive training in TMJ/TMD


Head Pain, Headache
1. Forehead Pain
2. Temple Pain
3. “Migraine” type
4. Sinus type
5. Shooting pain up the back of the head
6. Hair and/or scalp painful to touch

1. Pain behind the eye
2. Bloodshot eyes
3. Eyes may bulge
4. Sensitive to sunlight

1. Discomfort
2. Limited opening of the mouth
3. Inability to open smoothly
4. Jaw deviates to one side when opening
5. Lock shut or open
6. Can’t find bite

1. Clenching, grinding, gritting at night
2. Looseness and soreness of back teeth

Ear problems
1. Hissing, buzzing or ringing
2. Decreased hearing
3. Ear pain, ear ache, no infection
4. Clogged “itchy” ears
5. Vertigo, dizziness

Jaw Problems
1. Clicking, popping jaw joints
2. Grating sounds
3. Pain in cheek muscles
4. Uncontrollable jaw and/or tongue movements

Neck Problems
1. Lack of Mobility
2. Neck pain
3. Tired sore muscles
4. Shoulder aches and backaches
5. Arm and finger numbness and/or pain

1. Swallowing difficulties
2. Laryngitis
3. Sore throat with no infection
4. Voice irregularities or changes
5. Frequent coughing or constant clearing of throat
6. Feeling of foreign objects in throat constantly

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