THE MOST COMMON symptoms of TMJ disorders are facial pain, difficulty chewing and swallowing, limited mouth opening, unexplained (phantom) tooth pain, headaches (including common migraines), blocked eustachian tubes (stuffy ears), dizziness (vertigo), ringing or whooshing sounds in the ears (tinnitus), subjective hearing loss, and chronic neck tension. All these symptoms rarely occur together in one patient, and most patients suffer from only a few of them. For example, some only experience headaches, some only experience facial pain, and some only experience ear problems. A few TMJ disorder patients also suffer from unusual neurologic disorders such as facial twitching, numbness, and a variety of minor visual problems that we don't fully understand.
GENDER plays a role. In TMJ clinics all over the world, the vast majority of patients are women. Women are disproportionally affected because of their more downward and backward facial growth patterns. The female facial growth pattern diverges from the male facial growth pattern at puberty when females also become much more susceptible to TMJ disorders.
AGE also plays a role. TMJ disorders rarely cause significant symptoms in people under the age of 15 or over the age of 50. Children rarely suffer, because their extensive capacity for growth adaptation will change their facial structure to accomodate the strain rather than allowing the strain to create tissue damage. The elderly rarely suffer, because the normal decrease in neuromuscular reactivity that occurs during middle age removes a common element from the symptom generating cycle. In evolution, a decreased response of skeletal muscles to joint damage was necessary to allow aging joints to withstand the arthritic changes that were inevitable in those who were lucky enough to reach middle age. In TMJ disorders, jaw muscle tightening forms part of the vicious cycle that maintains the symptoms. After middle age, diminished neuromuscular reactivity removes one of the links from that vicous cycle. As a result, chronic TMJ inflammation becomes rare, even though aging TMJs keep undergoing more arthritic damage every year as seen on X-rays. Older people may have difficulty with mechanical operation of the joints, a shifting bite that causes dental problems, occasional bouts of pain, chronic postural muscle soreness that includes the jaw muscles, and some ear problems; but the symptoms they do experience just need minimal treatment to resolve.
TMJ PAIN, directly in the area of joint, is rare, because joint surfaces are designed to withstand large compressive forces and therefore cannot have sensory nerves in the area between the bones. The pain sensitive nerves in joints are located in the capsule surrounding the joint and in the attachments of the ligaments that reinforce the joint. These sensory nerves only signal pain when the joint capsule is stretched by swelling or the ligaments are pulled too tightly.
ACUTE TMJ PROBLEMS are usually accompanied by joint inflammation. Since the TMJs are located on top of the back ends of the lower jawbone, the swelling produced by inflammation there pushes the affected condyle down and away from the skull, thereby slightly changing the cant of the long lower jawbone and causing the teeth to fit differently or not at all, especially on the side of the swelling. Biting forcefully to try and achieve stable contact on all the back teeth causes immediate pain, because it drives the condyle into the area of inflammation.
JAW MUSCLE TENSION is always found in TMJ disorders, because damage to any joint produces a reflex tightening of the muscles which cross that joint. The muscles that cross the TMJ are the jaw muscles. When they must function on a damaged TMJ, they hold themselves braced in readiness to protect it, so they can never fully relax. As a result, their resting circulation is impaired and they may not be able to adequately flush the waste products out of their tissues.
The role of TMJ inflammation in jaw muscle tightness explains why earlier muscle oriented TMJ treatments usually provided only limited success. Treating the jaw muscles produced short term relief, because it helped flush waste products out of muscles which had been operating with insufficient circulation, but it ignored the cause of the muscle tightness. Treating the jaw muscles without also improving the conditions in the joint was like massaging the leg muscles of someone who has an untreated broken ankle. The massage helps relieve the pain, but the muscles tighten up again as soon as the patient gets off the table and starts walking again.
Since the jaw muscles attach all over the sides of the head, jaw muscle tension can apply enough pressure to disrupt its circulation. In monkeys, biting forcefully bends the whole skull, slightly but measurably opening the sagittal suture along the top of the head. In humans, the jaw muscles are stronger, but the skull is also thinner, so the force from the jaw muscles can still be a significant force. It is likely because of that force that headaches have proven to be a primary symptom of TMJ disorders. Although we still have no way to determine the cause of most headaches, decades of clinical experience has shown that a surprising number of different headache types (including common migraine) are often responsive to TMJ disorder treatment.
In addition, causes of headache are often cumulative. For example if you have chronic headaches because you have a TMJ disorder and you hit yourself in the head with a hammer every morning; then you treat the TMJ disorder but keep hitting your head with a hammer every morning, you will still have headaches but they will be less severe.
POSTURAL STRAIN is always involved in TMJ disorders, because the jaw muscles form an integral part of the head posture mechanism, and the body's muscles are all connected in long functional chains. Backward jaw posture, which is commonly found in TMJ disorder patients, is an important cause of forward head posture, as described in THE ROLE OF BODY POSTURE under TMJ DISORDERS and explained in detail in OCCLUSION AND POSTURE under FOR DOCTORS.
EAR SYMPTOMS include dizziness, tinnitus (ear ringing), stuffiness (blocked eustachian tubes), and frequent difficulty hearing what people say (subjective hearing loss). These symptoms can be produced by TMJ inflammation or by excess resting muscle tension.
INFLAMMATION in a TMJ can cause ear symptoms due to the pressure from swelling that easily crosses the thin membrane bones separating the TMJs and the middle ear. Anatomical studies of TMJs with dislocated disks have shown that most of the tissue bruising occurs at the extreme back end of the TMJ, located only 1.5 millimeters from the front of the middle ear.
BALANCE is often affected, because the body's balance mechanism is located in the inner ear. This mechanism is very delicate and sensitive to pressure. Serious injury to it can cause so much dizziness that the patient cannot walk and throws up. Mild injury to that same mechanism produces feelings of disorientation, inability to concentrate, a tendency to bump into things, and "spaciness".
EUSTACHIAN TUBE BLOCKAGE can also be caused by increased fluid pressure from an inflamed TMJ. The eustachian tubes pass just behind the TMJs, and swelling of a TMJ can push a tube closed. The blocked tube can no longer equalize pressure between the middle ear and the outside air when you go up or down in a plane or over a mountain. The ear often feels stuffy. In some cases, chronic TMJ inflammation has narrowed the tube, and any inflammation of the inner lining of the tube from a cold or an allergy can further narrow its lumen until it becomes blocked.
TIGHT JAW MUSCLES may be another cause of ear symptoms in TMJ disorders, because the tiny ear muscles (tensor tympani, stapedius, and tensor veli palatini) are controlled by the same motor nerve as the jaw muscles. When this motor nerve holds the jaw muscles too tightly, it also holds these little ear muscles too tightly. The increased resting tension in the tensor tympani and stapedius muscles, which tighten the ear drum, may cause the subjective hearing loss that causes TMJ disorder patients to complain they often miss things people say, even though hearing tests show normal results. The increased resting tension in the tensor veli palatini muscles, which normally pull open the eustachian tube during swallowing, can prevent the tube from clearing normally.
TINNITUS (ringing, roaring, or buzzing sounds in the ears) can have a number of causes, including an inflamed TMJ or tightened jaw and ear muscles. Tinnitus is a difficult symptom to treat, because its presentation tells us nothing about its cause. The same tinnitus can be caused by a blow to the head, a drug, a loud noise, or a TMJ disorder. In addition, like some other TMJ disorder symptoms, it can remain long after its cause has gone. A number of studies have shown that it responds to TMJ treatment in about half of the patients. That 50% success cure rate would be considered poor for many medical conditions, but it is considered great for tinnitus, because there are so few other treatments for the problem.
Whatever makes your TMJ disorder worse will make your symptoms worse, and whatever makes your TMJ disorder better will make your symptoms better, but some symptoms respond faster than others. We can use the more rapidly responding symptoms as indicator symptoms to be sure the treatment is on the right track. Pain is the best indicator symptom, tinnitus is the worst.