Temporomandibular joint (TMJ) disorders affect the joints that help move the jaw. They can cause pain, jaw clicking, and problems with chewing. Timely consultation with a doctor can prevent the development of further complications.
Let us consider a clinical case of a patient who presented to the YAREMA DENTAL clinic with complaints of pain, crunching, and grinding when opening the mouth.
Myklosh Yarema, Chief Physician, Prosthodontist, Gnathologist
What are TMJ disorders?
A person has two temporomandibular joints, one on each side of the face near the ears. These joints help with chewing, speaking, and jaw movement.
In dysfunction, displacement of the articular disc or the mandibular condyle may occur. In a normal state, it remains in the joint fossa and does not interfere with oral function.
According to the Cleveland Clinic, TMJ disorders affect up to 12 million people in the United States, mostly between the ages of 20 and 40. Women are affected twice as often as men.
Why do TMJ disorders cause headaches and ear pain? An anatomical model demonstrates the close connection of the joint with nerve endings.
Symptoms of TMJ disorders include:
- jaw or facial pain;
- headaches or migraines;
- stiffness or locking of the jaw;
- clicking, crunching, or grinding sounds;
- difficulty opening or closing the mouth;
- ear pain or ringing;
- toothache;
- neck or shoulder pain.
Causes of dysfunction:
- jaw trauma (e.g., fracture or dislocation);
- teeth grinding or clenching (bruxism);
- jaw arthritis;
- malocclusion;
- stress causing jaw overstrain.
Risk factors:
- chewing on pens, ice, or nails;
- poor posture;
- eating large pieces of food;
- using teeth as tools;
- daytime teeth clenching.
The causes often overlap, so it may take time to find the correct treatment.
How doctors diagnose TMJ disorders
To diagnose TMJ disorders, a doctor performs a physical examination and may order imaging tests. During the examination, they assess how the jaw moves and check for signs of pain or stiffness.
During the exam, the doctor may:
- check how wide the patient can open their mouth;
- press around the jaw to assess tenderness;
- evaluate joint function during opening and closing.
Imaging tests such as X-rays, CT scans, and MRI may also be required.
How TMJ disorders are treated
Treatment depends on the cause of symptoms and their severity. It usually begins with non-invasive methods.
Many treatments do not involve surgery. They focus on relaxing the jaw and improving mobility: custom splints or mouthguards and jaw exercises through physiotherapy.
“To achieve success, a multidisciplinary approach is necessary,” states a clinical review on PubMed.
TMJ disorders often have a biopsychosocial nature, so treatment frequently goes beyond dentistry alone—for example, combining prosthodontic and orthodontic treatment, as well as including physiotherapy and psychological support. Therefore, isolated, one-sided treatment is insufficient in such cases.
What did the patient come to the clinic for?
A 45-year-old patient presented with complaints of severe pain in the right masseter muscle and in the left temporomandibular joint. She also reported crunching and grinding when opening her mouth.
Clinical examination revealed characteristic sharp edges of the incisors and canines, as well as signs of pathological tooth wear.
Worn tooth surfaces are a common clinical manifestation of parafunctional activity, particularly bruxism. Meta-analyses show that the presence of bruxism increases the likelihood of TMJ disorders by approximately 2.2 times, confirming its role as an important risk factor in biomechanical overload of the masticatory system.
3D diagnostic results: red lines clearly visualize facial asymmetry and lateral displacement of the lower jaw. This disturbance was the cause of the patient’s muscle and joint pain.
The patient also noted a feeling of “fatigue” in the masticatory muscles during chewing and facial asymmetry: a shifted facial profile and a tilted eye line.
Such manifestations often occur with functional displacement of the mandible, as confirmed by studies.
Diagnostics
To refine the diagnosis, functional diagnostics based on the VieSID concept and computerized condylography were used. This method records how the lower jaw moves relative to the upper jaw during chewing, speaking, and parafunctional movements (e.g., bruxism).
Digital cephalometry and dentofacial system analysis: based on these calculations, YAREMA DENTAL specialists determine the ideal position of teeth and joints, taking into account individual anatomy and occlusal plane inclination.
The study provided a three-dimensional picture of TMJ function and revealed differences in movements between the right and left sides. The analysis showed lateral displacement of the mandible, explaining the pain in the muscles and joint.
Additionally, electromyography (EMG) of the masticatory muscles was performed. Increased tension of the temporalis muscles during chewing and asymmetric function between the right and left sides were identified.
Detailed functional diagnostics: mathematical calculation of jaw position. This allows not just treatment of teeth but restoration of proper biomechanics of the masticatory system to eliminate pain and clicking permanently.
Dental arch analysis: the top shows classification of anomalies, while the bottom shows 3D scans of the patient’s jaws. The images clearly demonstrate pathological tooth wear and arch asymmetry resulting from prolonged bruxism and malocclusion.
Panoramic X-ray also revealed moderate bone loss (moderate periodontitis) and multiple carious lesions.
Treatment
Treatment was carried out in several stages:
Occlusion correction with composite overlays (occlusal splint)
According to the Rudolf Slavicek concept, the therapeutic position of the mandible was determined—a physiologically stable position where masticatory muscles function more evenly and tension decreases.
The Slavicek method is a modern functional approach in dentistry that considers the jaw not as a “static bite” but as a dynamic system of muscles and joints.
Temporary composite overlays were placed on the teeth to slightly increase the bite and move the jaw into the new therapeutic position. The patient wore them for one month to adapt.
During this period, symptom changes were evaluated: pain in the masticatory muscles and joint disappeared, and joint crunching decreased.
Tooth preparation while maintaining therapeutic jaw position
After adaptation, all teeth were prepared for various ceramic restorations while strictly maintaining the established correct mandibular position, allowing fixation of the proper bite.
Based on virtual modeling and wax-up testing, polymethyl methacrylate (PMMA) temporary crowns were fabricated for the entire dental arch. These were produced using digital templates to precisely replicate the therapeutic occlusion.
This allowed additional evaluation of comfort and aesthetics over approximately two months. The use of temporary crowns proved effective in assessing functional parameters and stabilizing occlusion before final restoration.
Final restoration
After two months of wearing temporary crowns without complications, permanent ceramic crowns were fabricated, preserving the established occlusion.
Since the patient had periodontitis, periodontal treatment was carried out simultaneously. Professional cleaning was performed, and oral hygiene instructions were provided.
The final restoration ensured even distribution of masticatory load across all teeth.
Results and follow-up
After completion of prosthetic treatment, all symptoms completely disappeared. The patient reported no pain in muscles or joints, even during active chewing. No joint clicking or crunching was observed.
Six months after treatment, there were no complaints: the bite remained stable, and the mandibular muscles were relaxed.
This aligns with research showing that occlusal correction reduces pain and restores normal TMJ function.
Randomized clinical trials demonstrate significant reduction in pain intensity, improved function, and decreased muscle sensitivity within six months of treatment. Meta-analyses also confirm reduced frequency of joint noises (clicking, crunching) after occlusal therapy. In some studies, up to 80% of patients show improvement or complete symptom resolution, confirming the effectiveness of restoring a functionally stable relationship within the masticatory system.
Conclusions and recommendations
This case demonstrates a successful comprehensive approach to TMJ dysfunction:
- detailed functional diagnostics enabled identification of optimal jaw position;
- staged occlusal rehabilitation (splint, temporary PMMA crowns, final restoration) resulted in long-term improvement.
It is important that the therapeutic position was strictly maintained throughout all treatment stages.
The patient is advised to continue follow-up care (regular monitoring of occlusion and crown condition), as well as timely treatment of caries and periodontal control for long-term success.
Result of comprehensive rehabilitation: from pathological wear and pain to a healthy smile.
A happy smile of a YAREMA DENTAL patient after successful TMJ dysfunction treatment—where function and aesthetics are combined in one solution.
This case highlights the importance of functional diagnostics and coordination of prosthodontic and periodontal treatment in complex occlusal and TMJ disorders.