TMJ and TMD Treatment: Understanding Jaw Pain

The temporomandibular joints are the two joints connecting your lower jaw to your skull, just in front of each ear. TMJ refers to the joint; TMD, temporomandibular disorder, refers to the conditions affecting it and the muscles that move it.

TMD is common, often self-limiting, and surrounded by more aggressive treatment recommendations than the evidence supports. The great majority of cases improve with conservative care, and that should be the starting point in nearly every case.

What the joint does and how it fails

The jaw joint is unusual. It both rotates and slides forward, and the two joints are connected by a single rigid bone, so neither can move independently. Between the jaw bone and the skull sits a small fibrous disc that cushions the joint and moves with it.

Most TMD falls into three overlapping categories. Muscle disorders, the most common by far, involve pain and tightness in the muscles that close the jaw, usually driven by clenching and grinding. Disc displacement occurs when the disc slips out of its normal position, producing the classic click as it snaps back into place on opening, and occasionally locking when it does not. Degenerative joint disease involves arthritic change in the joint surfaces themselves.

Contributing factors include bruxism, stress, trauma to the jaw, arthritis, generalized joint hypermobility, and in some cases a bite that loads the joints unevenly. Poor posture, gum chewing, nail biting and habitually holding the jaw forward all play a role in the muscular variety.

The symptoms

Pain or tenderness in the jaw, in front of the ear, or in the temples and cheeks. Headaches, often on waking and often described as a band around the temples. Aching that radiates into the neck and shoulders.

Clicking, popping or grating with jaw movement. Limited opening, or the jaw catching or locking, either open or closed. A bite that feels like it has changed. Ear symptoms are frequent and misleading: earache, a feeling of fullness, ringing and dizziness are all reported, and many people see a physician for an ear problem before the jaw is identified as the source.

Worth noting: clicking without pain and without limitation is very common and by itself does not require treatment. Not every noisy joint is a disorder.

Getting the diagnosis right

Diagnosis is mostly clinical. We measure how far you can open, watch the path the jaw takes on opening and whether it deviates, listen and feel for joint sounds, palpate the chewing muscles and the joints for tenderness, and examine your bite and any wear patterns on the teeth.

A careful history covers when the pain occurs, what makes it worse, stress levels, sleep quality, previous trauma, and other pain conditions. Imaging is not needed in most cases; where degenerative change or a suspected internal derangement needs clarifying, a cone beam scan shows the bone and an MRI shows the disc.

It is also important to rule out other causes that mimic TMD, including dental pain, sinus disease, ear infection, trigeminal neuralgia and, in older patients with new temple pain, giant cell arteritis, which is a medical emergency.

Conservative treatment first

Self-care resolves or substantially improves a large share of cases. A soft diet for a few weeks, avoiding wide opening, hard and chewy foods and gum. Moist heat for muscle pain, ice for acute joint inflammation. Anti-inflammatory medication for short periods. Consciously keeping the teeth apart and the tongue resting on the palate during the day, since teeth should only touch when swallowing or chewing.

Gentle jaw exercises and stretching, often guided by a physical therapist, improve range of motion and reduce muscle pain. Physical therapy that also addresses neck and posture is frequently more effective than treatment focused only on the jaw.

An occlusal splint, a custom hard acrylic appliance worn at night, reduces the load on the joints and muscles and protects the teeth from grinding. It must be adjusted so contact is even. Managing stress genuinely matters here, since clenching is the mechanism through which stress reaches the joint. Where pain has become chronic, low-dose medication prescribed for muscle relaxation or pain modulation and cognitive behavioral approaches both have supporting evidence.

What to be cautious about

Because TMD often waxes and wanes on its own, almost any treatment can appear to work. That makes it especially important to be skeptical of irreversible interventions offered early.

Grinding down teeth to adjust the bite, full mouth reconstruction, or orthodontics undertaken specifically to treat TMD should not be first-line treatment. The evidence linking bite discrepancies to TMD is weaker than was once believed, and these treatments cannot be undone if they fail to help.

Surgical options exist and have a legitimate place: arthrocentesis, which flushes the joint, and arthroscopy are minimally invasive and useful for persistent locking; open joint surgery and joint replacement are reserved for severe structural disease that has failed everything else. These are a small minority of cases.

If your jaw hurts, clicks painfully, or locks, start with an evaluation and conservative care. Call Cedar Creek Dentistry in Portland.

Questions about your own care? The team at The Best Dentist In Portland, Oregon is happy to help — call us at (503) 646-1811.

This article is for general information only and is not medical advice.