In this article:
What Is TMJ?
The temporomandibular joint (TMJ) is one of the complex structures in the body that are made up of muscles, tendons, blood vessels, nerves, and bones.
You have a pair of temporomandibular sliding joints located on both sides of your head in front of your ears.
These joints connect your mandible or lower jawbone to your temporal bone on the side of the skull.
The facial muscles that make it possible for you to open and close your mouth are attached to the TMJ.
In fact, the movement of the jawbone itself is controlled by the TMJ, which can rotate and move forward, backward, and side to side.
This intricate framework of the joint, in combination with its attached muscles and ligaments, enables you to chew, swallow, speak, yawn, and make facial expressions, making TMJ one of the most frequently used joints of the body.
What Is TMD?
Temporomandibular joint and muscle disorders, commonly called TMD, refer to a heterogeneous group of musculoskeletal and neuromuscular conditions that affect the TMJ.
These conditions lead to the misalignment of the complex system of muscles, ligaments, discs, and bones that form the TMJ, preventing them from working as well as they should.
Any injury or inflammation to the TMJ can make the jaw joint and the muscles that control jaw movement quite dysfunctional.
Temporomandibular joint dysfunction (TMD), also known as TMJ syndrome, is often characterized by pain and tightness in and around the TMJ, which can make basic functions such as speaking and eating increasingly difficult. (1)
Statistics point toward a higher incidence of this disorder in the female population than in their male counterparts. But by and large, TMD is a fairly common condition with as many as 10 million Americans afflicted by it.
What Causes TMD?
TMD is commonly caused by the following:
- Malocclusion or poor positioning of your upper and lower teeth such that they do not fit together properly is the primary cause of temporomandibular disorders. (2)
This dental misalignment exerts undue stress on the TMJ as well on the adjoining muscles that are responsible for the jaw movement.
- In many cases, TMD is triggered by some trauma or injury to the jaw bone, joint, or adjoining muscles.
- People with preexisting arthritis are at a higher risk of developing TMD due to the gradual degeneration of the joint brought about by this disease.
- People born with certain structural defects in the jaw are more likely to develop this disorder.
- Getting dental work done can also trigger pain in the TMJ, as the joint is stretched open for extended periods of time.
- People who are in the habit of clenching or grinding their teeth or chewing gum, a pen or pencil, or their fingernails are more likely to develop this condition.
- Wearing ill-fitting partial or full dentures can also pave the way for TMD.
- The use of orthodontic braces can also make you more prone to this kind of problem.
- Poor body posture can exert undue strain on your neck and facial muscles, making you more prone to TMJ pain.
- Not getting enough sleep and nutrition can also contribute to the onset of TMJ syndrome.
- During pregnancy, women secrete a hormone that causes their joints to relax and soften, which ends up worsening TMJ pain.
What Are the Symptoms of TMD?
The signs and symptoms of TMD may show up on just one side of the face or both. The discomfort brought about by this condition can be felt not only in the face but also in the eyes, forehead, ears, and neck. Common signs and symptoms of TMD are:
- Dull, aching pain in the jaw joints and facial muscles, which may radiate to the cheeks, neck, shoulders, and back
- Pain that may persist at resting position and worsen while eating, talking, or simply opening the mouth
- Difficulty biting or chewing food
- Pain that may cause an earache, a ringing or buzzing sensation in the ear, numbness in the ear, and possible hearing loss
- Limited movement of the jaw
- Tenderness in and around the affected TMJ
- Unusual clicking, popping, or grating sound when opening or closing the mouth, which is accompanied by pain and limited movement of the jaw
- Difficulty opening or closing your mouth
- Tension headaches and/or migraines
- An affected joint that gets stuck or “locks” when opened widely and becomes difficult to close
- Pressure behind the eyes and blurred vision
- Sore, stiff, and tight neck muscles and jaw
- Muscle spasms in the jaw when the joint becomes overstretched
- Swelling of the face and mouth on the affected side
- Dizziness, vertigo, and nausea
How Is TMD Diagnosed?
TMD can be quite a challenge as far as diagnosis and treatment are concerned, given how complicated the concerned joint is.
The expertise of more than one medical specialist may be required to unearth the root of the discomfort.
Your doctor will consider all your symptoms and proceed with a thorough examination of your dental cavity to see if your teeth are properly aligned. He/she will physically assess the affected joint and muscles for tenderness.
The area around the jaw and the head will be pressed to locate the sensitive or painful sites.
The doctor will check the range of motion in your jaw and may ask you to slide your teeth from side to side. He/she will closely watch, feel, and listen to your jaw as you open and shut your mouth.
The doctor may even feel the need to prescribe the following tests:
- Dental X-rays to check your teeth and jaw for any abnormalities
- CT scan to take a detailed view of the bones involved in the joint
- MRI to identify any problem with the joint’s disk or surrounding soft tissue
- TMJ arthroscopy, wherein a small thin tube, called cannula, is inserted into the joint space followed by a small camera or arthroscope to view the area from within
Your doctor may then send you to an oral and maxillofacial specialist, an ENT specialist, or a dentist specializing in jaw disorders to confirm the diagnosis.
Medical Treatment for TMD
In most cases of TMD, proper self-care and lifestyle changes are more than enough to resolve mild-to-moderate symptoms. Your doctor may recommend the following treatment options: (3)
- Your primary care provider, dentist, or physical therapist can recommend appropriate exercises to gently stretch, relax, or massage the muscles around your jaw.
- TMJ patients may be given biofeedback training as well to help them manage their involuntary stress responses like stiffening of the jaw muscles, which may exert undue strain on the TMJ joint.
- Physical therapy involving specially designed jaw exercises can strengthen the muscles, improve flexibility, and facilitate a range of motion.
- If over-the-counter pain medications fail to provide considerable relief, your doctor could prescribe something a little stronger but only for a short period of time.
This includes muscle relaxants, analgesics, tricyclic antidepressants, nerve pain medications, sedatives, anti-anxiety drugs, and anti-inflammatory medications.
- If the TMJ syndrome is caused by involuntary grinding and clenching of the teeth during sleep, you may be advised to wear a prosthodontic appliance such as a night guard (bite guard) or an oral splint (bite plate).
These occlusal devices are custom-made to fit your mouth and are inserted between the upper and lower teeth to keep them from grinding against each other.
- People whose TMD stems from a preexisting degenerative condition such as osteoarthritis are often prescribed steroid injections for temporary or permanent relief from the discomforting symptoms associated with this condition.
- In some cases, Botox injections may be used to relax the jaw muscles that control chewing.
- Surgery is the last resort for TMD treatment and is only recommended when there is something wrong with the actual joint itself. Some cases can be resolved by minimally invasive procedures such as TMJ arthrocentesis or arthroscopy, whereas others warrant an open-joint surgery to fix the structural problems in the joint.
In rare cases, when the movement of the jaw becomes extremely limited and the symptoms are long-lasting, a total joint replacement may be needed.
That said, most patients with TMD do not require extensive medical care to improve their condition.
The symptomatic discomfort associated with an uncomplicated case of TMJ syndrome usually resolves with the help of simple self-care practices and prescribed home treatment.
How to Relieve TMD Pain at Home
Here are some ways that can relieve the discomfort associated with TMD.
1. Practice Self-Care
- It is best to consume small but frequent meals throughout the day instead of eating the conventional three large meals in a day. Going without food for long periods can lead to blood sugar fluctuations that are often responsible for increased grinding of the teeth.
- As your jaw is not in the best of condition, it is important to keep its movement minimal. Thus, chewing gum is strictly ill-advised.
- You can consult your doctor about the suitability of wearing a mouth guard to prevent nightly teeth grinding or clenching if you happen to suffer from such tendencies.
- Consuming soft foods that do not require a lot of chewing helps to rest your jaw and calm the joint inflammation. It may help to cut your food into small pieces.
- Take small bites of food, which are easier to chew and do not put undue stress on your jaw.
- Learn stress-reducing techniques to help control muscle tension in the jaw, such as yoga, meditation, and deep breathing.
- Keep your jaw in a relaxed position at all times by making a concerted effort to slacken your jaw muscles. The resting position of your jaw should be such that a slight gap between the upper and lower teeth is maintained while the tongue rests on the floor of your mouth with your lips barely coming together.
- If you feel a yawn coming on, try not to open your mouth too wide as it can strain your jaw further.
- Swear off crunchy solid foods that demand a lot of jaw-action for chewing. Instead, include easily chewable soft foods such as pasta and soup in your diet to minimize the strain on your jaw.
- Sleeping on your back or side.
- Maintain correct posture if you spend a lot of time working at a desk.
- Do not talk on your mobile phone for long hours.
2. Apply a Cold/Warm Compress
a. Cold Compress
Topical cold therapy is a safe and easy-to-follow method to ease the pain encountered by patients with TMD. (4)
When you apply an ice pack or a cold compress to the side of your face, the cold temperature exerts a mild anesthetic effect that may help desensitize the nerve endings in the area.
The numbing of the pain-ridden area may help reduce your distress, at least for a temporary period. (4)
b. Warm Compress
Gentle heat therapy may yield positive results for TMD pain relief by stimulating blood flow to the affected region.
The application of a warm compress over the jaw and the surrounding areas where the TMD pain can be felt may help relieve muscle tension and jaw stiffness to some degree.
If nothing else, the warm, comforting sensation helps distract your mind from the unabating pain.
Even if the respite is short-lived, this technique is worth a try as a preventative tool against mild TMD pain.
However, as therapeutic as it may be, a warm compress is largely ineffective in extreme cases of pain.
Conclusion: Heat therapy has been found considerably useful for TMD pain relief, provided that you apply just enough heat that is well within a tolerable degree.
3. Give Your Jaw Some Rest
Primary care for TMJ syndrome entails keeping your jaw relaxed and stress-free as much as possible.
You must ensure that your jaw is well rested for the strained muscles and joints to heal faster. Overexerting your jaw even when the TMD symptoms are still minimal will only make them worse.
On the contrary, resting the jaw during the initial stages of the disorder may help slow down or prevent further damage.
This is further echoed by a 2017 scientific review that pooled in the results of various studies on the management of TMD. (5)
The findings of this review showed that keeping your jaw in a resting position as much as you can while avoiding wide mouth opening is the preliminary step for relieving pain and other discomforts associated with TMD. (5)
The importance of resting your jaw cannot be emphasized enough, especially at the onset of this condition. As your myofascial muscles are already quite strained, minimizing jaw movement may help prevent further damage.
4. Give Your Jaw a Gentle Massage
Treating yourself to a gentle jaw massage may help relax the muscle tension and stimulate blood supply to TMD-affected area.
Excessive clenching or grinding of the teeth can exert undue stress on the adjoining jaw muscles, resulting in myofascial pain, which may be corrected in part through massage therapy.
The effectiveness of massage therapy for TMD-related pain relief is highlighted by a 2015 review, which stated that this kind of physical stimulation helps relieve tissue swelling in and around the jaw and stretch out the affected muscles to restore their proper flexibility. (6)
However, for the massage to work, it must be done correctly or else it can aggravate your condition. (6)
Another 2012 review published in Advances in Clinical and Experimental Medicine lent further support to the use of massage therapy as a simple, easy-to-follow treatment strategy for TMD myofascial pain. (7)
Scientific analysis tilts in favor of using massage as a complementary therapy for relieving TMD-related pain, but the technique is extremely important for this method to bear fruit. It is best that you consult your doctor to show you how to do it correctly.
5. Perform Jaw Exercises
Manually stimulating your jaw with the help of simple exercises is beneficial for patients with TMD.
These exercises can work as adjunctive measures to improve the mobility and function of your jaw.
According to a 2010 study published in the Journal of Dental Research, TMJ exercises are likely to fetch better results than using a mouth guard for increasing the extent to which you can open and move your mouth in the case of TMJ disc displacement. (8)(10)
On the contrary, a 2016 systematic review and meta-analysis of 48 randomized controlled trials presented little to no definitive evidence that would suggest that manual therapy or exercise is a superior alternative to the traditional treatment strategies rendered to patients with TMD. (9)
That said, this grand review does not disqualify the potential merits of manual therapy when used by itself or in combination with jaw or neck exercises to alleviate TMD symptoms.
There is, however, a pressing need for more research to garner high-quality evidence in support of manual therapy as a legitimate treatment intervention for TMD. (9)
Jaw exercises hold a great deal of promise as a potential treatment strategy for TMD pain, which needs to be further explored through rigorous and high-quality research. The current studies available on the adequacy of using this intervention neither confirm nor deny its benefits for patients with TMD in a conclusive manner.
6. Try Acupuncture
Acupuncture is an ancient healing technique rooted in traditional Chinese medicine that may hold some promise for the redressal of TMJ syndrome.
The procedure typically involves the insertion of hair-thin needles at specific acupoints that lie along the meridians of your body to release tension, stress, and pain.
Because this technique is remotely invasive, it must be performed by the trained hand of a specialist.
The findings of a 2017 meta-analysis of 9 eligible studies involving 231 patients encouraged the use of acupuncture therapy as an adjunctive tool for reducing the intensity of myofascial pain in patients with TMD. (11)
However, the study is not without limitations, which must be taken into account to get a more realistic understanding of the results. (11)
Several clinical trials included in the review failed to meet all the inclusion and exclusion criteria, and some were found lacking essential information on basic characteristics.
Needless to say, there is a need for more advanced and sound clinical studies to decisively establish positive results from this kind of preliminary research. (11)
Meanwhile, another systematic review and meta-analysis of seven randomized control trials assessing the effectiveness of acupuncture for TMD produced inconclusive or limited evidence. (12)
Thus, further research is warranted to confirm the therapeutic potential of this alternative treatment strategy to address TMD symptoms.
The potential benefits of acupuncture for patients with TMD need to be further investigated, as scientific studies on the topic have produced conflicting results so far.
7. Use Capsaicin Cream for Pain Relief
Capsaicin is known to exhibit some degree of pain-relieving and anti-inflammatory activities that may be beneficial for relieving TMD-related jaw pain.
One 2017 double-blind, vehicle-controlled clinical trial demonstrated that the topical application of a high-concentration (8%) capsaicin cream to the affected area of the jaw resulted in a significant decline in TMD pain. (15)
However, one cannot look past the relatively small sample size of the said study while analyzing its results.
For these results to be truly representative of TMD groups at large, more large-scale studies are warranted to evaluate the efficacy of capsaicin as a legitimate treatment option. (15)
The topical application of capsaicin produces a warming sensation that may stimulate blood circulation in the affected area and produce a pain-relieving effect.
However, if applied on ruptured or irritated skin, capsaicin cream is most likely to sting and aggravate your discomfort.
Although there is some scientific evidence attesting to the positive effects of capsaicin cream on patients with TMD, research fails to establish a direct and exact relation between capsaicin and TMD relief. Thus, more extensive studies are warranted to gain clarity on the subject.
8. Sign Up for Professional Care (Chiropractic or Osteopathic Manipulative Therapy)
Chiropractic care has emerged as a popular adjunctive technique for the relief of the pain associated with TMJ syndrome in a natural and noninvasive manner.
It is a multifaceted approach that involves a gamut of therapeutic tools, including customized exercise routines, massage, lifestyle counseling, and the administration of pressure and palpation for pain relief.
This mixed bag of procedures may help alleviate the tension in your jaw muscles, promote blood circulation in the affected area, and improve the mobility of your TMJ.
This is further corroborated by a 2015 study published in the Journal of Chiropractic Medicine, which concluded that proper chiropractic care could help mitigate the symptoms of TMD. (13)
However, for this technique to yield the desired results, it is essential that you seek the qualified expertise of a qualified and well-reputed chiropractic specialist.
You can also sign up for a more hands-on therapy known as osteopathic manipulative treatment (OMT). This technique is usually above the paygrade of a regular chiropractor and requires the trained expertise of an osteopathic physician (DO).
To be adept at OMT, a health professional needs to have a thorough understanding of the body’s musculoskeletal system, which includes a complex web of muscles, nerves, and bones.
DOs receive advanced specialized training about the workings of the musculoskeletal system as part of their education.
Given that all these elements are interconnected within the body, the health and functioning of one element impact the other.
OMT is a physical therapy intervention that involves stimulating these connected patterns by stretching, gently pressing, and applying resistance to the patient’s muscles and joints in such a way that provides relief.
A recent systematic review to gauge the effectiveness of physical therapy for patients with TMD favored the use of dynamic multidimensional exercises, manual mobilization, and postural training along with other TMD interventions for symptomatic relief. (16)
The conclusion of this systemic review has since been validated by subsequent research on the topic.
However, the findings of the studies conducted in the wake of the previous reviews to evaluate the adequacy and potential of physical therapy for the treatment of TMD are not very conclusive and need to be replicated on a larger scale.
That said, research-based evidential data, by and large, continue to support the use of such interventions either as a stand-alone treatment or in tandem with other traditional TMD therapies.
OMT, for instance, was found to induce positive changes in the stomatognathic system comprising the teeth, jaws, and associated soft tissue, which are the most severely affected by TMD. (14)
Much of the discomfort associated with TMD is restricted to this system alone. Thus, all in all, OMT and other such physical therapies can help provide some degree of relief to patients with TMD and can assist in their faster recovery.
Types of TMD
The bones within the TMJ are covered with a protective layer of cartilage where they meet each other and are separated by a soft, rubbery disc that helps to absorb the shock from chewing and other jaw movements.
Both these elements help to keep the movement of the TMJ smooth and seamless. Researchers generally agree that the TMD conditions fall into three main categories:
Facial Muscle Imbalance: One common form of TMD is characterized by myofascial pain, which is caused by facial muscle imbalance due to incorrect chewing habits or unfavorable facial expression habits.
For instance, people who tend to chew their food on one side of the mouth will naturally develop tighter muscles on that side than those of the side that is used less often.
In such a case, the flexed side will pull the jaw toward itself, causing stiffness in one side of the jaw and leaving the other relatively weak and loose.
The pain and discomfort in the muscles that control jaw function will initially be more noticeable on the looser side and can gradually be felt in and around the affected joint.
Internal Derangement of the TMJ: TMD can also stem from internal derangement of the TMJ, possibly due to disc displacement, jaw dislocation, or injury to the rounded ends of the lower jaw known as condyle.
The TMJ, like any other joint, is an intricate structure made up of various structural elements. One key component of this joint is an articular disc that is located between the skull and the lower jawbone and acts as a rubbery buffer between the two.
If the TMJ remains misaligned or out of balance for a prolonged period, this disc may slip out of its normal place and protrude forward.
The dislocation of this disc creates a vacuum in its place, which causes your joint to produce a clicking or popping sound when opening your mouth.
You may also experience a locked jaw, the inability to open your mouth, especially immediately after waking up in the morning. The pain often develops on one side of the jaw initially. (1)
Arthritis: Arthritis affects TMJ, just as it affects other joints in the body. Osteoarthritis can cause progressive degeneration of your TMJ due to the loss of cartilage.
Rheumatoid arthritis, on the other hand, is associated with the inflammation of the TMJ, which can also cause deformation of the joint in extreme cases.
Arthritis-induced TMD is characterized by a gradual breakdown of the joint surfaces, causing pain and grinding noises during movement of the jaw.
Risk Factors for TMD
The following medical conditions may increase your risk of TMD:
- Women between the ages of 18 and 44 years are more prone to developing TMJ syndrome than men. The risk is particularly high among women in their childbearing years, and so a possible link between the female hormone estrogen and TMDs is suspected.
- TMD is also more prevalent among people who grapple with preexisting ailments characterized by chronic pain, such as lower back pain and headaches.
- People who have a poor neck and back posture often suffer from neck strain and malfunctioning jaw muscles.
- Stress is often held responsible for increased muscle tension in the jaw, which leads to increased clenching and sets the ground for TMJ syndrome.
- Patients with chronic inflammatory arthritis, which includes osteoarthritis, rheumatoid arthritis, and fibromyalgia, are more likely to develop this disorder.
- People with jaw or facial deformities, jaw trauma including fractures and dislocations, misaligned teeth (crooked teeth), or a misaligned bite have an increased risk.
- Certain inherited factors such as a low threshold for pain and increased stress responses can also make one more likely to develop TMJ syndrome.
- Certain genetic factors related to psychological health and inflammation may increase the risk for TMJ syndrome, as well.
When to See a Doctor
A visit to the dentist is called for if you experience the following symptoms that may indicate a possible case of TMD:
- Difficulty in jaw movements
- Intense pain in and around the jaw area
- Clicking and popping sounds when you move your jaw
The doctor will conduct a physical examination and may order an X-ray, CT, or MRI scan to diagnose the condition and rule out other possibilities.
If your jaw becomes locked in a wide-open or closed position, you are advised to get yourself to a hospital’s emergency department.
Expert Answers (Q&A)
Answered by Dr. Jeffrey L. Brown, DDS (Dentist)
This is a good question. It all depends on how long it takes for the discs to move back into proper position, it all depends on whether or not the distortions to the cranial bones correct in short order or do they need a lot of time.
I generally tell our new patients that I need to work with them for about a year, and then we re-assess where we are at. Sometimes they are done at this point; other times they need more time to keep moving in the right direction.
Not at all. In almost all cases, we are able to help TMD patients, and they are able to resort to most normal activity. Think of it like a broken bone – you wear a cast for a while, then do physical therapy and rehab, then go back to normal life.
If you wait too long and ignore the initial signs of TMD, damage may occur, which is more difficult to treat. In those cases, TMD treatment will be needed and then possible surgical intervention to help reduce inflammation in the joints.
When the discs in the joints are out of place, they tend to rub against the condyle/jaw bone, and inflammation builds up.
Chronic inflammation can lead to erosion of the condyles and degenerative arthrosis, which is difficult to repair. It can lead to a need for total joint replacement, but none of my patients have ever had to do that because we treat them long before it goes that far.
So if you leave the TMD issues alone for too long, then the chronic inflammation sets in, and bone erosion occurs. We see this frequently when a patient says they have had TMD symptoms for many years.
We advise all our TMD patients to do a hot bath each night with Epsom salts and lavender or chamomile to reduce inflammation. Massaging the face and the joints will help to loosen muscles.
It is also important to not lift heavy objects or work out too hard at the gym as your body is trying to heal. If you have TMD, you do not want to stress out the joints. Stick to a soft food diet. Apply alternate heat and ice on the jaw joints.
Meditation and yoga are also great ways to reduce stress. Stress causes grinding and clenching in the jaw joints, which irritates the jaw joints when TMD is present.
Throughout the day, try and keep your tongue on the roof of your mouth, with your teeth apart and lips closed. This will help take the pressure off of the jaw joints as well. You can also do many at-home myofunctional exercises to relieve pain as well.
Absolutely. When the discs are displaced in the jaw joints, this can lead to inflammation in and around the ear canal, which can cause tinnitus.
Tinnitus is a very, very common TMD symptom. It is also something that occurs when the discs have been out of place for a long period of time.
Sometimes. As you lay back and the jawbones or condyles slip back into the sockets, this can put more pressure on the discs and cause more pain.
Also, at night, people are more prone to grinding and clenching their teeth. When there is TMD present, a person may wake up with a lot of facial and jaw pain.
Our office creates non-invasive customized dental appliances to help take the pressure off the jaw joints and align the cranial bones.
When you reduce pressure on the jaw joint area, the symptoms of TMD start to dissipate. We have had great success in helping patients conservatively using ALF, modified splints, and sleep appliances.
I try to explain to our patients that a slipped/displaced disc is kind of like having a broken bone. You need to ‘set’ it so it can heal.
So when we put our appliances into place, this allows the joints to heal and gives the discs a chance to get back into proper position. Unlike in your back, about all you can do is surgery; with TMD the appliances allow the discs to heal and go back into place much more readily.
The key is that when popping and clicking have started, that is the time to begin treatment. The clicking and popping are the early warning signs that you have a problem and should deal with it. This gives us the best chance to fix things in the simplest way possible!
The most important tip I can give you is if you are experiencing any of the symptoms below, see a TMD specialist. TMD was barely taught in dental school, so your dentist may not be aware of the jaw joints dysfunction.
We hear all of the time, “if the popping and clicking in your jaw don’t hurt, don’t worry about it!” This is simply not true.
Please take initial TMD symptoms seriously so you can easily fix the problem, instead of waiting until you are experiencing pain.
About Dr. Jeffrey L. Brown, DDS: Dr. Brown grew up in Maine and went on to Graduate Magna Cum Laude from Bowdoin College. He entered into the Georgetown School of Dentistry and completed his studies from there in 1986.
He has knowledge expanding over the fields of TMJ, sleep, and orthodontics that has given him an unlike edge over other practitioners who perform only the basic dentistry.
In addition, Dr. Brown has also learned the advanced techniques and medical procedures involved in expanding an airway so that both children and adults can breathe better. He completed his training at the famous Sleep Medicine Center.