The temporomandibular joints on each side of your face are two of the most complex joints in your body. They’re unique in that they not only hinge open and closed, but also slide forward and backward. These dual movements allow you to chew, talk, and yawn.
Though sturdy, the temporomandibular joints are still vulnerable to injury and disease. Problems with these joints or their surrounding muscles and other structures is called temporomandibular dysfunction (TMD). Its hallmark symptom is pain or tenderness in the jaw area that’s usually worsened with chewing,jaw clenching, or yawning. Other symptoms may include radiating pain to locations in the head, neck, and shoulder region; decreased range of motion in the temporomandibular joint; joint noises (clicking, popping, grating) with temporomandibular joint motion; headache; stiffness in the jaw muscle; limited jaw movement; a locked jaw; or the perception of ear or tooth pain. TMD can also cause decreased hearing or ringing in the ears (tinnitus).
TMD is sometimes referred to as TMJ—or temporomandibular joint—syndrome. The temporomandibular joints connect the lower jaw (the mandible) to the temporal bones in the skull. But,while TMD involves those joints, it can also affect the chewing muscles, surrounding ligaments, and other connective tissues. Therefore, TMD is a more accurate name than TMJ syndrome.
Most people experience temporary pain or discomfort that lasts for a few weeks or less. Their symptoms may improve on their own or with conservative treatment. A small portion of people may develop chronic TMD. For an unfortunate few, TMD can be incapacitating.
Finding the cause of TMD
The causes of TMD—as well as the severity and duration of symptoms—vary from person to person, making it difficult to diagnose and treat. Primary care doctors and dentists often diagnose TMD, but finding the reasons behind the disorder (or the cause of TMD-like symptoms) can be a challenge. In fact, the underlying cause is rarely determined with any certainty.
If your pain is severe or long-lasting, you might be referred to another doctor, such as an ear, nose, and throat (ENT) specialist; a neurologist; or a pain specialist. The specialist should have expertise in treating TMD and similar musculoskeletal (bone, muscle, and joint) conditions. You can also check whether an orofacial pain management clinic or a TMD center affiliated with a hospital or university is available near you.
Unfortunately, after years of study there’s still little consensus about the causes of TMD or what treatments are most effective. TMD was once attributed mainly to dental misalignment issues suchas overbites or underbites, but we now know that’s often not the case. Instead, TMD typically stems from more than one factor. The following factors and conditions have been associated with TMD:
- Joint diseases such as osteoarthritis and rheumatoid arthritis
- A traumatic injury to the jaw, such as a blow to the jaw or whiplash, or a jaw dislocation
- Overstretching the jaw, such as during lengthy dental procedures and breathing-tube insertions and from opening the mouth too wide when eating
- Frequent gum chewing, nail biting, pencil chewing, or similar repetitive actions that put a strain on the temporomandibular joint or the muscles used to chew
- Jaw clenching or teeth grinding (bruxism)
- Missing teeth, especially when combined with jaw clenching
- Individual variations in the perception of pain
- Prolonged pressure applied to the jaw, sustained jaw-muscle contractions, or repetitive motions of the jaw such as those that can occur with singing or with playing the violin or wind instruments
- Drug abuse or use of certain prescription drugs that affect the central nervous system
Stress and emotional problems can also contribute to TMD. Studies have linked the condition to mental health conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD).
TMD is most likely to develop in adults between ages 20 and 40, although it can affect people at any stage of life. It’s more common in women, and researchers are studying a possible link between TMD and hormones.
When It's Not TMD: Other Causes of Jaw and Facial Pain
Temporomandibular dysfunction (TMD) isn’t the only possible cause of jaw and facial pain. Ruling out other reasons can help your doctor arrive at the right diagnosis.
Treating TMD—first steps
Treatment of TMD will include general measures—both self-care and doctor-prescribed—as well as treatment directed specifically at the underlying cause, if known. The first line of treatment for most cases involves conservative self-care measures (see inset below), which improve symptoms in many patients.
You might also try an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin, others) to reduce acute pain and muscle spasms. But if you’ve used NSAIDs for more than a few weeks, it’s time to check with your doctor because they can cause serious adverse effects, such as gastrointestinal bleeding, kidney disease, a heart attack, a stroke, or chronic heart failure.
Self-Care Tips for TMD
Treatment of temporomandibular dysfunction (TMD) starts with the recommendation to avoid whatever is triggering your pain. These additional measures can also help.
When jaw pain lasts longer
If your pain hasn’t subsided after two to three weeks, your doctor may prescribe a muscle relaxant to help ease tense jaw muscles or, temporarily, an antidepressant, which can help control pain. TMD caused by grinding can sometimes be relieved with a custom-fitted mouth splint, also called a mouth guard or a bite plate, that you wear while you sleep, although some studies have found splints to be no more effective than self-help methods. This plastic device fits over your upper or lower teeth and helps stabilize the jaw to reduce grinding and clenching and protect your teeth. Splints have downsides, though: They can become less effective over time or cause bite changes when used too long. They can also worsen sleep apnea.
Corticosteroid or hyaluronic acid injections can ease osteoarthritis-related jaw pain for up to six months. Side effects of injections can include redness, pain, and swelling at the injection site, and though rare, infection. People with rheumatoid arthritis should see their rheumatologist, who may prescribe higher doses of their disease-modifying drugs.
Psychological or behavioral therapy may also be a component of treatment to help you deal with your pain. Behavioral approaches such as cognitive behavioral therapy may be able to help break bad habits such as teeth grinding, offer alternative strategies for managing stress, and help relieve anxiety or depression that may be contributing to your disorder. Some doctors recommend physical therapy, but there isn’t good evidence supporting its effectiveness.
Injections of botulinum toxin (such as Botox) are another treatment that has shown inconclusive study results, but it needs further study to determine whether there’s any risk with long-term use, so approach any suggestion for its use with caution.
Alternative ways to find relief
Some types of complementary and alternative medicine, while mostly supported by studies with significant design flaws, might help ease symptoms in some patients. Research suggests that acupuncture, which uses thin needles to stimulate specific points around the body, might help reduce the intensity of jaw pain. A review and analysis of nine studies on acupuncture for TMD published in theMarch 2017 issue of Medicine found that the practice relieved pain and muscle tenderness better than sham (fake) acupuncture and sham laser therapy. Serious adverse effects are uncommon.
In an older (2007) study, researchers found that people suffering from acute TMD responded well to relaxation training, biofeedback, distraction therapy, and related techniques. If your condition has resulted in chronic pain, such therapy might be useful.
TMD treatments to question
More permanent TMD treatments aren’t recommended. Crown and bridge work to balance the bite, orthodontics to realign the teeth, and occlusal adjustment—grinding down the teeth to create a more aligned bite—are irreversible, and they can sometimes make the problem worse.
Some practitioners advise surgery for severe and persistent cases, but it should be considered only as a last resort. Surgery is used for the small number of people who have a structural problem that causes severe, persistent pain, or for those whose jaw has locked to the point that they can’t comfortably eat or talk.
Procedures to treat TMD include arthrocentesis, which uses a needle to remove fluid and relieve pressure on the affected joint, and arthroscopic surgery to reshape or fix the damaged joint. Jaw implants are a bad idea, and reconstructive surgery can have disastrous results.
Studies haven’t confirmed the safety and effectiveness of these procedures, nor which people with TMD they’re most likely to help. If your doctor recommends a surgical procedure, ask about the risks and find out what alternatives are available before moving forward—and then get a second opinion. Most TMD experts say surgery has no place in TMD treatment.
This article first appeared in the March 2019 issue of UC Berkeley Health After 50.
Also see Dealing with Jaw Pain.
Published March 19, 2019