Where TMJ pain comes from
The temporomandibular joint (TMJ) connects the lower jaw to the temporal bone just in front of the ear, and it works with every bite, every word and every yawn. Problems in this area are known as temporomandibular disorders (TMD). Most often they come from overloaded chewing muscles, less often from the joint itself – a displaced articular disc or degenerative changes.
The overload usually has several causes at once: clenching your teeth during the day, grinding them at night, stress, lack of sleep and habits such as frequent gum chewing. Bite problems play a smaller role than is commonly believed.
Clicking usually means that the articular disc shifts in relation to the head of the jawbone and slips back into place as you open your mouth. This is common, including in people with no symptoms at all. It is only a cause for concern when the clicking suddenly stops and at the same time it becomes harder to open your mouth wide – the disc may then be blocking movement, and you need a dentist’s assessment.
The symptoms often go hand in hand with tension headache and neck pain – which is why we also examine the neck and head position.
What the assessment looks like
We start with the history: when it hurts, what makes it worse, whether you clench your teeth, how you sleep and what dental treatment you have had. Then we assess how you open your mouth – how wide, whether the jaw shifts to one side, whether there is clicking and at what point in the movement. We check tenderness of the chewing muscles and the area around the joint, as well as the mobility of the neck.
The assessment lets us judge whether the problem is mainly muscular or mainly in the joint, and pick up symptoms that need a dental or medical consultation – such as toothache, inflammation or warning signs. X-rays and MRI are rarely needed at the start, and what they show does not always match how severe the pain is.
What really helps
In most people the symptoms settle or ease considerably with conservative treatment. The foundation is education and changing habits: the resting position of the jaw (lips together, teeth apart), catching yourself clenching during the day, a soft diet for a few days and avoiding opening your mouth wide. On top of that come jaw movement control exercises and manual therapy of the chewing muscles and the neck. Research points to a moderate effect of this combination – mainly on pain and on how wide you can open your mouth. Many people feel the first improvement after a few weeks of regular work, but if you have been clenching your teeth for years and are under a lot of stress, the process can take longer.
An occlusal splint can help some people, especially with night-time grinding, but the decision about it belongs to the dentist. Clicking without pain and without restricted movement usually needs no treatment. We describe how we work in detail on the TMJ physiotherapy page.
When to come in and when to see a dentist first
It is worth coming in when jaw pain lasts longer than two or three weeks, comes back during stressful periods or makes eating and opening your mouth difficult. If you have toothache, swelling or a fever, or the symptoms started after an injury, see a dentist or doctor first. If your jaw suddenly locks and you cannot close your mouth, go to A&E. You can arrange an appointment via the Contact page.