Temporomandibular disorders (TMD)
Jaw pain, clicking, locking or difficulty opening your mouth: what it means, where it comes from and how it is treated.
“TMJ” is the name of the temporomandibular joint, the joint between the lower jaw and the skull, in front of the ear. As a term, “TMJ” is not a diagnosis: temporomandibular disorders (TMD) are several different problems of the chewing muscles and of the joint, with different treatments.
They are one of the most common causes of facial pain after toothache. The good news is that most patients improve with simple, conservative treatment.
Muscle pain (myalgia)
Most often, what people call “TMJ” comes from the chewing muscles (the masseter, on the cheek, and the temporalis, on the temple), not from the joint. It feels like a dull ache, tightness or tiredness in the cheeks and temples, sometimes also in the ear or teeth, especially in the morning or after chewing.
What keeps it going is usually clenching and grinding (bruxism), stress, poor sleep, habits such as chewing gum or biting nails, and sometimes posture.
Joint problems
- Joint pain (arthralgia): pain right in front of the ear, worse when chewing or opening wide.
- Disc displacement: a small disc in the joint changes position. You hear it as a click when opening or closing. On its own, a click with no pain and no locking doesn’t need treatment (see the article Jaw clicking).
- Locking: the mouth won’t open wide (closed lock) or, rarely, won’t close (open lock). A recent lock should be assessed quickly.
- Degenerative changes (TMJ osteoarthritis): wear of the joint surfaces, with grating or crunching on movement; not always painful.
- TMJ arthritis: inflammation of the joint, sometimes as part of a rheumatic disease; we treat it together with the rheumatologist.
Signs worth a consultation
- pain in the cheeks, temples or in front of the ear lasting a few weeks or coming back
- pain when chewing, yawning or talking
- limited, deviated or painful mouth opening
- jaw locking, even briefly
- headache or earache that gets worse with jaw movement
- a feeling that your bite “isn’t the same”
Diagnosis
The diagnosis is made mainly by talking and examining: feeling the muscles and joints, measuring mouth opening, listening to joint sounds (details under the orofacial pain consultation). Imaging (CBCT for the bone, MRI for the disc) is recommended only when it can change the treatment, for example with locking, after an injury or when arthritis is suspected.
Treatment
Treatment is step by step and reversible:
- information and self-care: soft food for a while, avoiding gum and very wide opening, warm compresses, resting the muscles, watching for daytime clenching
- exercises for the jaw and, if needed, physiotherapy
- medication, for limited periods, where indicated
- an occlusal splint, especially with sleep bruxism
- therapeutic injections (for example botulinum toxin or trigger-point injections) when muscle pain doesn’t respond to the earlier steps
- working with other specialists (physiotherapist, rheumatologist, psychologist, maxillofacial surgeon for the rare cases that need a procedure)
We don’t recommend irreversible treatments, such as grinding the teeth or dental work to “correct the bite”, as a treatment for TMJ pain.