TMJ Disorders (Temporomandibular Disorders)

How the jaw joint works

The temporomandibular joint (TMJ) connects the lower jaw (mandible) to the skull just in front of each ear. A small cartilage disc cushions the joint and allows smooth hinge and sliding movements for talking, chewing and yawning. Powerful muscles, including the masseter and temporalis, move the jaw.

Types of TMJ disorders

For an overview of jaw joint problems generally, see temporomandibular joint disorder.

Symptoms

• pain or tenderness in the jaw, in front of the ear, cheeks or temples
• clicking, popping or grating sounds when opening or chewing
• difficulty or pain when opening the mouth wide or chewing
• the jaw locking open or closed
• earache or ear fullness without infection
• tension-type headaches, especially at the temples
• neck and shoulder pain
• tooth pain or sensitivity from clenching
• ringing in the ears in some people
• a change in how the teeth fit together

Painless clicking alone is very common and usually needs no treatment.

Causes and risk factors

• bruxism: clenching or grinding teeth, especially at night
• stress and anxiety, which increase muscle tension
• jaw injury, such as a blow or whiplash
• arthritis: osteoarthritis, rheumatoid arthritis and juvenile arthritis
• habits: gum chewing, nail biting, chewing on pens, leaning on the jaw
• long dental procedures with the mouth open
• posture: forward head posture
• other pain conditions: fibromyalgia, migraine, chronic back pain, irritable bowel syndrome
• sleep problems, including sleep apnea
• female sex and genetic factors

Diagnosis

A dentist, oral surgeon or physician will:

• ask about pain, sounds, locking, habits and stress
• examine jaw movement and opening, listen for sounds and press on the joint and muscles
• check the teeth and bite

Imaging is not needed for most people. It is used when the diagnosis is unclear or before procedures:

• panoramic dental X-ray or cone beam CT for bone and arthritis
• MRI to show disc position and joint inflammation

Treatment

Most people improve with simple, reversible treatments, often within weeks to months.

Self-care

• eat soft foods and cut food into small pieces
• avoid gum, hard or chewy foods and wide yawning
• apply warm, moist heat or cold packs to the jaw
• keep teeth apart with lips together and tongue resting on the roof of the mouth
• avoid resting your chin on your hand
• manage stress with relaxation, breathing exercises or mindfulness
• improve posture and sleep habits

Jaw exercises and physical therapy

Gentle stretching, controlled opening and posture exercises help many people. A physical therapist may use manual therapy, ultrasound or other techniques.

Medicines

• over-the-counter pain relievers such as ibuprofen or acetaminophen (paracetamol), following the label dose
• short-term muscle relaxants at night
• low-dose tricyclic antidepressants for chronic pain
• steroid injections into the joint for arthritis in selected cases

Oral appliances

A custom night guard (occlusal splint) made by a dentist can protect teeth from grinding and may reduce pain. Over-the-counter guards are less reliable.

Other treatments

• cognitive behavioral therapy for chronic pain and stress
• botulinum toxin injections into the chewing muscles for some people with severe clenching (off-label)
• procedures: arthrocentesis (washing out the joint), arthroscopy, or, rarely, open joint surgery or joint replacement for severe structural problems

Irreversible treatments such as grinding down teeth or extensive orthodontic work to change the bite are generally not recommended for TMD.

Outlook

TMJ disorders often improve on their own or with conservative care. Some people have recurring flares during stressful periods. A minority develop chronic pain that benefits from a team approach.

Frequently asked questions

What are the symptoms of TMJ disorders?

Common symptoms are pain in the jaw, in front of the ear or at the temples, clicking or popping, difficulty opening the mouth wide or chewing, jaw locking, earache, headaches and neck pain. Symptoms often worsen with chewing or in the morning after night-time clenching.

What causes TMJ disorders?

TMJ disorders result from muscle tension, teeth clenching or grinding, displacement of the joint disc, arthritis, jaw injury, stress and certain habits like gum chewing. They often occur with other pain conditions such as migraine and fibromyalgia.

How do you fix TMJ pain?

Most TMJ pain improves with self-care: soft foods, avoiding gum and wide yawning, warm compresses, jaw exercises, stress management and over-the-counter pain relief. A dentist may suggest a custom night guard, and physical therapy can help. Surgery is rarely needed.

Is jaw clicking a sign of TMJ?

Jaw clicking is common and often harmless, especially if painless. It usually comes from the disc slipping as the jaw moves. If clicking comes with pain, locking or difficulty opening the mouth, see a dentist or doctor for assessment.

Can TMJ disorders cause ear pain and headaches?

Yes. The jaw joint sits just in front of the ear, so TMJ problems often cause earache or fullness without infection. Tension in the chewing muscles also commonly causes headaches at the temples and forehead.