Jaw Pain and TMJ: What It Is and What Actually Helps

Patients often tell me, "I think I have TMJ." Technically, everybody does. TMJ stands for temporomandibular joint, and you have one on each side of your head, just in front of your ears. What people usually mean is that something about that joint, or the muscles around it, hurts. The clinical term for that is TMD, for temporomandibular disorder, though almost nobody outside a dental office says it that way.

Jaw pain is a frustrating thing to live with, partly because it shows up in odd places. People come in convinced they have an ear infection, a sinus problem, or a bad tooth, and the source turns out to be a muscle that has been working overtime. Here is how I think about it when someone sits down in my chair with a sore jaw.

What it usually feels like

The pattern varies, but these are the complaints I hear most:

• A dull ache in front of the ear or along the side of the face, often worse in the morning

• Soreness or fatigue in the jaw while chewing, especially anything tough or chewy

• Clicking, popping, or grating when you open and close

• Headaches around the temples

• A jaw that feels tight, or that briefly catches before it opens all the way

Clicking on its own, with no pain and no limit on how far you can open, is very common and usually does not need treatment. It is the pain and the loss of movement that matter.

What tends to be behind it

TMD is not one condition. It is a group of problems in the same neighborhood, and the usual suspects are:

• Muscle strain, from clenching or grinding, often during sleep or during stressful stretches

• Trouble with the cushioning disc inside the joint, which can produce clicking or catching

• Arthritis in the joint, which we see more often in older patients

• An injury, such as a blow to the jaw or a long procedure with the mouth held open

Posture, sleep, and stress all feed into the muscle side of this, which is why jaw pain often flares during a hard month at work and settles when life calms down. That is not imaginary, and it is not a character flaw. Muscles respond to load.

What helps, and in what order

The important part, and this is well established in dentistry, is to start with the simplest and most reversible things and give them a real chance. For a lot of people, that is enough. Worth trying first:

• Rest the jaw. Softer foods for a couple of weeks, cut into smaller pieces. No gum, no ice chewing, no chewy candy.

• Avoid opening wide, and support your chin when you yawn.

• Moist heat on sore muscles for ten or fifteen minutes. Some people do better with cold on an acutely painful joint, so use whichever one actually helps you.

• Gentle movement within a comfortable range, not stretching into pain.

• Over-the-counter anti-inflammatories, if your physician says they are fine for you.

• Notice the clenching. Many people hold their teeth together all day without realizing it. At rest, your teeth should be slightly apart.

If that is not enough, the next steps are still conservative. A custom-fitted splint or night guard can take load off the muscles and protect teeth from grinding. Physical therapy for the jaw and neck helps some people a great deal. And because clenching is so often driven by sleep problems or stress, addressing those is part of the treatment rather than a side note.

What I would be cautious about

When a jaw has hurt for months, there is a real temptation to reach for something permanent. I would be careful there. Treatments that permanently change your bite or your teeth, such as grinding down tooth surfaces, extensive crown work done specifically to correct the bite, or surgery, are not first-line care for most jaw pain, and they cannot be undone if they do not help. There are situations where surgery is the right answer, but they are the minority, and they come after conservative care has been given a fair trial. If someone proposes irreversible work early on, it is reasonable to ask why, and to get a second opinion.

When to be seen sooner

Call rather than wait it out if:

• Your jaw locks open or closed, or you cannot open more than a little

• The pain is severe, or has not improved after a few weeks of taking it easy on the jaw

• There is swelling, fever, or a tooth that hurts on its own, which can point to an infection rather than a joint problem

• The pain started after an injury

One more thing worth knowing. Jaw pain can occasionally be a sign of a heart problem rather than a dental one, particularly when it comes along with chest discomfort, shortness of breath, nausea, or pain spreading into the arm or neck. That combination is an emergency. Call 911, not a dentist.

Most jaw pain is not that, and most of it gets better. Still, it is worth having someone look rather than waiting indefinitely, if only to rule out the things that need a different kind of help. At an appointment we check how far the jaw moves, where it is tender, how your teeth meet, and whether there are signs of grinding, and we build a plan from there.

This post is general information to help you understand what might be going on. It is not a diagnosis. Jaw pain has many possible causes, and sorting out yours takes an exam.

Hashimi Dental, 3701 Market St. Suite E, Riverside, CA 92501