The temporomandibular joint (TMJ) is one of the most complex joint structures in the body. When you open and close your mouth, many muscles, ligaments, and joint structures have to all work in conjunction to create a smooth and pain-free movement. Researchers are just now starting to understand exactly how it functions and the best ways to treat pain coming from the area.

TMJ pain and dysfunction (also known as TMD) is an extremely common issue. Some estimates say that close to 15% of the population in the United States suffers from some type of oro-facial pain, including joint pain, muscular pain, headaches, or earaches. In many cases this pain is directly linked to some type of TMJ disorder. Women seek treatment for TMJ pain at a much higher rate than men (especially during the child-bearing years). It isn’t entirely clear whether they have a higher rate of TMD or whether men just don’t seek treatment as often.

For many people, TMJ issues will resolve on their own without any treatment. Unfortunately, a large number of people will also develop chronic or recurring pain associated with the joint that requires some type of treatment. Usually a combination of dental appliances, exercises, and lifestyle changes will create significant relief for these people.

How the TMJ Works (and doesn’t work)

We usually break the TMJ into two major areas when we are discussing it. The first is the joint itself, which consists of the condyle of the mandible, a disc that cushions the condyle as it moves, and the bone of the skull in which the condyle sits and moves. The second is the muscles that move the joint during opening and closing. A large majority of TMJ pain is muscle related and can be managed with simple reversible treatments. This can manifest itself it many different ways including headaches, earaches, soreness, or pain on opening or closing. A much smaller percentage of people develop TMJ pain associated with some type of disorder within the joint itself. There is usually (but not always) clicking, popping, or grating of the joint itself.

Before we get into all that let’s talk about how the joint functions normally. As you start to open the condyle (ball shaped end of your jawbone / mandible) starts to rotate, cushioned by the disc. Once you have opened approximately half-way the joint starts to move forward and down following the bone of the skull. The disc moves with the condyle down this slope. When closing the process just happens in reverse until the condyle is seated back into its home position.

Now that we understand how it should function, let’s take a look at what can go wrong…

Muscular Problems

The majority of TMJ problems are related to the muscular system associated with the joint and jaw. For various reasons the muscles get overworked and end up becoming so irritated that they go into a spasm. Each muscle creates different symptoms when in spasm.

Temporalis – This is a large muscle that extends from the TMJ, up the side of your head. The most common complaint with this muscle is headaches.

Masseter – This large muscle goes from the bottom of your jaw and and ends on the zygomatic process connected to your skull. It is the main muscle for closing your jaw. A common symptom when this muscle is in spasm is mild-moderate pain when you try to open your mouth. Oftentimes you’ll have an ache in your cheek area that is worse when you wake up.

Lateral and medial pterygoid muscles – These smaller muscles are also very important in proper functioning of the TMJ. When having problems with these muscles, you’ll generally feel a more localized pain behind your very back molars towards the TMJ joint. If take your finger and apply some pressure in this area you’ll also have some generalized soreness.

Other Muscles – There are quite a few other muscles that provide a supplementary support in opening and closing your jaw. These include multiple muscles in the front and back of your neck. These can also contribute to some amount of TMJ pain if overworked.

Joint Problems

Less commonly there can be physical problems with the joint itself on top of muscular issues.

The first and most common type of joint problem is when the disc that cushions the joint is “dislocated” in a position where it shouldn’t be. Most of the time it dislocates forward of the condyle. When you open your mouth you hear a nice “pop” sound as the disc pops back into the correct position. When you close again, it oftentimes dislocates back to its forward position and you’ll hear a second “pop” as it dislocates. This is known as dislocation with reduction. The disc can also be displaced in several other directions, each causing a unique pattern of pain and noise as the joint moves.

Occasionally, someone will have a disc that is displaced / dislocated forward of the joint and even when opening and closing, the disc never goes  back to the correct position. This is known as disc dislocation without reduction. Sometimes this will present where you can open partially but at a certain point are unable to open any wider even if you put significant pressure on your jaw. This is one scenario when you should see a professional ASAP. Generally they will create a splint that attempts to recapture the disc into the correct position. If the disc is out of place for too long of a period, adhesions and scar tissue can develop and simple, conservative treatment will no longer be a viable option. These are some of the cases that end up needing surgery.

Some people also eventually develop arthritic or deformed joints from constant bone on bone contact. Sometimes you can hear a grating type sound when you open and close your mouth. At this point it is rare to have any type of clicking or popping sound as the disc has usually degenerated. Some people learn to function with little to no pain and others develop significant pain and dysfunction. For those people who are unable to learn to function, surgery is oftentimes the next step.

TMJ Treatment

Things to Do:

Effective treatments for TMJ problems have been a hotly debated topic for many years now. There are many different types of treatment for TMJ problems and most people will need to use several different techniques in order to gain long term relief. The first thing to understand with TMJ treatment is that you should attempt every type of reversible (non-permanent) treatment that is available before doing anything that will cause permanent changes. Examples of permanent treatment include “bite equilibration” from a dentist or surgery on the joint itself. Except in some very limited situations, these permanent treatments generally aren’t recommended by the most current expert recommendations. See our section on “Things Not to Do” at the bottom of this page. The worst thing that will happen with reversible treatments is that you will have a spent a little bit of money and/or you won’t get any relief (although this is pretty rare). You generally can’t make the problem any worse than it already is with all these reversible treatments. The permanent treatments on the other hand can very well cause long term damage and sometimes make the problem worse. That is why we don’t recommend them until all other options have been attempted!

It is also helpful to remember that the types of treatment also partially depend on what kind of TMJ issue it is. The following are suggestions that are helpful for most people with TMJ problems.

Dental Appliances – There are several different types of dental appliances that can help quickly resolve acute (short term) TMJ problems. See your dentist or local TMJ specialist for options in this area.

Hot compresses – The heat helps relax the muscles and speed the repair process.

Myofunctional therapy and exercises – This is a set of exercises and behavior modification techniques that are designed to help re-educate oral and facial muscles into more positive patterns. Some people attempt these treatments by themselves and other people will need the help of a speech therapist who has specific experience with TMJ problems.

Cognitive behavioral therapy – Many times there is a psychological component to TMJ problems. Cognitive behavioral therapy helps re-orient your thinking. Many studies have shown this to be an effective treatment for reducing the symptoms of TMJ. You can learn CBT techniques on your own, but some people need the help of a licensed psychologist to guide them through this process. I am not a licensed psychologist, but I do have some experience with the process and can give some insight on how to apply these techniques.

Things That May or May Not Help:

Chiropractors. Many people swear that chiropractic treatment has helped significantly with their TMJ issues. There is limited evidence that certain types of chiropractic care can help with some types of TMJ dysfunction. The chiropractic treatment often is similar to physical therapy or massage of the area. People also get some relief as a result of the placebo effect. Because they believe it will help, it actually does reduce pain.

Things NOT To Do!

There are some dentists who will recommend something called “equilibration” in order to treat TMJ issues. Equilibration is when a dentist “adjusts” your bite in order to eliminate any issues with how your teeth come together and function. There are some schools of thought in dentistry that believe that bite problems are the cause of most grinding and TMJ issues. Current research suggests that equilibration is not an effective treatment for TMJ or grinding. It is also an irreversible change to your teeth. Most major organizations involved with TMJ and bruxism recommend that most people should not have irreversible procedures (equilibration or surgery) done unless all other options have been exhausted.

Surgery is also sometimes done for people with TMJ issues. Generally the only people who need surgery are those whose joint/s have physically deteriorated. This can present in several different ways and you need a TMJ specialist to make that recommendation. Again, this is always the last option to consider as there are significant issues with recovery and the results are not consistent.