TMJ / Jaw pain

What is it TMJ / Jaw pain?

We use our jaws to chew, talk, drink, and even yawn. Our jaws are meant to help us open and close our mouths. Chronic jaw pain is called TMJ which stands for the temporomandibular joint. TMJ is not a disorder, but instead the name of the joint involved in the disorder. The correct medical term for jaw pain is TMD, temporomandibular dysfunction, or disorder.

It is estimated over 10 million Americans suffer from jaw pain. The average age range is between 20-40 years old, and it affects women more than men. Jaw pain occurs at the TMJ which is in front of your ear. At this juncture point, it is where the lower jawbone, mandible, connects to the skull. The jaw is the strongest face bone, and it holds your teeth in place, but where it forms the TMJ, it is susceptible to injury. (diagram of the jaw?)

The TMJ is a hinge joint, its main motion is up (closed) and down (open), but it also has minimal movement side-to-side or a gliding motion. There are four main muscles to help with movement of your jaw:

  • Temporalis Muscle- jaw closure
  • Masseter Muscle- jaw closure
  • Lateral Pterygoid Muscle- jaw opening, side-to-side and forward movements
  • Internal Pterygoid Muscle-jaw closure

These muscles are very powerful and if overused, which is not common, can cause jaw pain. Often it is the meniscus disc, which provides cushioning within the joint space, that it the culprit to jaw pain. The meniscus moves within the joint space as you open and close your mouth. When the disc is not properly moving or dislocated, this can cause jaw pain, clicking, or popping noises.

Another reason you may experience jaw pain is from wear and tear or degenerative changes to the joint. Sometimes the jaw tissue becomes irritated, inflamed, or possibly arthritis settles within the joint.

There is also a primary facial nerve, trigeminal (known as the “fifth nerve”) that may cause severe jaw and facial pain. Not only is this nerve the largest of the cranial (head) nerves, but it also controls important functions like chewing, swallowing, speaking, hearing, and provides sensory input to your teeth.

When the trigeminal nerve is irritated or inflamed, it can cause severe facial and jaw pain. Also, often people will report headaches and neck pain too. This pain occurs because the nerve originates from the spinal column and lays deep within your neck. Starting at your neck, it branches into three areas of the face-ophthalmic (eye), maxillary (upper jaw), and mandibular (lower jaw). Each area capable of being coupled with jaw pain.

What causes jaw pain?

A few common causes of jaw pain are:

  • Arthritis
  • Bad posture
  • Bruxism (clenching jaw)
  • Displacement of meniscus disc
  • Grinding of teeth
  • Fracture
  • Malocclusion (misalignment of teeth)
  • Trismus (lockjaw)
  • Stress
  • Surgery

There are a few other medical conditions that may cause jaw pain, but are not TMJ-related:

  • Abscessed tooth
  • Cardiac Arrest-heart attack
  • Gum disease
  • Osteomyelitis-bone infection
  • Sinus infection
  • Tooth decay
  • Tumors or cysts

Symptoms of TMJ / Jaw pain

Common symptoms of jaw pain are:

  • Aching around the ear, or just in front of the ear
  • Clicking
  • Difficulty chewing
  • Dizziness
  • Headache
  • Facial pain
  • Fatigue of the jaw
  • Loss of range of motion (locked)
  • Neck ache
  • Numbness
  • Periodontal disease (tooth decay)
  • Popping
  • Ringing in ears
  • Swelling
  • Tenderness to touch

Seek immediate medical attention if you are experiencing the following symptoms, as they may be related to a heart attack:

  • Chest or middle of the back pain or pressure
  • Dizziness
  • Left arm pain or numbness
  • Nausea
  • Shortness of breath

How is jaw pain diagnosed?

If you get regular check-ups of your teeth, then your dentist is usually the first to diagnosis if you have TMD. During your exam, your dentist checks range of motion of your jaw as well he or she assesses for tenderness, popping, or clicking with jaw movements. Also, once per year your dentist will most likely take X-Rays of your teeth and jaw. He or she may also look at the integrity of the TMJ with the image results.

Not all of us see our dentist on a regular basis, so in this circumstances, or, if you are in-between your check-ups and are experiencing jaw pain, either your physician or physical therapist are commonly the second in line for diagnosing TMD.

Same as with your dentist, both your physical therapist (PT) and physician will check for a range of motion, clicking, popping, grinding, or tenderness around your TMJ. Your physical therapist will also assess your neck during his or the exam. Commonly jaw pain and neck pain go hand in hand. Because the trigeminal nerve can be a common culprit to jaw pain, your PT will determine if this is a primary cause of your jaw pain.

A physical exam is the most common form of diagnosing TMD. Imaging such as an X-Ray may be used by your dentist to confirm the diagnosis. Rarely is an MRI used for diagnosis of jaw pain.

Treatment

With the early onset of symptoms, it is best to seek out a proper diagnosis and treatment. The earlier you seek intervention for your symptoms the less debilitating they become, and the more likely conservative care will resolve your pain.

Begin conservative care with a few of the following tips:

  1. While sleeping, if you grind or clench your jaw, your dentist may need to fit you for a mouth guard to help protect your teeth and minimize the stress caused on the TMJ from this activity.
  2. Over-The-Counter (OTC) meds like ibuprofen or naproxen may help alleviate the intensity of your symptoms. OTCs are not a cure to the problem, but they can help manage your symptoms. Always check with your pharmacist or physician before taking any medications.
  3. Apply ice to the jaw and side of the face where symptoms are prevalent for about five mins a couple of times per day. For some, applying heat helps more than the cold pack treatment.
  4. Eat soft foods like cooked vegetables, fish, yogurt, or oatmeal.
  5. Avoid overextension of your jaw while yawning.
  6. Avoid over chewing gum or other chewy foods and candies like beef jerky or taffy.
  7. Don’t rest your chin in your hands as this only exacerbates a clenched jaw and compresses the joint.
  8. Focus on good posture. Forward head posture is a big culprit to the neck, head, and jaw pain.
  9. Avoid sleeping on your stomach which increases neck rotation and stresses the TMJ.

These tips are a good starting point to managing your jaw pain. In most cases of TMD, seeking treatment from a PT is recommended. In most states, you can be seen by a PT first, without a physician’s order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.

After a complete examination of your neck, jaw, and head, your PT will establish a customized treatment plan for you. Since most often the trigeminal nerve along with neck and facial muscles are involved with TMD, your PT will work with you first on managing your musculoskeletal symptoms. Beyond that, he or she will begin manual treatment, cervical spine (neck) alignment, proper muscle tone and balance, and improve posture. With treatment progression, gentle strengthening along with training on proper posture and head alignment will be important for long-term resolution of symptoms.

In rare cases when conservative treatment for lockjaw or severe TMD is not working, your dentist may perform a minor surgery called arthrocentesis which is a minimally invasive procedure. Your dentist cleans out and removes any damaged tissue in the TMJ and makes sure your meniscus disc is in its proper place.

Next Steps

Jaw pain can be annoying and debilitating. If you experience frequent clicking or popping of the jaw, or, facial pain including headaches and neck pain, visit your dentist, physician, or local PT. The sooner you address your symptoms, the more likely conservative care will work for you.

As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider, like a physical therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.

To get started with conservative care today, you can find a highly qualified PT in your area. There are many qualified PTs, so to find one near you, please click on Find A Clinic. This link will help you find a PT that has top national rankings for treating TMD.

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