The temporomandibular joints (TMJs) connect the lower jaw to the skull, just in front of the ears. Problems with these joints and the chewing muscles are called temporomandibular disorders (TMD), often shortened to “TMJ”. This article explains the symptoms and causes, and the treatment options from self-care to surgery.

Symptoms

Pain or tenderness in the jaw, face, temples or around the ear.
Clicking, popping or grating sounds when opening or closing the mouth. Clicking without pain is common and often needs no treatment.
Difficulty opening the mouth wide, or the jaw getting stuck or locking.
Headaches, earache or a feeling of fullness in the ears.
Pain when chewing.

Causes

TMD often has more than one cause. Contributing factors include clenching or grinding the teeth (bruxism), muscle tension related to stress, jaw injury, arthritis in the joint, and displacement of the small cartilage disc inside the joint. In many people no single cause is found.

Diagnosis

A dentist or doctor asks about your symptoms, examines the jaw muscles and joints, and checks how your jaw opens and moves. X-rays, CBCT or MRI may be used if a joint problem such as arthritis or disc displacement is suspected.

Self-care: the first step

Most people with TMD improve with simple measures, often within weeks to months.

Rest the jaw: choose softer foods, cut food into small pieces, and avoid chewing gum, very chewy foods and wide yawning.
Heat or cold: a warm pack can relax tight muscles; a cold pack can ease acute pain.
Notice habits: keep teeth slightly apart and the jaw relaxed during the day; avoid nail biting and resting your chin on your hand.
Manage stress: relaxation, breathing exercises and regular exercise can reduce clenching.
Gentle jaw exercises as shown by a dentist or physiotherapist.

Other non-surgical treatments

Occlusal splints

A custom-made splint, usually worn at night, can reduce the effects of clenching and grinding and ease symptoms for some people. It should be made and checked by a dentist; poorly fitting or over-the-counter devices can make things worse.

Physiotherapy

A physiotherapist experienced in jaw problems can use exercises, massage, joint mobilisation and posture advice to improve movement and reduce pain.

Medicines

Anti-inflammatory pain relief such as ibuprofen, if suitable for you, can help in the short term. A doctor may sometimes prescribe a muscle relaxant or a low dose of certain other medicines for ongoing pain. Injections into the joint or muscles are used in selected cases.

Psychological support

For long-lasting pain, approaches such as cognitive behavioural therapy can help manage pain and the stress that often makes it worse.

Bite and dental treatment

Grinding down teeth to change the bite, or orthodontic treatment, is not recommended as a routine treatment for TMD, as there is little evidence that it helps. Worn or broken teeth caused by grinding may still need repair in their own right.

Surgery

Surgery is rarely needed and is considered only when there is a clear structural problem in the joint and other treatments have not helped. Options include arthrocentesis (washing out the joint), arthroscopy (keyhole surgery) and, uncommonly, open joint surgery. These are performed by oral and maxillofacial surgeons and carry surgical risks.

Complementary therapies

Some people try acupuncture or other complementary approaches. Evidence is limited, so discuss them with your health practitioner and use them alongside, not instead of, the treatments above.

When to seek help

See a dentist or doctor if jaw pain lasts more than a couple of weeks, keeps returning, or you cannot open or close your mouth fully. Seek urgent care if your jaw locks open or closed, or after a significant injury.