TMJ and Jaw Pain: Symptoms, Causes and Treatment

What is the TMJ?

The temporomandibular joint (TMJ) is the hinge on each side of your face that connects your jaw to your skull. It moves in several directions so you can chew, speak, swallow and yawn.¹

TMJ dysfunction means a problem with the joint, with the muscles around it, or both.¹ Dentists and doctors also call it temporomandibular disorder, or TMD. Many people simply say “I have TMJ”.

TMJ symptoms

• Pain in the jaw, especially when eating
• An ache in front of the ear
• Clicking, popping or grating when you open your mouth or chew
• A jaw that locks or won’t open fully
• A bite that feels uneven or uncomfortable
• Ringing in the ears
• Headaches and earache^1,2

Symptoms are often worse when you are stressed or anxious.¹

Is jaw clicking a problem?

Usually not. Clicking without pain is very common. In a meta-analysis, about one in four adults had the kind of disc movement inside the joint that causes a click.³ A click that doesn’t hurt and doesn’t limit your jaw doesn’t need treatment.

How common is it?

Nearly half of all people have some jaw dysfunction at some stage of life.¹ Ongoing painful TMD affects 6 to 9 per cent of adults, which makes it the second most common long-term muscle and joint pain condition after low back pain.²

What causes TMJ pain?

• Clenching your jaw or grinding your teeth, which may be linked to stress. See teeth grinding
• An injury to the jaw, head or neck
• Arthritis in the joint
• Dental changes that alter your bite, such as new fillings or dentures¹

Often there is no obvious cause.¹

A large American project followed more than 3,000 adults who had no jaw problems to see who developed TMD. About 4 per cent a year did. The strongest predictors were not features of the jaw or teeth. They were general ones: having other health conditions, having other bodily symptoms, and habits such as clenching.⁴ This fits with TMD behaving like other long-term pain conditions, where the nervous system’s sensitivity matters as much as the joint. See central sensitisation.

What to do at home

In most cases, TMJ dysfunction improves over time, and symptoms may go away without treatment.¹ To give the jaw a rest:¹

• Eat soft foods and cut food into small pieces
• Avoid chewing gum and biting your nails
• Avoid opening your mouth very wide, including when yawning
• Notice when you are clenching. Your teeth should be slightly apart when your jaw is at rest
• Use relaxation techniques if stress is part of the picture

A warm pack on the side of the face and gentle jaw stretches can ease tight muscles.

Treatments that work

In 2023, an international panel published a guideline for jaw pain lasting three months or more, based on a network meta-analysis of 153 trials with more than 8,700 people.^2,5

Strongly recommended

• Supervised jaw exercises and stretching
• Hands-on treatment from a therapist, such as jaw mobilisation and trigger point therapy
• Supervised posture exercises
• Cognitive behavioural therapy, with or without relaxation training or biofeedback
• Usual care: home exercises, stretching, education and reassurance²

The most effective of these increased the chance of meaningful pain relief by about 36 percentage points compared with placebo.⁵

Advised against

• Irreversible treatments. The panel made strong recommendations against splints that permanently change the bite and against surgery to remove the joint’s disc²
• Most injections and several medicines. The panel made conditional recommendations against these, because the evidence of benefit was weak²

What about mouthguards?

Removable splints worn at night are widely used, and they can protect teeth from grinding.¹ For jaw pain itself, the evidence is poor. A British review of 52 trials found no evidence that splints reduced pain compared with no splint or minimal treatment,⁶ and the 2023 guideline made a conditional recommendation against them for long-term TMD pain.² If you already have one and it helps, there is no harm in continuing.

When to get urgent help

• Jaw pain with chest pain, shortness of breath or sweating can be a sign of a heart attack. Call triple zero (000)
• A jaw that is stuck open or closed
• Jaw symptoms with double or blurred vision, trouble eating or drinking, or frequent severe headaches¹
• Jaw pain after a blow to the face

In people over 50, new jaw pain that comes on with chewing, along with a new headache or scalp tenderness, needs to be seen the same day.

When to see a doctor or dentist

• Jaw pain that hasn’t improved after a few weeks¹
• Trouble opening your mouth
• Pain that is affecting your eating or sleep
• Any change in your mouth or jaw that worries you¹

References

1. healthdirect. Temporomandibular joint dysfunction (TMJ).
2. Busse JW, Casassus R, Carrasco-Labra A, et al. Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline. BMJ. 2023;383:e076227.
3. Valesan LF, Da-Cas CD, Réus JC, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clin Oral Investig. 2021;25(2):441-453.
4. Slade GD, Ohrbach R, Greenspan JD, et al. Painful Temporomandibular Disorder: Decade of Discovery from OPPERA Studies. J Dent Res. 2016;95(10):1084-92.
5. Yao L, Sadeghirad B, Li M, et al. Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials. BMJ. 2023;383:e076226.
6. Riley P, Glenny AM, Worthington HV, et al. Oral splints for patients with temporomandibular disorders or bruxism: a systematic review and economic evaluation. Health Technol Assess. 2020;24(7):1-224.