The Complete Guide to Temporomandibular Joint Disorder (TMD, TMJ)

TMD treatment options range from jaw relaxation techniques to surgery and everything in between. Here's what you need to know to choose the right TMD treatment option for you.

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The Complete Guide to Temporomandibular Joint Disorder (TMD, TMJ)

If you have TMJ pain, I think you’ll agree with me that it’s one of the most frustrating conditions to have. It can be jaw pain, ear pain, neck pain, or even a headache—and you never know when it’s going to show up.

Not only is it painful, it can feel impossible to treat—you’ve probably been told to stop chewing gum and just “wait and see” if it gets better. The lack of a clearcut solution combined with intense, unpredictable pain is enough to drive anyone crazy.

The key thing with treating TMD is to go slowly. I’ve outlined everything you need to know and do, step-by-step, below.

But first, what is TMJ disorder? Is it the same thing as TMD? How do you know if you have it? What are treatment options? Who do I see for treatment? We’ll break down this and more in this article.

What is TMJ Disorder (TMD)?

TMJ is the anatomical abbreviation for the temporomandibular joint, which is the joint connecting your lower jawbone to the base of your skull. It allows us to form words and chew food, and open our mouths for breathing. The TMJ is referred to as single joint, but there are actually two hinge points in front of each ear that enable movement. To accomplish all of these movements, the joint has the ability to rotate in several different directions and essentially create a hinging, or translatory, gliding movement. One example of this motion is chewing. The TMJ allows for rotation, gliding and hinging all at the same time by being relatively mobile within the socket. And this is where it gets complicated. There are a series of complex tendons, muscles and joint pads (called the meniscus) that help move and help protect the joint while it is in motion. Because of this anatomical and functional complexity, the TMJ is susceptible to having many things go wrong.

Because this joint is one of the most frequently used joints in the body, when it gets inflamed, it can be very painful and impact many aspects of normal activities. Problems with the TMJ are called TMD, temporomandibular disorder, or TMJ disorders. But people (and often even dentists) often simply refer to this condition as “TMJ”.

More than 15 percent of American adults suffer from chronic facial pain, such as jaw pain, headaches or earaches all of which may be related to TMD. The disorder disproportionately affects women ages 20-40. Sometimes it only lasts for a few weeks or months before resolving on its own, but often it can last indefinitely.

What are TMD symptoms?

TMD affects many people differently. Many sufferers end up seeing multiple doctors for various other symptoms before realizing that they are originating from the TMJ. Symptoms include:

  • Pain and tenderness around jaw, cheeks, ears, and neck
  • Headaches or migraines
  • Jaw pain or stiffness
  • Popping, grating, or clicking jaw
  • Earache
  • Inability to open jaw completely, locking jaws
  • Painful chewing
  • Tired feeling in face
  • Change of facial expression
  • A change in how your lower and upper teeth fit together, e.g., can’t make one side of one’s bite or the other meet

How is TMD diagnosed?

Unfortunately, no one type of doctor is responsible for diagnosing or treating TMD. Many TMD sufferers may be become frustrated by the amount of time it takes to diagnose, since they may have previously visited an ENT for ear pain, their dentist for tooth pain, or a neurologist for headaches.

If you suspect you have TMD, talk to your primary care physician or your dentist. They will be able to check for symptoms and help you develop a treatment plan. You may consider visiting a TMD specialist in your area for further treatment if the problems persist.

If you truly believe your symptoms are due to TMD your best choice for a correct diagnosis and efficacious treatment is to seek out a dentist that specializes in the treatment of TMD (link to a TMD list of doctors?) To diagnose, the dentist will ask you questions about symptoms and areas of pain, and will physically inspect the joint as you move your jaw around. They will check your bite to inspect how your teeth come together.

In checking your bite, the dentist may check for a CR/CO discrepancy. CR stands for “centric relation” and CO stands for “centric occlusion”. In layman’s terms, CR is the ideal state of your upper and lower jaw positioning and CO is the actual state of affairs. To simplify this concept, consider this analogy…. if the front wheels of your car are not in alignment the suspension joints will wear prematurely and cause other alignment issues with your car. Similarly if your TMD is out of alignment the joint will wear prematurely and cause cause pain and inflammation.

In some cases, your doctor or dentist may recommend other tests to rule out other possibilities, such as lupus, arthritis, or gout. They may also recommend imaging tests, such as x-rays, CTs, MRIs, or ultrasound to look more closely at the joint and surrounding tissue.

What causes TMD?

There is no one cause of TMD. Anything that causes tension in the jaw and temporal muscles or a CR/CO discrepancy can lead to problems with the TMJ. There are often multiple factors that coincide to cause the disorder and pain. These could be:

  • Injury to the jaw or neck (e.g. hit in the face or whiplash): This is one of the most frequent causes of sudden onset of severe pain
  • Grinding or clenching your teeth (also called bruxism)
  • Sleep disordered breathing occurring when your airway collapses while you’re asleep blocking your breathing. the lower jaw’s instinct is to clamp down or thrust forward in an attempt to open the airway
  • Arthritis: arthritis can occur in any joint, including the TMJ
  • Dislocation or erosion of the joint
  • Improper bite alignment
  • Poor dentistry, such as high crowns or fillings, that change how your teeth are coming together

Stress is often considered a cause of TMD. However in my experience I have seen stress as exacerbating a condition that already exists.

I prefer to DIY. What are some at-home remedies for TMD?

Many doctors and dentists will recommend at home treatments as a first step for treating mild TMJ disorder. Since it is a joint, with tissue and muscle, like any other in the body, the treatments are similar to how you would treat any other inflamed joint or muscle with rest and relaxation.

Here are some easy, at-home treatments to try:

  • Rest the joint: eat soft food, avoid gum chewing
  • Apply ice in the beginning and later heat packs to decrease muscle inflammation
  • Experiment with different pillows to allow for proper neck support. Practice jaw exercises to stretch and relax the muscles
  • Over-the-counter pain medicines or anti-inflammatories can help provide short term relief
  • Correct your posture: slouching can push your lower jaw forward, putting stress on the TMJ. This often happens with people who spend many hours at a desk
  • THC/marijuana treatment (if you’re in a state where it’s legal)
  • In addition to direct muscle relaxation, decreasing your stress levels can help treat the symptoms and causes of TMD. Practicing stress reduction techniques such as meditation, yoga, or mindfulness are great additions to any TMD treatment plan.

What to discuss with your dentist and doctor: TMD Treatment Options

Since TMD symptoms can involve the jaw, ear, nose, throat, face, neck, upper back, and even eyes, dentists and ENT doctors often pass TMD patients back and forth, not really knowing what to do with them or how to treat them. This makes things difficult when deciding which TMD treatment is right for you. Take it slow and make sure you fully understand your options, and any potential side effects, before agreeing to treatment.

I’ve listed these treatments for TMD in the order you should approach them—start at the beginning of the list and work your way down. It’s best to conservatively treat in the beginning to see if TMD symptoms go away first before getting to the more serious treatment options, like surgery. All of these should be chosen in consultation with your dentist, TMD specialist, or ENT doctor, or a combination.

Also be aware: There are several things that can be the root cause. Sometimes TMD can heal quickly on its own, and sometimes it can take months of treatment or even surgery to resolve. For some people, it never fully resolves, and it’s a matter of learning how to reduce the pain so you can get back to your life. Depending on your unique situation, your doctor or dentist may recommend more than one treatment.

Give your jaw a break: In many milder cases, TMD symptoms will go away just by letting the overworked jaw muscles rest. If you’re getting clicking or popping when you yawn or open your mouth wide, try not to open wide for the next several days. Cut smaller pieces of food so that you don’t have to open as wide to take a bite or chew as hard. Limit the amount of tough chewing with a softer diet. Cut out chewing gum.

Treat it like a muscle injury: Try treating your jaw the same way you would a pulled muscle. Massage the jaw muscle, put a hot washcloth on it, take an anti-inflammatory like ibuprofen, and let it rest.

Try muscle relaxation exercises: Just like a muscle that cramps from overuse, the jaw can cramp from too much use. Simple exercises can help you learn how to correct abnormal jaw positioning and relax tense jaw muscles that can contribute to TMD pain. All exercises should be done during times when you do not have any pain. If your jaw starts to hurt while you are performing the exercises, stop and rest. Jaw positioning exercises should be done in front a mirror so you can watch your progress. Many people who have TMD have a deviation in the way the joint moves, but are capable of learning a new, more correct position. Put a small sticker on the middle of your chin and open your mouth. If your jaw shifts to the side when you open your mouth, the sticker will shift also. When you see this happening, make a conscious effort to keep your jaw perfectly aligned when you open your mouth. It may feel unnatural at first but over time it will feel more normal and you may notice a reduction in your joint pain. Muscle relaxation and stretching exercises can be done anywhere, at home, in the car or while you read a book. Gently open your mouth as wide as you can without discomfort. Close your mouth slowly. Once your muscles have loosened up, you can use your hand very carefully to open your mouth a little bit wider. This type of stretching can prevent your jaw from becoming locked or unable to open and close smoothly.

Check your posture: Poor posture places the spine in a position that causes stress to the jaw joint. When people slouch or hunch over, the lower jaw shifts forward, causing the upper and lower teeth to not fit together properly, and the skull moves back on the spinal column. This movement puts stress on muscles, joints and bones and, if left untreated, can create pain and inflammation in muscles and joints when the mouth opens and closes.

Get a sleep study: TMD is often caused by grinding the teeth at night, which is a sign that you’re struggling to keep your airway open while you sleep. Recent studies are showing that TMD symptoms are often indicators of a larger disorder – and that includes sleep apnea. A mandibular advancement device, which is made by your dentist and used to treat sleep apnea, often cures TMD because it positions the jaw in a such a way that forces it to relax completely. Assuming the device is worn at night, eight hours of forced relaxation every day can be very effective in reversing TMD symptoms.

Check your stress levels: We often clench without realizing it—and TMD can often be resolved by treating a root cause of major stress, unhappiness in work or at home, etc.

Bite guards: Many dentists will recommend custom bite guards to reduce clenching and grinding of teeth at night to reduce stress on the TMJ. These guards will help the jaw alignment so that the joint can rest. However, make sure that you and your dentist have ruled out sleep apnea as a night guard has the potential to interfere with your sleep and make your grinding worse.

Sleep apnea treatment: A sleep apnea specialist will work with you to design a specific treatment plan if you are diagnosed with sleep apnea. Grinding all night long to keep your airway open is not conducive to TMJ health.

Medical marijuana: if you’re in a state where medical marijuana is legal, your doctor may be able to prescribe it for stress and pain relief. This is palliative only and will not treat the root cause of your TMD.

Join a support group: The TMJ Association is a non-profit organization that focuses on patient advocacy. Especially for severe sufferers of TMD, this is important because you don’t want doctors and dentists pressuring you into treatment you don’t need.

Invisalign: If the root cause of your TMD is an occlusion issue, Invisalign may be able to fix the alignment your jaw, and thus help TMD symptoms. Also, many Invisalign patients achieve immediate relief from their TMD symptoms as the liners prevent you from biting in a misaligned position.

Take over-the-counter meds: Taking ibuprofen, or another anti-inflammatory, can give you immediate relief by reducing swelling or tenderness in the jaw, face, head, or neck. This kind of treatment, however, won’t work in the long term. Being dependent on painkillers is no way to live your life. Pain is also the body’s way of telling you to stop hurting yourself—and taking this away can cause you to further damage your body. Painkillers are great for immediate relief, but be sure you are searching for and treating the root cause. Be wary of any TMD specialist, dentist, doctor or medical professional that advises you to treat your TMD with painkillers alone.

Try occlusional equilibration: This method can take several visits that are weeks apart until the muscles adjust and find a new position. What your dentist will try to do here is aim to equilibrate your bite in a way that gets rid of your jaw pain or other TMD symptoms. Many people have an “actual” bite that differs from their “ideal” bite. Bringing the two positions into harmony is key in treating TMD. This requires strong 3D thinking and premodeling on a model by your dentist in order to treat your TMD and make the teeth less of a trigger point for grinding. A stable well balanced bite puts less stress on the jaw joint. You may need work done to reshape your teeth or jaw through braces or other appliances. A dentist can also fit you with a mouth guard that will help you stop clenching your jaw and grinding your teeth at night. Think of this like an orthotic shoe insole for the mouth. It works to attain that balance and comfort, at least while you’re wearing it.

Orthodontic treatment to adjust for proper bite: In some cases you will need regular metal braces to expand the arches and reverse improper facial development and to improve the bite.

Surgery: Surgery should only be used as a last resort after trying multiple other, non-invasive treatments. However, in extreme cases, surgery on the jaw or on the joint may be necessary. This should only be as a last resort after going through all of the treatment options above, experimenting with different combinations of treatments, working closely with your dentist, and getting a second (or even a third) opinion. Surgery on the actual joint has fallen out of favor. Orthognathic surgery, while an extreme option, may be necessary. As with everything, research your options and understand what TMD is and what causes it before committing to any heavy duty treatment. Depending on the severity of your TMD, you might need to go through some trial and error to figure out which treatment or combination of treatments works for you, but that’s where a good dentist, TMD specialist, or ENT doctor should take care of you and be your advocate throughout the process.

TMD is a complicated condition with many possible combinations of causes and symptoms. Do not get discouraged if your symptoms do not go away quickly after trying one treatment option! It often takes some trial and error to figure out what works best for you. But with patience and diligence, your symptoms can either be well-managed or completely healed.

Dr. Mark Burhenne DDS

read next: What is TMD and How Do I Know If I Have It?

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