What causes TMJ Pain? Symptoms, Treatments, Exercises, and More

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Condition

Temporomandibular Joint Disorder (TMD)

Limited joint mobility and varying levels of pain in the temporomandibular joint (jaw joint).

Prevalance: Common (more in women than men)

Ages Affected: All

  • Pain in jaw, cheeks, ears, and neck
  • Headache
  • Jaw pain/stiffness
  • Facial muscle spasms
  • Clicking jaw
  • Earache
  • Locked jaws
  • Painful chewing
  • Tired feeling in face
  • Change of facial expression
  • Improper bite
  • Painful or sensitive teeth
  1. Stretching and Relaxation Exercises
  2. Sleep Apnea Treatment
  3. Bite Correction
  4. Steroid Injections
  5. Physical Therapy
  6. Medications
  7. Surgery

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—common advice may be to stop chewing gum or to “de-stress.” However, the complex nature of this disorder means there’s likely more to correcting it.

Some causes of TMJ pain are ones your dentist will need to help you fix, like issues with bite and bruxism. Others, like arthritis and sleep-disordered breathing, may require a multifactorial approach with multiple healthcare providers.

Fortunately, there are many home remedies for TMJ pain that you can begin implementing today.

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

What is a TMJ disorder (TMD)?

The Temporomandibular Joint

TMJ is the anatomical abbreviation for the temporomandibular joint, the jaw joint connecting your lower jawbone to the temporal bones at the base of your skull. It allows us to form words, 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 jaw 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. 

Types of TMJ Disorders

So, what causes pain in the TMJ?

There are a series of complex tendons, muscles and joint pads (called the meniscus) that help move and help protect the jaw 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 becomes inflamed, it can be very painful and impact many aspects of normal activities. Problems with the TMJ are called by many names, including:

  • TMD
  • TMJD
  • Temporomandibular joint disorder
  • Temporomandibular disorders
  • TMJ disorders

Most people (and often even dentists) often simply refer to this condition as “TMJ.”

There are three basic types of TMJ disorders:

  1. Myofascial pain: This is the most basic type of TMD. With myofascial pain, the muscles in control of jaw function hurt or feel tight or uncomfortable.
  2. Joint derangement: Injury to the condyle (the end of a bone that connects to another), a displaced disc, or a displaced jaw can cause internal derangement/misalignment of the TMJ.
  3. Arthritis: Arthritic pain, including rheumatoid arthritis, can manifest in degeneration and inflammation of the temporomandibular joint.

It is possible to experience multiple types of TMD at the same time. Sometimes, TMD only lasts for a few weeks or months before resolving on its own, but often it can last indefinitely and cause lasting, chronic pain.

TMJ Statistics and Prevalence

Pain in the TMJ is one type of orofacial pain, meaning pain in the face, jaw, and/or mouth. A UK-based study found that up to 26% of people regularly experience some kind of orofacial pain.

The National Institute of Dental and Craniofacial Research (NIDCR) compiled research to estimate that between 5-12% of people in the US suffer from facial pain and other symptoms of TMJ disorders. This means somewhere around 10 million Americans struggle with this condition at any given time.

The disorder disproportionately affects women ages 20-40 and occurs in women between 1.5-2 times as often as men. Female hormones may play a part, as women on oral contraceptives or hormone replacement therapy (estrogen) experience this pain most frequently.

TMD is unique, in that it’s rare for chronic pain conditions to affect more young to middle-aged people than the elderly. People over the age of 65 are least likely to complain of TMJ symptoms.

Between 33-49% of TMD cases are chronic and do not go away within five years. This condition may result in upwards of 17.8 million lost American work days each year. The health care burden of TMJ disorders is largely attributed to the less common cases of patients who pursue treatment and continue to feel chronic TMJ pain.

How can I tell if I have TMD?

When it comes to self-diagnosing TMJ disorders, there’s a simple way to test.

  1. Place one finger over the jaw joint in front of your ear, on the bottom edge of your cheekbone.
  2. Open your jaw slightly.
  3. Then open wide until you can feel the joint move.

Grating, clicking, or crackling noises are a common sign of problems. If you have a temporomandibular joint disorder (TMD), you may also notice tenderness to the touch.

While these are quick diagnostics, you may also suffer from various types of TMD if you regularly struggle with TMJ symptoms.

Symptoms of TMJ Disorders

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. TMJ symptoms include:

  • Pain and tenderness around jaw, cheeks, ears, and neck
  • Headaches or migraines
  • Jaw pain or stiffness
  • Facial muscle spasms
  • 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., bite doesn’t meet properly)
  • Painful or sensitive teeth without evidence of another oral health issue as the root cause, such as cavities

Causes and Risk Factors for TMJ Disorders

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
  • Teeth grinding: Also called bruxism, the grinding or clenching of teeth is one major cause of muscle pain in TMJ disorders
  • 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, exhausting the jaw muscles.
  • Arthritis: Osteoarthritis or rheumatoid arthritis can occur in any joint, including the TMJ
  • Dislocation or erosion of the joint
  • Improper bite alignment
  • Poor dentistry: High crowns or fillings can change how your teeth come together, leading to orofacial pain.
  • Stress: This is often considered a cause of TMD. However, there is some evidence that stress simply exacerbates the problem of TMJ disorders.

If you don’t treat TMD, it’s possible it will go away on its own. However, it’s far more likely that you’ll experience worsening pain over time, particularly if the cause is anything other than stress.

The NIDCR has determined a group of common risk factors that make it more likely an individual will develop a TMJ disorder. These are:

  • Female gender: It’s not entirely clear why, but women are more susceptible to TMD than men. Two possible reasons for this are the differences in hormonal activity and the different ways in which women respond to pain relievers. The childbearing years seem to impact this risk factor the most.
  • Genetics: So many facets of health are related to genetics and epigenetic changes. Research suggests those at a higher predisposition to inflammation, psychological issues, and stress reactions are more likely to get TMJ disorders.
  • Other forms of chronic pain: Those with chronic headaches, lower back pain, and other chronic pain carry a higher risk for orofacial pain like TMD.
  • Pain tolerance: A low tolerance to pain may increase the risk for TMJ problems.
  • Age: The most frequent age ranges for TMJ are 18-44 year old women, although men don’t show this same trend.
  • Depression: Individuals with moderate-to-severe depression are more likely to develop TMD than non-depressed people.
  • Trauma to the facial area: Traumatic injury to any area of the face makes TMD more likely, even if it doesn’t appear to be the direct cause.
  • Wisdom teeth removal: Once you’ve had your wisdom teeth removed, your risk for TMJ disorders goes up. This happens because your jaw’s meniscus is overextended during most of the surgery and causes muscle strain.
  • Poor posture: Sitting in a way that strains the jaw muscles (or surrounding muscle groups) can increase the risk for TMD.
  • Somatization: Some people have a tendency to express psychological distress through physical pain. This is called somatization, and it may account for more than a tenth of medical visits overall. This tendency may sometimes manifest as TMJ symptoms.
  • Playing violin: Because of the positions common to violin playing, violinists are more susceptible to TMJ pain.
  • Scuba diving: When you constantly bite down on a face mask and regulator for several hours, it can strain the TMJ muscles.

Home TMJ Treatment, Including Stretching Exercises

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 chewing gum, ice, or pens.
  • Apply ice packs for 10 minutes. Stretch your jaw (as long as your stretches don’t cause increased pain and have been approved by your medical provider). Then, use heat packs to decrease muscle inflammation for an additional 5 minutes.
  • Experiment with different pillows to allow for proper neck support.
  • Practice jaw exercises and massages to stretch and relax the muscles (more on that below).
  • Over-the-counter pain relievers and anti-inflammatories can help provide short term relief. Common pain medications include ibuprofen, naproxen, and acetaminophen and should be taken strictly as directed unless instructed otherwise by a doctor or dentist.
  • 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.
  • Utilize medicinal THC/marijuana treatment (if you’re in a state where it’s legal).
  • In addition to direct muscle relaxation, relaxation techniques to lower your stress levels can help treat the symptoms and causes of TMD. Practicing stress reduction techniques as part of regular self-care, such as meditation, yoga, or mindfulness, are great additions to any TMD treatment plan.

5 TMJ Exercises for Pain Relief

Sometimes, using jaw stretching and mobilizing exercises improves TMD symptoms as (or more) effectively than a splint, which is frequently used to treat this pain. Try these exercises and stretches for mild-to-moderate TMJ pain relief.

  1. Double Chin: Align your shoulders back with your chest out, then pull your chin directly backwards to make a “double chin.” Repeat 8-12 times, holding each double chin for about 3 seconds.
  2. Chin Resist: Open your mouth wide, like a yawn. With your first two fingers, apply pressure towards your neck to the divot between your bottom lip and chin. Close your mouth, opposing the pressure. For even more muscle relaxation, hold the index finger of your other hand on your TMJ during the exercise.
  3. Half Moon: Make a fist with your hand. In the space just below your cheekbones, gently drag your knuckles in a half-moon pattern from just in front of your ears until you reach the corners of your lips. Repeat this several times to release tension on the masseter muscle.
  4. Marionette: With your tongue firmly on the roof of your mouth, open your jaw widely. You’ll feel tension (but shouldn’t feel additional pain) along the entire TMJ and attached muscles on both sides. Repeat 10-15 times, 2-3 times a day.
  5. Thumb Up: Open your mouth as wide as is comfortable. Place one thumb under your chin and close your mouth, while resisting the push with your jaw. Hold in place for several seconds, then release the pressure.

Need some visuals? Bob and Brad, physical therapists, share their favorite TMJ stretches and relaxation exercises in this video:

TMJ Disorder Prevention

Once you’ve experienced problems with your TMJ, more may follow even after the initial pain subsides. Here are some simple prevention techniques you can practice without a physician.

  • Avoid hard chewing. Swap out the chewing gum for sugar-free mints. In general, treat your jaw somewhat tenderly to avoid stressing the muscles connected to the TMJ. This includes keeping your chewing to a minimum, especially when it comes to very hard or chewy foods.
  • Improve your neck and jaw posture. Ever seen someone holding their mobile phone between shoulder and cheek? This is just one example of poor neck/jaw posture that can aggravate TMJ. Another common position to avoid is resting your chin on your hand.
  • Practice regular relaxation techniques. Regularly practicing yoga and mindfulness or getting a massage can help to relieve TMJ pain, and they’re also great ways to prevent it from happening in the future. A newer, but very effective, method of stress reduction called biofeedback may help your overall stress relief efforts and are also effective for TMD.
  • Massage your jaw, cheeks, and temples. Even when you’re not actively dealing with pain in your TMJ, massaging the muscles may help to prevent a recurrence.
  • Use moist heat for spasms. If you notice muscle spasms in the area around your TMJ, apply moist heat like a very warm, damp washcloth.
  • Watch your sleep posture. Avoid sleeping flat on your stomach or with your neck in an awkward position. Use a supportive pillow.

Working with a Doctor for TMD: Diagnosis and Conditions to Rule Out

No one type of doctor is exclusively responsible for diagnosing or treating TMD. Many TMD sufferers may 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.

Doctors that deal directly with TMD on a regular basis include:

  • Dentists
  • Primary care providers
  • Myofascial therapists (a type of physical therapist that deals specifically with areas of the head)
  • Oral/maxillofacial surgeons (for severe cases)

If you suspect you have TMD, start by talking to your dentist or primary care physician. They will be able to check for symptoms and help you develop a treatment plan. These providers may also be able to recommend a TMD specialist in your area for further treatment if the problem persists.

Because medical professionals see things in the way in which we were trained, it’s common for an MD to see ear pain as an ear infection, while a dentist might see it as a sign of a TMJ disorder. If you find you’re being diagnosed with recurrent ear infections, talk to your dentist about whether or not it could possibly be TMD.

To diagnose, the physician or dentist (a DDS or DMD) 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.

CR/CO discrepancy is when these don’t match up, causing you to bite down in a way that means your TMJ has to slide or shift to bite down properly. Misaligned teeth can be the cause of this discrepancy

If your TMJ is out of alignment, the joint will wear prematurely and cause cause pain and inflammation.

During diagnosis, your doctor/dentist will also press on areas of the jaw, watching for pain in specific areas. S/he will look for your jaw’s range of motion and listen for the classic “clicking” noises of TMD.

In some cases, your doctor or dentist may recommend other tests to rule out underlying conditions that are treated differently than standard TMD. Conditions that may appear as pain in the TMJ include:

  • Lupus
  • Gout
  • Osteoarthritis
  • Rheumatoid arthritis
  • Advanced tooth decay/cavities
  • Sinus or ear infections
  • Facial neuralgia (nerve-related pain)
  • Tumors

Your provider may also recommend imaging tests, such as x-rays, CTs, MRIs, CBCT (cone beam), or ultrasound to look more closely at the joint and surrounding tissue.

One particular type of diagnostic test, a TMJ arthroscopy, is performed by insertion of a cannula (thin, small tube) into your temporomandibular joint. Then, the tiny camera called an arthroscope can view the interior of the joint to look for visible problems.

We’ll talk about arthroscopy later, as it’s also one type of surgery that’s used for treating TMJ pain.

5 TMD Treatment Options for Pain Relief: Therapies, Surgery, and More

A little less than half of the people who struggle with TMD experience pain to the point they need to see a physician. Of those, about 1% end up needing surgical treatment to relieve pain.

Below are the various treatments you may talk about with your doctor or dentist for addressing TMD. S/he may recommend multiple courses of treatment at once or work with you on one at a time until finding out what works for your case.

Skip to a specific treatment:

  1. Stretching and Relaxation Exercises
  2. Sleep Apnea Treatment
  3. Bite Correction
  4. Steroid Injections
  5. Physical Therapy
  6. Medications
  7. Surgery

Keep in mind that many remedies for TMD aim to relieve pain as quickly as possible, but not to treat the root cause. As you seek out treatment, keep an eye out for those that provide relief without treating the deeper issue. Work with your healthcare providers

1. Stretching and Relaxation Exercises

While you can perform TMJ exercises at home, your doctor, dentist, or physical therapist may give you targeted ones to try in specific time increments. In general, these stretches should help relieve muscle tension but should not cause much, if any, additional pain.

One study found that therapeutic intervention with stretching exercises helped with pain relief even faster than an oral splint.

In general, stress is also one agitator of jaw pain. A medical provider can advise you on more professional forms of stress relief, such as therapy/counseling for TMD in those suffering with depression.

2. Sleep Apnea Treatment

Sleep apnea is a condition characterized by periods of disrupted breathing at night. While it’s not the only form of sleep-disordered breathing, sleep apnea is thought to be one reason people grind their teeth at night (bruxism).

Since bruxism is one major cause of TMJ pain, your dentist or doctor may recommend you get a sleep study to figure out if this is the root cause of your issues. You may be sent to a sleep study at a facility or a home sleep study to test for sleep apnea.

If you’re diagnosed, you’ll likely be prescribed one or multiple treatments, including a sleep apnea oral appliance, CPAP/APAP machine, or a night guard for grinding. A night guard will not help get to the bottom of your grinding problem like the other potential solutions, but is a stopgap measure to protect your teeth from grinding damage.

A mandibular advancement device (MAD) is one great way to treat TMJ pain caused by sleep apnea-related grinding. A MAD will place your jaw in a totally relaxed position during sleep, which may help relieve some muscle strain while also resolving the underlying problem—a collapsing airway, which leads to nighttime grinding.

For mild sleep apnea, you may be able to resolve grinding by using mouth tape and being sure to sleep on your side.

Not able to go for a sleep study, or unsure if grinding is causing your issues? Your dentist will be the one able to tell you for sure, but grinding/clenching may also be associated with poor sleep quality. You can get a benchmark of your sleep quality by using a sleep app to track your sleep.

3. Bite Correction

Many cases of TMD start out with issues in the bite of your teeth, known as “occlusion.” As I mentioned earlier, your dentist should be looking for a CR/CO discrepancy at each dental visit. This allows him or her to see when there’s a misalignment in your bite.

Why does this matter for TMD? If your bite is off (malocclusion), you may develop pain in your TMJ because one tooth makes contact with the other side of teeth first (known as intercuspation). For more drastic cases, a CR/CO discrepancy will pull your condyles out of the socket each time you close your mouth.

In layman’s terms, a poor bite can literally force your TMJ to work tirelessly in a way your jaw isn’t designed to do long-term.

When TMD is caused by malocclusion, there are a number of methods your dentist will use to correct the problem. Keep in mind, all of these either take a significant amount of time to correct or give fast relief without addressing the root issue.

Here are the various steps in correcting your bite to get relief from TMD, from least to most expensive.

Mouth Guard/Night Guard

Using a night guard for grinding is a stopgap measure to reduce the damage to your teeth created by teeth grinding. A night guard is cast by your dentist and will cost between $200-500. This type of mouth guard looks similar to clear braces and can be worn throughout the day, but may interfere with speech and eating.

This is a fast, relatively inexpensive method to stop some of the pain of TMD but doesn’t fix any of the underlying problems.

TMJ Splint

Similar to a night guard in appearance but with a much more complex design and construction, an oral splint (also called a TMJ splint or a repositioning splint) is a great way to temporarily reset your CR/CO. Most people will experience TMJ pain relief soon after starting this therapy.

Splints also look somewhat like clear braces but have “ramps” in front, designed exactly to put your bite into place. The cost of a splint is typically in the $750-1100 range and this device is typically used while your dentist works on correcting your bite issues more permanently.

One reason this isn’t a long-term solution is that you can’t eat or speak properly with an oral splint. Even eight hours of sleep with a splint won’t make up for 16 hours of waking time with a malocclusion.

Clear Braces (Invisalign)

One useful way to correct the bite is by a course of orthodontics. In almost every case of adult orthodontic treatment, clear braces are the way to go. I mention Invisalign above, rather than at-home clear braces, because any effort to reverse malocclusion for TMJ pain relief should be conducted with the supervision of your dentist.

Invisalign allows your dentist or orthodontist to correct crowding, improper tooth position, and other parts of a CR/CO discrepancy. A full course of Invisalign can cost anywhere between $5000-8000, depending on where you’re located and the extent of your issues. Invisalign is typically covered in small part by dental insurance.

Occlusal Equilibration

Occlusal equilibration is the process of grinding down teeth that touch first in order to reduce and reverse CR/CO discrepancy. For many, this involves significant reduction of the tooth structure, so complex occlusal equilibration often requires adding crowns to teeth in order to protect them from breaking.

Severity plays a big part in the cost of this process. For just a few teeth, you may only be looking at $500-2000 for tooth restructuring. However, I’ve worked with one patient who required reshaping of nearly every tooth and several crowns because of the extent of her CR/CO discrepancy. The entire, multi-year process came to a price tag of around $60,000.

It’s important to work with a dentist you trust for this type of therapy because the cost can be astronomical for severe cases. It also requires many visits and consultations to track progress.

4. Steroid Injections

If your TMJ is caused by degenerative arthritis, your doctor may recommend steroid injections. This might help reduce pain, swelling, and inflammation. It typically takes a week or so for noticeable effects.

It’s important to note there is only limited evidence on the benefit of this practice. While it probably does cure pain from this type of TMD, it’s also clear that it doesn’t help with other symptoms, like mouth opening capacity or improper jaw growth and positioning.

5. Physical Therapy

When at-home exercises and stretches don’t help to restore range of motion or relieve pain, your dentist or doctor may suggest physical therapy. Beyond just helping you stretch the muscles around your jaw joint, modern physical therapy involves a broad spectrum of options, including types of light, heat, and electrical stimulation therapy.

Physical therapy interventions for TMD include:

Although these all show promise in treating many symptoms of TMD, they have varying levels of success.

6. Medications

Medications for TMD can help to chemically reduce the amount of pain you have, but won’t be able to treat the real cause of your condition.

When over-the-counter pain relief isn’t helping, it’s time to talk to your doctor about prescription-strength anti-inflammatories or pain relievers. These can only be prescribed for a limited time and should be taken with an abundance of caution.

Antidepressant medications, specifically tricyclics (TCA) like amitriptyline, and some anti-anxiety medications may be used for TMD involving bruxism (clenching and grinding teeth). This is a common, but off-label, use.

If you’re 24 years of age or younger, these medications may cause thoughts of suicide during the first weeks of use, so pay attention to these signs and contact your doctor right away if you begin having suicidal ideations.

Your doctor might prescribe muscle relaxants to calm muscle spasms and reduce tension caused by muscle spasms in the muscles connected to your TMJ.

Injections of anesthesia, pain meds, or corticosteroids may be injected in the muscles surrounding the TMJ at specific “trigger points” meant to relieve pain. Some practitioners use botox for TMJ pain, but this should be approached carefully, as there are various possible side effects.

7. Surgery

Surgical interventions are only needed in about 1% of TMD cases. However, these may be approached when nothing else has been successful. Below are the various types of surgeries for TMJ pain.

Arthrocentesis

Least invasive of all surgical options, arthrocentesis is performed by using anesthesia on the jaw, then inserting small needles into the joint and irrigating it. Sometimes, debris, inflammatory byproducts, or dead tissue may be littering the joint and causing pain, and this irrigation can eliminate them.

During the procedure, your dentist may also re-mobilize the joint or move a disc lodged in the joint using a specialized tool.

This is often performed at your dentist’s office when you experience a “locked” TMJ, sometimes called lockjaw. There should be no lasting scars from this procedure.

TMJ Arthroscopy

An arthroscope is a tool with a camera lens and a light that can be inserted into the area around the jaw. This surgery is done under general anesthesia, meaning you won’t be awake.

A small incision is made in front of the ear to insert the arthroscope. Depending on what becomes visible, inflamed tissue may be removed and/or the disc or joint realigned.

Because it’s not an “open” surgery, a TMJ arthroscopy requires a shorter recovery time than other surgeries and leaves a very small scar.

Modified Condylotomy

If your mandible has a displaced disc or degrading bone tissue, you probably suffer from internal derangement of the TMJ. In these cases, your oral/maxillofacial surgeon may want to perform a modified condylotomy.

This low-risk surgery involves reshaping the condyle, the end of the temporomandibular joint. Modified condylotomy surgery has been performed for several decades with good outcomes and very low complication rates for correcting major TMJ pain. It has a slightly longer recovery time than arthroscopic surgery and may take several months to eliminate pain completely.

A condylotomy is frequently performed as part of a multidisciplinary approach to severe TMJ pain and may be done in conjunction with occlusal equilibration or orthodontic intervention. This surgery may be suggested if you have an arthritic condition.

Open-Joint Surgery (Arthrotomy)

After all other options have been exhausted, your dentist or doctor may look into the possibility of open-joint surgery of the TMJ. Called an arthrotomy, this involves a full opening of the jaw joint to look for structural problems. An arthrotomy is typically used to either make major repairs to or entirely replace the joint.

You would be most likely to get open-joint surgery on the temporomandibular joint if you have:

  • Wearing on the bony structures of the TMJ
  • Tumors on or around the TMJ
  • A scarred jaw joint
  • Bone chips in the joint (from trauma)

This is the most risky of all TMD surgeries and will likely leave a significant, visible scar. It also requires the longest recovery time and more frequently results in nerve damage.

Key Takeaways: TMJ Disorders

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 trial and error to figure out what works best for you. With patience and diligence, your symptoms can either be well-managed or completely healed.

The TMJ Association is a non-profit organization that focuses on patient advocacy. Especially for severe sufferers of TMD, support can be encouraging and a major part of recovery. They also offer options for making sure you’re not overcharged or the victim of malpractice.

Do you have questions about pain in your TMJ? Just ask me.

Read Next: What is TMD and How Do I Know If I Have It?

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  7. Crider, A., Glaros, A. G., & Gevirtz, R. N. (2005). Efficacy of biofeedback-based treatments for temporomandibular disorders. Applied psychophysiology and biofeedback, 30(4), 333-345. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/16385422
  8. Haketa, T., Kino, K., Sugisaki, M., Takaoka, M., & Ohta, T. (2010). Randomized clinical trial of treatment for TMJ disc displacement. Journal of dental research, 89(11), 1259-1263. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/20739691
  9. Stoustrup, P., Kristensen, K. D., Verna, C., Küseler, A., Pedersen, T. K., & Herlin, T. (2013, August). Intra-articular steroid injection for temporomandibular joint arthritis in juvenile idiopathic arthritis: a systematic review on efficacy and safety. In Seminars in arthritis and rheumatism (Vol. 43, No. 1, pp. 63-70). WB Saunders. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/23352251
  10. McNeely, M. L., Armijo Olivo, S., & Magee, D. J. (2006). A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Physical therapy, 86(5), 710-725. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/16649894
  11. Núñez, S. C., Garcez, A. S., Suzuki, S. S., & Ribeiro, M. S. (2006). Management of mouth opening in patients with temporomandibular disorders through low-level laser therapy and transcutaneous electrical neural stimulation. Photomedicine and laser surgery, 24(1), 45-49. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/16503788
  12. Shukla, D., & Muthusekhar, M. R. (2016). Efficacy of low-level laser therapy in temporomandibular disorders: A systematic review. National journal of maxillofacial surgery, 7(1), 62. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242077/
  13. Al-Badawi, E. A., Mehta, N., Forgione, A. G., Lobo, S. L., & Zawawi, K. H. (2004). Efficacy of pulsed radio frequency energy therapy in temporomandibular joint pain and dysfunction. CRANIO®, 22(1), 10-20. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/14964334
  14. Westesson, P. L., Bronstein, S. L., & Liedberg, J. (1985). Internal derangement of the temporomandibular joint: morphologic description with correlation to joint function. Oral surgery, oral medicine, oral pathology, 59(4), 323-331. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/3858767
  15. Hall, H. D., Navarro, E. Z., & Gibbs, S. J. (2000). One-and three-year prospective outcome study of modified condylotomy for treatment of reducing disc displacement. Journal of oral and maxillofacial surgery, 58(1), 7-17. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/10632159
  16. Puricelli, E., Corsetti, A., Tavares, J. G., & Luchi, G. H. M. (2013). Clinical-surgical treatment of temporomandibular joint disorder in a psoriatic arthritis patient. Head & face medicine, 9(1), 11. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621370/

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32 Comments

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  1. Linda Fritzer says:

    Dr. Burhenne, I was very pleased to come across your article. I now know I’ve been suffering with TMD for over 10 years. I’ve been shuffled between dentists, oral surgeons, nuerologists, pain specialists and even went through a 9 week pain management program. I’ve been on several medications and even had nerve block injections in my throat just in front of the tonsils. Nothing has ever helped.
    Your article described the symptoms so perfectly, I was amazed that all the specialists I have dealt with didn’t consider this condition.
    I will be trying the exercises you suggest. I have worn a night guard for several years and am actually on my second one.(Broke the first after several years)
    The article also helped me understand why when I was on muscle relaxers for a back injury, it really helped the TMD pain. Not a good permanent solution I guess, but it sure answers a lot of questions I had that no doctor ever had answers for.
    Thank You.

    • Dr. Mark Burhenne says:

      Linda, thank you for the kind words. I’m glad some of that resonated. It just goes to show that TMD/TMJ is such a complex condition that it’s difficult to completely grasp, even for some dentists. I’m sorry to hear of your dental woes, but I think the key in the end in success is keeping at it and seeing many different people. Make sure that your bite has been equilibrated to perfection — this, I find, is probably the most important starting point.

      – Dr. B

  2. Hello Dr. Burhenne
    It’s been 2 1/2 weeks since I had a brutal lower back molar tooth extraction. An old crown fell off and there was nothing to grab to pull it out so my dentist had to take it out in pieces and it was very stubborn. I had to hold my mouth all the way open for a long time. It was the very back rear tooth. Since a couple days after the surgery, both of my ears are plugged and I can barely hear. I have a very good dentist but he said it would not be from the surgery. I want to mention that a week before my surgery I had a cold and I also have seasonal allergies right now. When I wake in the morning I can hear but within several minutes my ears plug. I’m wondering if there is swelling or something holding fluid in my ears?????? I have never had this happen before and I’m worried it will be permanent. I’ve been searching the internet for a week for answers. I hope you can ease my mind. If you think the reason could be my jaw, could you suggest what I can do to get back to normal hearing?
    Thank you
    Linda M.

  3. Anonymous says:

    I ‘recently had crown on back lower molar break off. I had like 4 shots maybe more and now my throat,ears, and jaw hurts. I also can’t open my mouth hardly. I work in a call ‘venter so I suffer a lot at the end of day.

  4. Alisha silbaugh says:

    Consider Botox injections in the massetter muscles too. It helped me greatly, but only lasted about three months.

  5. I’m so glad I found this site 🙂 I’ve had a locked jaw, can barely fit a finger in between my teeth for 2 days now. I have made an appointment with a new dentist and have a fear my wisdom teeth have finally come through and raising hell (i’m 33). I’m worried that if I can’t even open my mouth, how bad the extraction will be. Do you recommend acupuncture before the surgery to remove my wisdom teeth to try and loosen my jaw? Grateful for your suggestions.

    • Chokolate says:

      How did it goes for you .. please im in the same situation !

  6. Shauna D Baker says:

    I’ve suffered since high school with crackling jaw, grinding my teeth, migraines, numbness in my skull, pain n eyes,ears,neck,shoulders, tinnitus, it is causing me to be a extreme insomniac which of course leaves me in a severe state of depression. Sometimes i feel as if I can’t take anymore. I am seeing a great family dr who sent me to a ent and audiologist. I was diagnosed with hearing loss, and tmd. I haven’t seen a dentist yet. Thus far nothing has been prescribed but some excersies that haven’t seemed to relieve anything. Idaho doesn’t do medicinal marjuana or I would try that. I’m not a pot smoker. But would rather do that than Perscription addiction.
    I’m in my 50s and am tired of suffering from this aliment. Thanks for your post. Any advice would be appreciated.
    Grandma in idaho

  7. Dear Dr. B

    I recently was diagnosed with TMD but all the specialist told me to do was take xanax and use heat 3 times a day. I am so glad I came across this. It has gave me some other things to try- As of yet I am still waking up in the night with pain and sometimes in the day time

  8. Joan Mallon says:

    I had an upper back tooth removed 4 months ago. I have trigeminal neuralgia. I thought this was the cause of my pain. I have deep roots, and, the tooth was difficult to remove.
    Gradually, I have lost more and more jaw function.
    Today, I can’t eat at all. I’m seeing a specialist in a week, but, I can’t wait that long.
    I’m in intense pain, worse when I try to eat. I dread waking up, as the pain is horrific then. The TMJ and TN kick in together. I’m reaching, the stage, when I have trouble swallowing medication.
    What can be done. I can’t have surgery. I can’t take ibruprophen. I’m using heat and ice which helps.
    What treatments are available?

  9. I’d like to also add seeing a physical therapist or even a massage therapist that specializes in treating TMJ related disorders to the list of conservative interventions to consider. As Dr. B mentioned, TMJ related disorders are related to an imbalance in muscle strength/activation, but also the flexibility of the muscle and tissues in the head, jaw, and spine, which effect the movement of the tempomandibular joint. Physical therapists can address correcting these issues with exercises as well as various manual techniques, which may include myofacial release (MFR) and/or craniosacral therapy.

  10. Thank You so much Dr B for this article on TMJ. After 6 years of terrible chronic daily pain I was finally diagnosed with TMJ by a head and neck specialist 6 months ago. After having a orthotic made to wear day and night for months, I finally begin to experience less pain. I also find short term relief from NSAID/Aspirin during the really hard flare-ups. I will begin some of the muscle exercises suggested in your article. Have you heard of the Bowen Work Therapy for TMJ relief? I just wonder if this help with pain relief or healing.

  11. I had dental surgery on tuesday of this week. I had 3 wisdom teeth removed and 2 molars removed. My jaw hurts soo bad. I can barely open it, it’s sore, swollen, and tender. Is it due to TMD or TMJ?? I go back to see my dentist on the 2nd of June but I really need to know now. This is the first time I’ve had surgery done on my teeth and I really don’t want this pain to be permanent. Please let me know. Thank you.

  12. This is long but worth reading! I have suffered with TMJ for years – since 2008. I noticed it not long after a dental visit gone wrong where my jaw was cranked open, multiple cavities filled, crown put in, a really painful traumatic visit. Being holistically minded, I tried for years to get everything back to normal without painkillers- saw a TMJ dental specialist, who referred me to a PT for a lot of intensive exercises that actually created neck pain where there wasn’t any before. A costly bruxism nightguard started shifting my teeth around at night which was painful and worrisome so I stopped wearing it. I tried seeing an osteopath, massage therapist, chiropractor, acupuncturist- all to no avail or only very temporary relief. Hot baths, infrared heating pads, TENS units…I tried everything! My TMJ dentist thought it was stress-induced because of my job, but taking time off from work (thanks to my partner) and being very stress free for a long while did not change a thing in regards to my pain levels. To be clear, my symptoms were fairly serious- headaches, constant jaw pains, flare ups, neck pain, poor sleep, night clenching, perhaps even increased anxiety, etc. I was told by a “spine specialist” MD after an MRI that “there is nothing wrong” and perhaps the symptoms were in my head. I could’ve punched that guy. Also tried diet related things although I’m already healthy in that regard. MMJ did help by relaxing my muscles- it’s legal here in CO- but for me I wanted a long-term solution. Also once we started looking into creating a family that was out. I am so happy to report I have finally, almost 10 years later found some relief.

    Recently friend who had suffered for years from migraines after a car accident had been telling about a chiropractor she had seen who had erased her migraines by doing a procedure called Atlas Orthogonal. I was very skeptical after years of nothing helping but I decided to give it a try. I am squeamish about chiro work but this type is different and was actually painless. It involved repositioning your atlas which is an interior bone that cradles the base of your head with a specialized machine. They had to take 4 specific xrays to see if mine was misaligned. When the Dr went over the results with me she was as surprised as I was. You could see how off centered my atlas was. She said people experience discomfort with .5 degree off and I was 6.5 degrees off base. I could see it for myself. Also she showed my how the C-spine of my neck had lost a huge degree of curvature, which is unusual for someone my age. She said these two things would make it feel difficult to hold the weight of my head up at times (so true!) and always leave my head tilted slightly to one side, which we confirmed as I’m standing there. And to have that bone which connects to your head and spine be so out of whack, well, not hard to imagine it can create a lot of pain that muscle massages and such will not truly address.
    I’ve had only 3 treatments and I cannot tell you what a difference it has made. No more severe jaw pain since my first treatment, only mild and only occasionally. I feel like I’m finally getting back to my old self but I will keep going periodically as I feel the need… old body patterns die hard and you need adjustments from time to time to maintain your new equilibrium. One word of caution- in my pre-appointment research online I found there are a lot of atlas “providers” who sprung up recently looking to capitalize on this treatment and many not qualified that were doing actual harm to some. Make sure you see a chiropractor or MD who’s been trained and certified in this procedure. And make sure they are going to do xrays to see EXACTLY where you need the adjustment, otherwise they are just guessing- this is an interior bone- you cannot feel that it’s out of place like they do with everything else. I have no affiliation with this industry just want to help anyone out there that’s suffered needlessly as I did for so long. Hopefully this treatment can help you too!!

    • Colleen Ramirez says:

      Kate, I am also in CO and have been suffering for 14 years with very similar symptoms. I am curious about the provider you are seeing for your treatment.

  13. About 6 weeks ago I had my top right wisdom tooth removed, which was straightforward and had no issues with recovery. Since then I have been back to the dentist multiple times to get a total of 13 fillings (it had been about 17 years since I last went to the dentist), with one of them resulting in me needing a root canal. My last visit to the dentist was just over a week ago, which was when it was discovered that I needed the root canal, which was partially done, but not fully completed, and I’m scheduled to go back in a couple of weeks to get it finished and then prep for a crown (I’m goi g to Thailand for this, as it is ridiculously priced in Australia).
    Anyway, since my last trip to the dentist about a week ago, I have noticed pain in my right jaw and I feels “sticky” when I try to open wide or if I yawn; it’s not unbearable pain, but it’s pain I’ve never had until now. If I clench my teeth I feel a kind of shooting pain up in my teeth where I’ve just had fillings put in, but not sure if the pain is actually in my tooth or up in my jaw – it’s hard to pin-point. This shooting pain really only happens in the evening or at night, and only if I clench or bite food right in that area of my mouth (I don’t clench it all the time, but I know I need to stop doing it).
    Does it sound like I have TMD/TMJ?

  14. Lisa Ouderkirk says:

    20 years ago I had both of my TM joints replaced with artificial ones after trying many other remedies/treatments that didn’t provide any relief. Following the surgery I had surgical pain for about a week followed by 20 years of no issues at all with this disorder. I faithfully wore my mouthpiece for 10 years following surgery, but after some dental work I had to either get fitted for a new mouthpiece or go without; due to financial issues I had to go without. The last three months I have returned to the way I was 20 years ago with extreme headaches, constant jaw pain and clicking, and also ear and neck pain. The last time they said it was due to clenching and grinding of teeth and I know I am doing that again. My dentist went to fit me with a new mouthpiece but I couldn’t open my mouth wide enough to get the mold in so he is having my go to an oral surgeon, who I can’t get into for three months. I am taking ibuprofen and using heat and cold, but is there anything else that might help alleviate some of the pain until I see the oral surgeon? Any suggestions would be greatly appreciated!

  15. I was recently diagnosed with TMD due to extensive dental work, replaced upper right and lower right bridge , double root canal and deep filing procedures. What are your thoughts regarding some of the new TMD treatments such as cold laser therapy, stem cell injections, and Botox?
    How do you select a neuromuscular dentist?
    Thanks!

  16. About one month ago, after Dentist did a filling, I had hard time bite normally. The tissue inside the mouth, between upper and bottom jaw hurt. Just 2 weeks ago, my jaw dislocated, only at one side, the same side the filling was done. It was put back by general Dentist, and he prescribed 4mg Methylprednisolone for 6 day. Before I finish the medicine, I feel my tongue is kind of swelling. I went back to the dentist office. He adjusted the jaw. I feel a lot better, but still the tongue looks a little swelling, a little hard to make certain sound. There is scallops mark at both side of tongue. Can dislocation of jaw or the medicine cause the tongue swelling? Can tongue swelling if the jaw was not placed in the perfect position?

    Thanks,
    Vivian

  17. Ramon Barragan says:

    I don’t know if I have tmj or not but my left cheek is really sore and its not hurting but its sore and I can’t smile good. I have no clue what it is. Can you please help me?

  18. Thank you Dr. B, your article on TMJ was very informative and I wish it had been something I had found 5 years ago. I have a blunt square jaw so when I first presented the symptoms of TMJ to my dentist. They chalked it to stress from a pregnancy and told me to wait it out. It only progressed. The muscles around my jaw are now pronounced making the sharp edges of my jaw stick out more. I’ve warn out teeth and feelings. The muscles also spasm causing a lock down. It’s progressed to the point I can’t eat a meal without it happening at least once. I’ve had to change how I talk, sleep, and eat. Recently my dentist fitted me for another night guard and prescribed a 3 week soft food diet and treatment of muscle relaxers. I’ve been doing the treatment for a few days and it only seems to be aggravating the condition.the aches have moved down to my neck and I’ve noticed a tension headache start up once the medication takes effect. Is this normal?

  19. I had braces for four years. Before I got braces the right bottom side of my mouth was an underbite. The orthodontist fixed the underbite; however, now when put my bottom and top teeth together I can tell that one side does not line up tooth for tooth. Ever since then I have had severe jaw issues. Clicking, locking, a stick, a cracking noise sometimes, and even lock jaw. I get my wisdom teeth out in two weeks and I am terrified to have my mouth open and yanked around for that long. If you have any suggestions, they would be greatly appreciated. I am beyond scared and have not yet seen a specialist for TMD. Although I know for sure that I have it, because I have every symptom.

  20. I have been suffering for about 9 weeks with ear pain, joint pain , pain under my jaw, in my mastoid and down the side of my neck. Have been on Naproxen for 4 weeks, have done the hot and cold and night splint. Had an Mri done which shows 2 tears in the disk, flattened epicondyle, fluid buildup, arthritis and osteophytes. Would like your opinion on what I should do next.

  21. Levticus Bennett says:

    I never knew that sleep apnea can affect people with TMJ. My sister has been complaining that her jaw is hurting, we thought it was just temporary but she still has pain. We should probably check with a dentist because my sister has trouble sleeping along with her jaw pain.

  22. I have typical symptoms for TMJ for a long time ,I would say classical symptoms but recently I have some serious night and day sweats,impossible to control , and shivers ,and antibiotics seems to help a lot but the moment I stop them my symptoms,sweating ,shivers terrible headache ,dizziness,sinus pain,ear ache .Looks like some kind of infection,is that related to TMJ?

    • Dr. Burhenne says:

      Hi Mark!

      Thanks for being a reader.

      Typical symptoms for TMJ do not include fever, shivers, headache, dizziness, sinus pain or ear ache. It sounds like that’s something on top of the TMJ. There is no connection between the TMJ and all the other symptoms that you listed.

      Go see an ENT or a primary care phisician and find out if this is a sinus infection, as it seems like it is a serious sinus infection. Part of it could feel like TMJ but it is referred pain from the sinuses, perhaps.

      Hope this helps. Good luck!

      drb

  23. Alina smith says:

    Nice article its very helpfull thanks for sharing

  24. Hazel Owens says:

    That’s good to know that TMJ could be caused by sleep apnea which is signaled by grinding your teeth at night. My husband told me that his jaw is starting to really hurt and he doesn’t know why, and it seems he has symptoms of TMJ. He does tend to grind his teeth when he sleeps so it might be either due to that or sleep apnea, so we’ll have to set him up an appointment with a doctor to see if he has TMJ and what he can do to treat it and if he has any other underlying issues causing his jaw to hurt.

  25. I’ve been wearing a night guard for almost 30 years. During the last five years, the pain from my grinding has become worse. It is not constant, but I have good times and bad. What I have noticed is that I don’t sleep well and I know I sometimes snore. I’ve recently noticed that my teeth are getting crocked year by year. One of my front teeth overlaps the other and on that same side one tooth is getting pushed back. Could this be caused by my night guard? My dentist says she’s never heard of that. I’m finally going to see a sleep specialist and see what the real issue is. She says I need to consider my TMJ if I get a different device than a CPAP. What are your thoughts?

    • Dr. Burhenne says:

      Hi Linda,

      It’s very possible. I don’t usually do night guards for my patients with sleep apnea. The guard can actually interfere with rhythmic masticatory muscle activity (RMMA) that is trying to open your airway at night. Given your TMJ and poor sleep, I’d get the sleep study as soon as you can. Good luck!

      drb

  26. Amy Lafond says:

    Hi Dr :-),

    Thank you for your informative articles! I have a few questions for you re:TMJ/TMD. I’m a 47 year old female, diagnosed with Ehlers-Danilo’s type 3 a couple years ago. The genetic condition combined with a couple decades teaching yoga lead to me needing bilateral (done separately) hip replacement. Recently, I’ve been cured of my 2/3 pack a day, decades long fun chewing habit. And now my jaw is really hurting! A non direct force chiropractor has realigned the jaw (only once so I’m guessing more is needed), and I’ve had numerous acupuncture treatments.
    While the dentist said I “grind”-I believe the wear is from the OCD gum chewing and s decade of bulimia in my younger years. As a yoga practitioner/meditator (both of which I teach) I’m wondering if I should just try Botox? And if any of this is caused by the EDS? If you’re not familiar Ewrs-Danlos is a generic condition where you lack collagen on the genetic code, which results in loose connective tissue. For example I lobe getting dental X-Rays as my cheeks and jaw are so stretchy! Thank you!!!

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