Jaw Pain & TMD (Temporomandibular Disorder)

Overview

The temporomandibular joint (TMJ) is the hinge just in front of each ear that connects the jaw to the skull. Temporomandibular disorder, or TMD, is the umbrella term for pain and dysfunction of this joint and the chewing muscles around it. It is one of the most common causes of face pain, affects women more often than men, and is especially frequent in people in their twenties and thirties.

Typical symptoms are an ache in the jaw or in front of the ear, clicking or popping when opening wide, a jaw that feels stiff or catches, and pain on chewing or yawning. Because the chewing muscles attach to the side of the head and the jaw joint sits close to the ear, TMD often produces headaches at the temples, a feeling of fullness or pain in the ear, and sometimes neck pain as well. Many people only realise they clench their teeth when the jaw starts to hurt.

TMD is usually a load problem rather than damage: the joint and muscles are being asked to do too much, often because of clenching, grinding, stress and a forward-head posture that changes how the jaw sits. Most cases improve with conservative care, though outcomes vary and some people have episodes that come and go over years.

Causes and risk factors

• Clenching or grinding the teeth (bruxism), awake or asleep, often linked to stress
• Forward-head posture from desk and phone use, which alters jaw mechanics
• Habits such as chewing gum, nail biting, chewing on one side or resting the chin on a hand
• Upper neck stiffness and tight neck muscles, which share nerve pathways with the jaw
• Recent dental work, such as a long procedure with the mouth held open, or a new filling or crown that has changed how the teeth meet
• Direct injury to the jaw or whiplash
• Joint hypermobility, where the jaw opens further than usual
• Poor sleep and anxiety, which increase muscle tension

How we may be able to help

TMD sits between dentistry and musculoskeletal care, and we are clear about the split. Your dentist looks after the teeth and bite, can rule out dental causes of face pain and may provide a night splint to protect the teeth from grinding. We look after the joint, muscles and neck. If you have not seen a dentist about your jaw, we recommend you do so alongside treatment with us.

Our assessment examines how your jaw opens and closes, listens and feels for clicking, measures range, and tests the masseter, temporalis and other chewing muscles for tenderness and trigger points. Because the upper neck and jaw are closely connected, we also assess your upper cervical joints and posture. Treatment may include hands-on mobilisation of the jaw joint and upper neck, soft-tissue and trigger-point work to the chewing muscles both outside and, with your consent, inside the mouth, and dry needling of the masseter and temporalis by our physiotherapists. Where upper neck stiffness is a factor, our chiropractor may treat it. Therapeutic ultrasound may be used for localised joint or muscle pain, and a 3D posture scan can show the head position that is adding to jaw load. We then teach you jaw relaxation, controlled opening exercises and posture habits, which aim to reduce clenching and help the joint move more comfortably. Many people find that combining this with a dentist's splint works better than either alone.

What you can do at home

• Check your jaw several times a day: teeth slightly apart, lips together, tongue resting on the roof of the mouth
• Eat softer foods during a flare, cut food small and avoid chewing gum
• Apply a warm pack to the jaw muscles and temples for 10 to 15 minutes, then gently massage them
• Avoid wide yawns and biting into thick sandwiches or apples while the joint is sore
• Raise your screen and bring your head back over your shoulders to take load off the jaw
• Wind down before bed and ask your dentist about a night splint if you grind in your sleep