Temporomandibular disorder

Also called TMD, TMJ, Jaw joint problems, Bruxism

Jaw pain, clicking and headaches, usually from clenching. Almost always managed without surgery, and irreversible dental work should be resisted.

What it is

Pain and dysfunction of the jaw joint and the muscles that move it. It is common, affects women more than men, and peaks in early to middle adulthood.

Most cases are muscular rather than structural: clenching and grinding, often at night and often related to stress, overworking the muscles. Clicking alone, without pain or locking, is common and needs no treatment at all.

The overwhelming majority improve with conservative management: soft diet during flares, jaw rest, heat, gentle exercises, addressing clenching, and treating stress and sleep. Most settle within months.

The important warning in this entry is about what not to do. Irreversible treatments, grinding teeth down, extensive crown work, orthodontics or surgery, undertaken to fix jaw pain, have a poor evidence base and can leave people worse and unfixable. Conservative treatment first, for a long time, is the correct sequence.

It commonly coexists with tension headache, neck pain, fibromyalgia and anxiety, and treating those helps the jaw.

Locking, where the jaw will not open or will not close, needs prompt dental or maxillofacial assessment.

Signs you might notice

Pain in the jaw joint, just in front of the ear, in the cheek or the temple.

Pain on chewing, yawning or talking, often worse in the morning if grinding at night.

Clicking, popping or grating on opening.

Headache, particularly in the temples, and earache with a normal ear.

Difficulty opening wide, or the jaw locking open or shut.

Tenderness of the jaw muscles, and worn or sensitive teeth from grinding.

Same-day: a jaw that has locked and will not move, facial swelling with fever, or jaw pain with chest pain or breathlessness, which can be a heart attack presenting as jaw pain.

Persistent one-sided ear or jaw pain with a normal examination in an adult needs assessment; see head and neck cancer.

How it can affect day-to-day life

Night grinding is invisible to the person doing it, and often first reported by a partner or noticed by a dentist as tooth wear.

Morning jaw pain and headache is the classic pattern, and it responds to a properly fitted splint from a dentist rather than a shop-bought one.

Chewing gum, hard foods, nail biting, wide yawning and resting the chin on a hand all keep it going.

Stress and poor sleep are genuine drivers rather than a dismissal, and treating them is treating the jaw.

People often see several professionals, dentist, GP, ENT, before anybody names it, because the pain is felt in the ear and the head rather than the joint.

Supporting someone well

Rest the jaw during a flare: soft food, small bites, no chewing gum, no wide yawning, and support the chin when yawning.

Heat over the muscles for 15 minutes, several times a day.

Simple pain relief regularly for a short period rather than occasionally.

Gentle jaw exercises from a dentist or physiotherapist, done consistently.

Ask a dentist about a custom splint if grinding at night; shop-bought guards fit badly and can make things worse.

Address stress and sleep directly.

Refuse irreversible dental treatment offered to cure jaw pain, at least until conservative measures have had months.

Get a locked jaw seen promptly.

Where to get help

A dentist first; they assess the joint, the bite and tooth wear, and make splints.

A GP practice for pain management and referral.

Oral and maxillofacial surgery for locking, or for pain not responding to conservative treatment.

Oral Health Foundation publish patient information on jaw problems and grinding.