Jaw Pain? Here's Everything You Need to Know About TMJ
Pain in the jaw joint could be the result of TMJ, or temporomandibular joint syndrome. Here's everything you need to know about this confusing condition, including home treatment options that can help ease symptoms.
When I was a senior in high school, I developed a sudden, persistent pain in my left jaw joint. At first, I figured it was from something I'd eaten—pizza was a staple in my teenage diet, so maybe I'd gnawed too hard on some crust? But when the pain worsened instead of going away, I started to get worried, especially as the mobility in my mouth became more and more limited. I told my father I thought I'd somehow injured my jaw, but he was unfazed. "It's probably just TMJ," he said. "I have it too."
A Google search confirmed my symptoms: tenderness in the jaw joint and near the ear, pain when chewing or yawning, and possibly even a locked or clicking jaw. I took ibuprofen and applied a warm compress to the area, which helped somewhat. A few weeks later, my symptoms disappeared as randomly as they'd begun, and I forgot about TMJ for awhile.
Then, 10 years later, my TMJ came back. Suddenly, I had a long list of foods that were too crunchy, chewy, or generally difficult to eat: sandwiches, nuts, bananas, bagels, gum, hard candy, even sushi (sob). I talked to my doctor and my dentist, and now home remedies help ease the symptoms. After a few weeks my TMJ goes away—but it always flares up again a few months later.
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What is TMJ?
Technically, this condition is called TMD (temporomandibular joint disorder), a cluster term for many conditions that occur in the face, ranging from joint to muscle to ligament pain. But the term TMJ is more commonly used and specifically refers to pain in the jaw joints (also known as temporomandibular joints), says Nojan Bakhtiari, DDS, a board-certified TMJ and oral facial pain specialist based in New York City.
"It's not good enough to just call it TMD, because that's very broad—it's like saying 'bellyache'," he explains. "Do you have a bellyache because you have Crohn's disease, an ulcer, or something else?''
Whatever you call it, TMJ is a complicated condition. The National Institute of Dental and Craniofacial Research (NIDCR) estimates that more than 10 million Americans suffer from this syndrome, but scientists don't yet have real answers about what causes it. More research is also needed on the best treatment options (more on that later). Trickier still is that people sometimes assume it's "just TMJ," only to later realize that their symptoms are something else entirely; Dr. Bakhtiari has seen patients who actually had a misdiagnosed tumor, multiple sclerosis, or other brain lesions, for example.
If you tell your general practitioner you think you have TMJ, there's a good chance he or she will suggest you talk to your dentist. Your dentist can fit you for a mouthguard or oral appliance if you grind your teeth at night, but that doesn't explain all TMJ cases, says Dr. Bakhtiari. For this reason, although ruling out any teeth issues with your dentist is a good first step, the NIDCR recommends looking for someone who specializes in treating musculoskeletal disorders and chronic pain conditions if you have severe, persistent TMJ that doesn't improve with home remedies.
What causes TMJ?
More research is needed on exactly what causes TMJ. But scientists do know that most people experience an onset of symptoms during their teen years. At that time, "your jaw is developing at a different pace than your skull, and things are finalizing," explains Dr. Bakhtiari. Stats point to a higher frequency of TMJ in women, but Dr. Bakhtiari believes those figures may be misleading. "The current theory is that women are just better about seeking care for chronic health conditions than men are," he says.
Groups who appear to be more at risk include those with osteoporosis or osteopenia (or other conditions in which the bone or cartilage are undergoing changes), rheumatological concerns, headache conditions like migraines, and other pain (such as lower back pain or fibromyalgia). Dr. Bakhtiari adds that some women also experience a resurgence in TMJ symptoms when they enter menopause.
Steven Syrop, DDS, diplomate at the American Board of Orofacial Pain and section chief of the TMD facial pain service at Weill Cornell Medical Center, adds that other possible triggers include stress, yawning ("Going past a certain point is going to aggravate everything, so I always advise people to cushion a yawn"), eating very crunchy or chewy foods, and potentially even weather. "Cold, windy days can stimulate muscle pain," he says.
Teeth grinding is often cited as a major cause for TMJ. "It's one we talk about a lot, but it's over-emphasized," says Dr. Bakhtiari. He points out that plenty of nighttime teeth grinders don't have TMJ; meanwhile, many other people with the condition don't grind their teeth. In a 2013 study from New York University College of Dentistry, Weill Cornell Medical College, and the University of Montreal, researchers found that sleep bruxism (also known as nighttime teeth grinding) wasn't the cause of participants' TMJ symptoms. In fact, less than 10% of the people with TMJ showed bruxism in their sleep studies, about equal to the control group.
"Healthy patients grind their teeth to the same degree, it's just that TMJ patients report it more often," says Dr. Bakhtiari. "So it appears that maybe TMD patients are not sleeping as well, or [there's] something else that makes them more aware that they're grinding."
Nor is teeth grinding the only habit that can exacerbate TMJ symptoms. Other common ones include nail biting, cheek biting, chewing on pens, cuticle biting, or generally clenching your teeth throughout the day, Dr. Syrop says. "If you're just relaxed and not doing anything, your teeth shouldn't be touching," he points out.
The good news? For most people, TMJ is "remitting and self-limiting, meaning it goes away and doesn't get worse," says Dr. Bakhtiari. However, there is a smaller group of people for whom symptoms continue to worsen throughout their life. "Those are the ones that need some sort of intervention."
Because the surgical options are irreversible and not always effective, the NIDCR stresses the importance of seeking out conservative, reversible treatments first. As an initial step, try at-home remedies such as an ice pack or warm compress, over-the-counter pain medications, stress reduction techniques (Dr. Syrop is a big proponent of meditation to relax the jaw muscles), and, if teeth grinding is to blame, a bite plate or mouth guard to separate the top and bottom teeth while you sleep. Some people even find relief from over-the-counter topical products such as menthol and arnica applied around the jaw joint.
It's also a good idea to switch up your diet to include mostly soft, easy-to-chew foods, particularly during a TMJ flare. "Eating very thick foods like a hero sandwich, that would be off the list, and I would not have bagels," says Dr. Syrop. "Chewy foods are going to aggravate it in general. So fish is better than steak, mushy cereal is better than crunchy cereal, and [eat] cut up foods more than you normally would."
If first-line treatments don't help, book an appointment with a specialist who can help you determine whether the pain you're experiencing is stemming from the muscle or joint. For a muscle issue, your doctor might decide to use a muscle relaxant or injections to the muscle at trigger points. Botox is sometimes recommended for people with enlarged muscles in the area that are causing them pain, or for someone who also has chronic headaches; but Dr. Bakhtiari notes that it has side effects and shouldn't be a first-line treatment. Joint issues may be treated with injectable anesthetics or steroids.
Sometimes surgical treatments or implants are recommended for TMJ patients, such as if the person has a problem with the joint and conservative management has failed. But surgery for TMJ is sometimes controversial, in part because it's permanent and there are limited studies on its effectiveness. "It's important to emphasize that surgical options should be absolutely a last resort," says Dr. Bakhtiari. "Reversible treatments are the standard of care."
Dr. Syrop agrees. "I have to warn patients all the time not to do anything invasive that's irreversible," he says. "The overwhelming majority of these problems are treated with reversible techniques."
Important to note: Although at-home self-care strategies are the first-line defense against TMJ pain, if your jaw remains locked or restricted in movement for more than two or three days, you should see a doctor immediately for an X-ray. "A locked jaw that goes on can be very dangerous," says Dr. Bakhtiari. "That's one area that people definitely benefit from better care earlier on."
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Does TMJ ever really go away?
I'm not the only one whose TMJ symptoms typically ebb and flow throughout their life. "TMJ comes and goes for many people for a variety of reasons," says Dr. Syrop. "These problems by and large heal, and then a period of time goes by and they can be reinjured." Those same triggers—stress, hard-to-eat foods, weather changes, teeth grinding, or other habits—may be to blame.
But while TMJ can come and go, Dr. Bakhtiari adds that it should never be chronic or continuous—you should be able to get some relief between flares. If you don't, that might be a red flag that something more serious is to blame for your pain. Hopefully, though, self-care strategies help you manage the condition and, over time, identify the specific triggers that exacerbate your symptoms. "It will probably reoccur," he says. "But, the second time around, you will hopefully have a game plan."