Jaw Pain / Temporomandibular Joint Pain (TMJ Pain)

Janet D. Pearl, MD, MSc

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Jaw Pain / Temporomandibular Joint Pain (TMJ Pain)

What is it?

Temporomandibular joint (TMJ) pain, or jaw pain, is pain that develops as a consequence of a disorder of the joint that connects the jaw to the temporal bones on the sides of the skull. TMJ disorders can affect the joint itself, as well as the muscles and ligaments in the face that control it, leading to an impaired function of the TMJ joint.

TMJ pain can arise from injuries to the tissues around the joint, due to dislocation, muscle disorders, impact or another source of trauma leading to contusions or fractures. A number of medical conditions can also entail TMJ pain; the most common syndromes are myofascial pain disorder, disk derangements, and different forms of arthritis. Other causes include infection, dislocation, and muscle disorders.

Emotional and mental health conditions may also lead to the development of TMJ disorders. In fact, stress and anxiety are among the most common causes of TMJ pain. Stress is often associated with behaviors that lead to jaw pain such as teeth grinding, tightening of facial and jaw muscles, or jaw clenching. Another common behavior usually associated with stress and anxiety is bruxism, a condition in which you unconsciously grind, gnash or clench your teeth, usually during sleep. These behaviors put a lot of pressure on the joint, leading to pain.

Given the relative subjectivity of symptoms, along with the overlap of symptoms between different TMJ disorders and with non-TMJ disorders, such as dental conditions, the specific cause of TMJ pain may sometimes be difficult to diagnose, requiring the aid of imaging techniques such as radiography or magnetic resonance imaging (MRI).

 

Function of the Temporomandibular Joint
Temporomandibular Joint Pain

Who gets it?

Temporomandibular pain is the second most common chronic musculoskeletal condition after chronic low back pain. Anyone with a TMJ disorder is potentially at risk of developing Temporomandibular pain. TMJ disorders affect up to 15% of adults, with a peak incidence between 20 and 40 years of age, and are twice more common in women than in men, although the reason for this difference is unknown.

Common causes of TMJ pain include: emotional distress, nocturnal bruxism, tooth clenching, lip or cheek biting, acute trauma to the jaw, disk derangement disorders, trauma from hyperextension (e.g. dental procedures, oral intubations for general anesthesia, yawning, cervical trauma), joint instability or laxity, prior surgery, gout/pseudogout, psoriatic arthritis, rheumatoid arthritis/juvenile rheumatoid arthritis, ankylosing spondylitis, myofascial pain, acute muscle strain, muscle spasm, fibromyalgia, chronic pain conditions, and myotonic dystrophy.

TMJ Pain

What kind of pain results?

Temporomandibular pain can be temporary or last for years. It may affect one or both sides of the face, with symptoms can range from mild discomfort to severe and debilitating pain, including limitations of jaw function.

Pain or tenderness is usually felt in the jaw joint area, but it may radiate to other regions, causing toothaches, headaches, or pain in the neck and shoulders; pain can also be felt in or around the ears, especially when chewing or speaking, and different hearing problems may develop, including tinnitus (ringing in the ears).

Pain may be accompanied by swelling on the side of the face, particularly when it is due to local inflammation. While moving, the jaw may sometimes click, pop, grate or even get locked, and this may also be painful. Increased pain and discomfort may be felt while chewing, particularly when chewing harder foods. Given that the Temporomandibular joint may be used 1500–2000 times a day, Temporomandibular joint pain can be a massive source of discomfort.

TMJ Pain

Treatment of TMJ pain

Depending on the causes, acute temporomandibular joint pain can be treated with ice, particularly when accompanied by swelling and warmth, which are signs of inflammation. In other cases, moist heat may be more effective. Resting the joint by eating soft foods is also important. Physical therapy through gentle jaw exercises may improve healing and increase jaw mobility, when this is an issue.

 

Since TMJ pain is often due to stress leading to clenching, relaxation techniques may also be helpful, either through yoga, massage, or meditation, for example. A dental night guard, a plastic mouthpiece that covers the teeth and prevents them from touching, may be effective when pain is caused by grinding and clenching during sleep.

Pharmacological treatment for TMJ pain is usually achieved with nonsteroidal anti-inflammatory drugs (NSAIDs), like naproxen or ibuprofen, or with corticosteroids, such as cortisone. These can relieve inflammation, swelling, and muscle pain, being effective for many TMJ disorders.

Muscle relaxants (baclofen, tizanidine, cyclobenzaprine) may be needed when there is teeth grinding or jaw clenching. Botulinum toxin type A (commonly known as Botox) is a recent treatment option that can be useful in a number of TMJ disorders. This toxin is a muscle relaxant and can relieve muscle pain by reducing muscle tension in the head and neck; it also decreases bruxism at night.

Anxiolytic drugs, such as benzodiazepines, may be effective when TMJ pain arises as a consequence of stress and anxiety. In chronic TMJ pain, antidepressants may also be used as an analgesic, reducing headaches and neuropathic pain, and improving sleep quality. Anticonvulsant drugs such as pregabalin or gabapentin are also effective in some TMJ disorders.

Transcutaneous electrical nerve stimulation (TENS) may also offer pain relief by relaxing the jaw joint and facial muscles, while ultrasound may relieve soreness and improve mobility.

Trigger point injections to the masseter muscles, which are the largest muscles involved in chewing, may lower pain that arise from inflammation of these muscles.

Injections of the TMJ joint  with steroid, usually ultrasound guided, can reduce pain and inflammation due to arthritis of this joint. Platelet rich plasma injections can be done if trigger point injections or TMJ injections with steroid do not provide long term relief of pain.

Orthodontic treatment may be required if joint pain is being caused or intensified by the position of the teeth or bite problems. Severe cases may require maxillofacial surgery.

Trigeminal neuralgia is another cause of pain in the jaw area.  This pain is often described as a searing or lancinating jaw or mouth pain that occurs suddenly and briefly, and can be triggered by chewing. An Xray guided Injection with corticosteroid to this nerve branch can alleviate the pain caused by  dysfunction of the trigeminal nerve.

Night guard for TMJ pain
medication
tmj injection
tmj-injection-diagram

References

  • Ahmad M, Schiffman EL (2016). Temporomandibular Joint Disorders and Orofacial Pain. Dent Clin North Am, 60(1):105-24. doi: 10.1016/j.cden.2015.08.004
  • De Rossi SS, et al (2014). Temporomandibular disorders: evaluation and management. Med Clin North Am, 98(6):1353-84. doi: 10.1016/j.mcna.2014.08.009
  • Durham J, et al (2015). Temporomandibular disorders. BMJ, 350:h1154. doi: 10.1136/bmj.h1154
  • Gauer RL, Semidey MJ (2015). Diagnosis and treatment of temporomandibular disorders. Am Fam Physician, 91(6):378-86. PMID: 25822556
  • Schiffman E, et al (2014). Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache, 28(1):6-27. doi: 10.11607/jop.1151
  • Wieckiewicz M, et al (2015). Reported concepts for the treatment modalities and pain management of temporomandibular disorders. J Headache Pain, 16:106. doi: 10.1186/s10194-015-0586-5

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