Temporomandibular disorder (TMD) 

  • Overview

Introduction 

Although not a serious condition, temporomandibular disorder can make a significant impact on quality of life 

Headaches

Most headaches aren’t serious and can be easily treated

Temporomandibular disorder (TMD) is a problem affecting the 'chewing' muscles and the joints between the lower jaw and the base of the skull.

Doctors sometimes refer to the condition as "myofascial pain disorder".

It's been estimated that up to 30% of adults will experience TMD at some point in their lives.

The condition itself isn't usually serious, and the symptoms it can cause  including pain, jaw joint clicking or popping, and difficulties eating  usually only last a few months before getting better.

However, these symptoms can significantly lower quality of life, and specialist treatment might be required if they're severe.

What are the symptoms?

TMD can cause:

  • clicking, popping or grating noises as you chew or move your mouth
  • muscle pain around the jaw
  • pain in front of the ear that may spread to the cheek, ear and temple
  • difficulty opening the mouth  the jaw may feel tight, as if it is stuck, making eating difficult
  • headache or migraine
  • earache or a "buzzing" or blocked sensation in the ear
  • pain in other areas of the body  such as neckache or backache

These symptoms may lead to related symptoms, such as disturbed sleep.

What are the causes?

Possible causes of TMD include:

  • clenching your jaw or grinding your teeth during sleep (bruxism) – which overworks the jaw muscles and puts pressure on the joint (often caused by stress)
  • wear and tear of the inside of the jaw joint – usually caused by osteoarthritis
  • injury to the jaw joint – for example, after a blow to the face or surgery
  • stress  some people may inherit increased sensitivity to pain or stress
  • uneven bite  for example, when new fillings, dental crowns or dentures are fitted
  • specific diseases  TMD may be associated with specific diseases such as rheumatoid arthritis, gout or fibromyalgia

However, some people may develop TMD without an obvious cause being found.

How is TMD treated?

If you have TMD, see your GP or dentist first for diagnosis and to discuss treatment options.

Generally, non-surgical treatments such as lifestyle changes and self-help physiotherapy-type treatments are tried first.

A small number of people with severe TMD may be referred to an oral and maxillofacial surgeon to discuss further treatment options.

Lifestyle changes

There are a number of self-help measures that can help improve TMD, including:

  • resting the joint by eating soft food and avoiding chewing gum
  • holding a warm or cold flannel to the jaw for 10-20 minutes, several times a day
  • doing a few gentle jaw-stretching exercises  your healthcare professional can recommend appropriate exercises
  • avoiding opening the joint too wide until the pain settles
  • avoiding clenching the teeth for long periods of time
  • massaging the muscles around the joint
  • relaxation techniques to relieve stress
  • not resting your chin on your hand

Mouth guards

Mouth guards (plastic devices that fit over your teeth) may be helpful if you grind your teeth.

These cover the teeth at night to reduce jaw clenching and teeth grinding, and can be made to measure by your dentist.

Read more about treatments for teeth grinding.

Medication

Painkillers such as paracetamol, ibuprofen or codeine can help relieve the pain associated with TMD.

If these aren't enough to control the pain, your doctor may prescribe stronger medication such as a muscle relaxant or antidepressant.

Steroid injections

If TMD is caused by a disease such as arthritis, a steroid injection into the jaw joint can help reduce pain and swelling in a joint or the surrounding soft tissue.

Most people report feeling less pain within the first 24 hours to one week.

You may find your pain improves for a period of a few weeks to several months and, in some cases, the injection resolves the pain completely.

Read more about corticosteroids (steroids).

Surgery

If the above measures don't help and the source of your symptoms is the temporomandibular joint  rather than the chewing muscles  your specialist may suggest a surgical treatment such as arthrocentesis (joint wash-out).

Open joint surgery may be considered in the rare cases where there is an abnormality within the joint.

Total joint replacement may be recommended for an extremely small number of people with severe, long-lasting symptoms and impaired jaw function. The National Institute for Health and Care Excellence (NICE) has produced guidelines on this procedure.

Read the NICE 2009 guidelines on artificial total temporomandibular joint replacement.

All joint surgery can have significant side effects and you should discuss these with your surgeon.

Outlook

Most cases of TMD improve over time and do not get worse, and most people will not need surgery.

In the meantime, symptoms can often be improved with the treatments mentioned above.

Page last reviewed: 21/08/2014

Next review due: 21/08/2016

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Comments

The 15 comments posted are personal views. Any information they give has not been checked and may not be accurate.

RheannaLouise said on 08 November 2014

I am 17 years of age and have suffered with temporamandibular joint disorder/dysfunction for a couple of years now, I was referred to a maxillofacial specialist and was diagnosed with tmjd, and was fitted a mouth guard however it caused me to grind and put more pressure on my jaws by clenching more as it was uncomfortable, I took it out in my sleep and just wouldn't stop grinding, later I was given medication for the symptoms, these were muscle relaxers and anti inflammatorys- bearing in mind the muscle relaxers the doctor gave me was for people suffering from MS, so was very strong, felt great however was dangerous when travelling home in the winter late at night at college..was fun though! I later had an x-ray and no damage has been caused yet, was meant to be sent a follow up appointment within the 3 months- a year has passed and they couldn't be bothered so I rang up, was meant to have an appointment last week however the hospital changed the appointment and now here I am with a swollen jaw and my jaw severely grinding and hurting to open...not all NHS establishments are bad but have found my one is...appointment is next month so will post again my results...fingers crossed something can be done and just not be spaced out and drugged up!

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NoraRioux said on 05 September 2014

I have suffered with tmjd my whole life, I am 18 years old and as far as I can remember my jaw constantly has clicked when chewing, I suffer from headaches and earaches also tinnitus. I recently chewed a piece of gum for a long time which has now left my jaw really painful and uncomfortable. I had an x ray at the dentist a few months back and they told me I had tight jaw bones and the air that gets between them makes the grinding/popping noise and that if it becomes painful to go to a gp but try to eat soft foods or cut food into small pieces as to not stretch the jaw too much. Now I am planning to book an appointment at my gp as the pain and noise is becoming worse, I will comment further if I receive any treatment and/or advice.

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sarah0512 said on 25 August 2014

My gp mentioned TMJD last time I was there with severe pain in the right side of my jaw and ear, I have also had what seems to be tinnitus and as a music student some of my tutors have tinnitus so when I described the constant sound I hear they agreed so going to discuss this with my doctor next time I go. Over this bank holiday weekend I have been in agony and no doctors are open can anyone suggest anything I can try thats around the house as I honestly cant deal with the pain anymore I have the pain in my jaw, ear and also my teeth like I have had them clenched for a long time, my ear constantly feels blocked just a nights worth of relief would be amazing so I can actually sleep !

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Jessica_97 said on 26 April 2014

I'm 17 and have been suffering with TMJD for about 4 months now. I saw my dentist about it about 2 months ago who referred me to a maxillofacial specialist. I saw the specialist about a month ago now who couldn't work out the cause of my problems other than the bone had bunched up at the front of the joint, causing the clicking/popping, and that there was
A slight lack of fluid around the joint. I was put on a soft food diet for 2 weeks and given a mouth splint to wear at night. Neither of these treatments improved my symptoms or subsided the pain in the slightest so I went to my GP last week who didn't bother examining the joint at all and prescribed me 400mg ibuprofen tablet which seem be causing me headaches and tiredness. I was not impressed by my last visit and wanted to ask people's opinion on what I should do next to try and get this sorted.

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Indiarae said on 14 April 2014

I have Ménière's disease as well as TMJ. The teeth grinding aggravates the Menieres. I am waiting to see a maxiofacial surgeon for what looks like is going to be my third op to remove debris from the jaw. The pain is awful and I am so depressed. Painkillers don't touch it. A med called Maxalit was mentioned on this thread but I can't find any info on it?? Any idea gratefully received.
Thanks for reading this x

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sonya1234 said on 06 April 2014

I have been suffering with severe pain that starts by the inside of my right ear for 2 years. I was always fobbed off with painkillers which never worked. I have also used a upper mouth shield for 2 years with no joy. I have used maxallt 10mg for the pain which would stay around for 3 days. I recently played a visit to my dentist who was concerned about the constant strange feeling to my back teeth and took a x ray and discovered that the disc between my skull and jaw bone is missing. After another bad bout of pain in the week I have now been given an appt with the Max facial tomorrow. Anyone else had this problem as I'm totally wiped out physically and mentally. Thanks sonya

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JJ69 said on 22 March 2014

I would just like to offer some advice for those out there suffering with this debilitating problem.

Following a fall, I have had major problems with my left jaw joint for almost 10 years. A dentist is useful for mouth guards, but frankly I found them of no further help dealing with my condition.

I would recommend asking your GP to book an appointment with a maxillo facial surgeon which can now be done very easily under the 'choose and book' system. This will get you the specialist treatment you need, and therefore hopefully avoid this becoming a chronic problem. You have the right to be referred to a consultant at a hospital of your choice, so please do not allow your GP to fob you off!!

I subsequently had a left jaw replacement, and although it will never be as good as it was, can now open my mouth, eat properly, and am almost pain free.

Good luck!!

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DataRascal UK said on 11 March 2014

Hello, Today, 11/03/2014 I attended an appointment at Birmingham's huge, Queen Elizabeth Hospital to see a Maxillofacial Surgeon. I underwent a face X-ray using a specialised X-ray for that purpose. I was diagnosed with TMJ Dysfunction Syndrome. I have found using ice-packs or freezer-sprays, used on the left side of my face, to be hugely beneficial with this affliction. However, though nobody believes me on this, I believe I have an affliction on the left side of my brain and it is that, that is causing this TMJ Dysfunction to originate down the left side of my face. It's up to yourself to try the ice-packs and freezer sprays. They work very well for me! Thank you.

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wendy nolan said on 27 February 2014

today I had surgery for my jaw joint, which was clicking and grinding, then locked shut for the last 6 months. I had an arthrocentesis. afterwards I found my jaw ached a little bit, but I didn't feel any different to when I went in. I am meant to do light exercises but I honestly don't think it has worked, I still cant open my mouth as far as I used to be able to before it locked shut. I have to go back in 6 weeks for a check up but I am pretty sure I know what they are going to say.

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Hcae said on 24 February 2014

Mine has been aggrivated by having a back tooth out. I had to have general anasthetic (Due to a phobia of dentists) .the dentist knew I had a clicky jaw...this is now worse since having the tooth removed as it now hurts.


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student128 said on 19 February 2014

It would be good if more people here post about their tmj experience so that we can all help each other. Has anyone tried a steroid injection and if so what was your experience? Thanks

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PrincessRainycorn said on 06 January 2014

@bird on a wire
Have you tried a dental outreach clinic? They are run by universities for students about to sit their exams, I know this sounds daunting but I have been using one for years and have never had a problem, it is all free, even mouthguards! This was a blessing to my mother after she took allergic reactions to all of her crowns and fillings and couldn't afford the £3000 to have it fixed by the NHS dental hospital, have a look in your local area and you should find some answers :)

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Bird On The Wire said on 14 October 2013

I pretty much know I have TMJ Dysfunction in the right side of my jaw joint, which is causing some tinnitus and wax to build up in my right ear too. TMJ can effect your ear, and it can be painful, mine is getting painful. When I wake up in the morning sometimes my jaw locks and it takes me a good 15 minutes to get it unlocked.
The problem is I cannot afford a dentist, not even and NHS dentist if it was possible for me to actually get one. I am on benefits, but I cannot claim anything income related as my husband works. The problem is, due to me having Asperger's Syndrome, and him being suspected of being on the spectrum, there are no laws that say he must hand over part of his wages to me to pay for dental care, he insists in keeping all finances separate and cannot get his head around the idea that we are married and it shouldn't work like that, so in reality I live only on my ESA and a small bit of DLA. Because my ESA is not 'income related' I cannot apply for free dental care.

My problem could be so easy to fix, at worst requiring I have a small operation, but it seems TMJ is dealt with by dentists, which are currently out of my reach.

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Bashir_R said on 23 September 2013

This information relating to Temporomandibular joint disorders (TJDs) is very helpful and saves me time to visit my GP or NHS...after reading through I quickly find the course of my joint disorder. Which was what I do most of the time....."resting chin on your hand". Thanks NHS for this update.

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Banane said on 09 December 2012

My local GP told me that the only choices I had for my deteriorating jaw condition were either the Tricyclics or corticosteroid injections. Now I see that there are other choices available, as I do not wish to have medication that messes with my head or the steroids. I've been down those paths before, and both have horrible side effects neither I want to try again.

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