Pop, Click, Ouch? How to Treat Jaw Pain From TMJD

Much like our teeth, when injury, inflammation or other discomfort strikes the joints and muscles of the jaw, a host of taken-for-granted functions – breathing, chewing, swallowing, talking and sleeping – can be an exercise in severe pain.

This condition is called temporomandibular joint and muscle disorder (TMJD), and it ranges from joint degeneration, which may require surgery, to joint displacement and/or muscular inflammation and stress.

Thomas Fry, DDS, an assistant professor in the Department of Diagnostic Sciences & Surgical Dentistry at the University of Colorado School of Dental Medicine, said the condition is sometimes debilitating for patients, but it can also be relatively short-lived with the proper care.

Non-invasive treatments are the primary approach, including physical therapy, muscle relaxants, dry needling and local anesthetic injections. Red light therapy is becoming a more common therapy for various physical conditions, including TMJD.

Fry said less than 10% of patients who experience TMJD end up seeking treatment. “It is a small subset of this population that needs this care. Within about six months, 50% of those patients will feel better,” he said. “TMJD is very akin to any other type of musculoskeletal injury and pain.

“For most patients that I see with TMJDs, the goal is helping them toward their recovery and making their current symptoms more tolerable. Sometimes people just need to be kind of pushed in the right direction, and their body takes care of the rest.”

In the Q&A below, Fry explains the differences in TMJD cases, the causes of the disorder, who is most susceptible, and available treatments. The interview has been condensed and edited for clarity.

What is TMJD?

It’s when a patient has either pain or a loss of jaw function due to a problem with the temporomandibular joint or the muscles that move the lower jaw.

How do you diagnose TMJD?

A thorough exam of the TMJs and the chewing muscles can identify the source of the pain, and/or the reason why the patient is unable to open or close normally. This is an important step, as patients often have difficulty knowing whether their pain is coming from the joint or the muscles.

What kind of pain do TMJD sufferers experience?

It can cause pain in the jaws, teeth, ear, or side of the face. Patients can also develop headaches, dental pain, or pain in other parts of the head and neck. The pain is often dull, and worsens during jaw movements, as when chewing or speaking. Patients who grind their teeth may experience more severe pain after doing so. Pain can be mild-to-severe, and can last anywhere from a few hours to years. Most patients feel better without treatment in a week or two. Because we use our jaws throughout the day, many patients will seek care for significant pain that lasts longer than that.

Can TMJD become a debilitating condition for patients?

Absolutely, it can be a significant issue – people who have not suffered from significant jaw pain don’t realize how often we use our jaws. These are essential, every-day functions: We speak, we breathe, we chew, we swallow. Patients with severe pain may end up with a significantly limited diet. They may only be able to eat soft foods, and they may have other conditions that make that type of diet exceptionally problematic. You can end up losing weight – and not in a healthy way – or gaining weight from a soft diet high in carbohydrates. You can have work issues, problems socializing, and it can affect your sleep.

What are the main causes of TMJD?

It’s not always east to pin down why certain patients develop them and why others don’t. Especially for acute TMJD, the most common precipitating factors are stress and acute injury. The latter can happen if a patient’s mouth is open for a long time for a dental exam, or they take a blow to the face. Or maybe they carry a lot of stress in their head and neck, which a lot of people do. Stress can lead to parafunction – habitual clenching and griding of the teeth – that can make jaw pain worse or make it harder for patients to recover fully.

Are there certain age groups or other demographics that are most susceptible to TMJDs?

Interestingly, the very old and the very young are less commonly affected – it’s really a disease of early adulthood and middle age. The people I most commonly see are ages 20 to 40. We know from survey data that stress levels and life satisfaction do worsen during early adulthood and middle age, which could help explain why this is.

Women are more likely to seek treatment for TMJD than men, and we don’t have a perfect explanation for why. Is it a difference in the nervous systems of men and women? Is it a difference in the way men and women are socialized, the differences in the reasons they seek healthcare? You get into very complicated topics when it comes to this because the way people experience pain and the way that people seek treatment for pain is individual and cultural.

What are the main therapies used to treat TMJDs?

It varies depending on which structures are affected. For many patients, if I can find the right non-invasive therapy, I can make their recovery shorter and more tolerable. For patients with new onset or mild symptoms, I often recommend home physiotherapy, including warm or cold compresses, self-massage and gentle stretching. Physical therapy with a TMJ specialist can also be very helpful for many patients.

When patients have moderate or severe symptoms, or don’t respond quickly to self-care or physical therapy, we have a number of other therapies we can try. Anti-inflammatory medications or injectable or oral steroids can be helpful for joint issues. For the muscles, other non-invasive treatments include muscle relaxants, dry needling or local anesthetic injections.

Surgery for TMJD is not as common as many people believe, especially in acute cases with no joint degeneration. Even in cases with significant joint degeneration, surgery can often be forestalled or prevented with less-invasive measures. That said, surgical treatments can be very helpful for certain patients, and remain an important management tool for pain specialists and oral surgeons.

Infrared light therapy, or red-light therapy, appears to be gaining traction as a non-invasive therapy option for muscular disorders, including TMJD. Is this kind of therapy helpful for some patients?

There is evidence that red light and near-infrared light therapy reduces pain and inflammation in many kinds of tissue, and some light therapy devices are FDA (Food and Drug Administration) cleared for musculoskeletal pain relief. A well-calibrated, well-targeted therapy with this type of light can be helpful for some patients, but these therapies can be expensive and time consuming, and they won’t work for everyone.

In some parts of Europe, red light therapy is approved for treatment of mucositis (inflammation of the mucosa lining the mouth and gastrointestinal tract). That’s an area of interest for me, because patients who go through head and neck radiation often develop significant mucositis, and this can be a way to limit their pain and discomfort.