Why does my jaw hurt?

Some people experience localized jaw pain, usually on one side, that manifests itself around the ear or the muscles of the jaw. The resulting pain is known as temporomandibular disorder (TMD) and it is common in all age groups. This condition often affects women more than men.²

What is TMD?

The temporomandibular joint (TMJ) is the joint that connects the jaw to the skull. It is a complex joint responsible for chewing, swallowing, yawning, and speaking. TMD is an umbrella term that includes various disorders of the TMJ.⁷ TMD is one of the most common causes of pain in the face and neck regions. It may restrict the opening and closure of the mouth, which affects eating, yawning, laughing, and speaking.

Patients often complain of cramp-like pain in the jaw and a clicking sound in the joint. According to the UK National Health Services,⁴ the Canadian Dental Association,⁵ and the National Institute of Dental and Craniofacial Research,⁶ TMD is caused by a combination of factors and has a wide range of signs and symptoms. Treatment is often non-surgical and depends on the cause of the pain.

Causes

Apart from trauma or physical injury to the neck, head, or jawbone (such as fracture or dislocation), in most cases, the causes of TMD are not clear. It may be due to:^1,7,11

• Dental issues such as infection or abscess
• Sinus infection
• Ear infection
• Grinding of teeth
• Underlying conditions such as arthritis or other chronic inflammatory diseases
• Misalignment of teeth/uneven bite
• Stress, which increases muscle tension in the TMJ
• Chewing gum

Signs and Symptoms

Patients with TMD may experience a wide range of signs and symptoms. Some patients do not experience any pain but may have a limited range of motion. Others report episodic pain or locking of the joint with the inability to open the mouth wide.¹ Symptoms of TMD vary depending on the cause and include:^{1, 7, 11}

• Pain on one or both sides of the jaw
• Difficulty chewing
• Unexplained toothache and/or increased teeth sensitivity
• Pain in the neck and shoulder area
• Headache
• Locking of jaw
• Ear pain and/or tinnitus
• Popping sounds

Diagnosing TMD can be challenging because the exact causes and the associated signs are controversial and can vary considerably.

The dentist or a TMJ specialist usually performs a physical examination to identify the range of motion, asks for a detailed medical and dental history, and possibly recommends an X-ray, CT scan, or MRI and/or blood test.

Complications from TMD depend on the cause and the severity of the symptoms. Possible complications include fever, swelling, infections, chronic pain, distress, or loss of appetite. 

Treatment

Most patients with TMD get better without treatment.⁷ A small percentage of affected individuals seek or need treatment due to the mild and fluctuating nature of the pain.³ Many treatment options aim at reducing pain and/or joint noise and improving jaw function within two or three months and are usually non-surgical. ^{7, 9}

Corrective dental procedures such as bridges or braces might be needed. The doctor may recommend self-care treatment options such as ice compresses to numb the pain and relieve discomfort. Over-the-counter muscle relaxants and anti-inflammatory drugs such as ibuprofen, or a bite guard (nightguard) may help to reduce the stress and clenching of the jaw.^{1, 10}

Behavioral changes include avoiding yawning and chewing gum, adopting a temporary soft-food diet (soup, smoothies, pasta) to prevent excessive chewing, and cutting food into small pieces to avoid overworking the jaw muscles.⁹ Other recommendations include massage therapy and relaxation techniques to release tension.¹⁰

In more severe cases where non-surgical treatments fail, irreversible surgical interventions might be an option, but are rare and often not recommended. Invasive surgery requires a dental surgeon with a specialization in disorders of the TMJ.¹¹

• Arthrocentesis:¹⁰ is a minimally invasive procedure that involves inserting needles into the jaw to remove fluid buildup and reduce inflammation.
• Arthroscopy:¹⁰ is an invasive procedure. An arthroscope is inserted to remove any scar or inflamed tissue.
• Joint replacement:⁸ is a risky procedure that is often not recommended. Parts of the TMJ are replaced with implants to restore function. In other cases, the whole joint is replaced with a prosthetic.

Prevention

Prevention of TMD depends on reducing the risk factors. To prevent the recurrence of TMJ pain, it is recommended that patients seek regular dental care, quit chewing gum, choose soft food regularly, practice relaxation techniques, and seek help if the pain intensifies again.

References

• Durham, J., Newton-John, T. R. O., & Zakrzewska, J. M. (2015). Temporomandibular disorders. BMJ : British Medical Journal, 350(mar12 9), h1154–h1154. https://doi.org/10.1136/bmj.h1154

• Maini K, Dua A. Temporomandibular Joint Syndrome. [Updated 2021 Apr 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551612/

• Valesan LF, Da-Cas CD, Réus JC, Denardin ACS, Garanhani RR, Bonotto D, Januzzi E, de Souza BDM. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clin Oral Investig. 2021 Feb;25(2):441-453. doi: 10.1007/s00784-020-03710-w. Epub 2021 Jan 6. PMID: 33409693.

• National Health Service https://www.nhs.uk/conditions/temporomandibular-disorder-tmd/

• Canadian Dental Association https://www.cda-adc.ca/en/oral_health/talk/complications/temporomandibular_disorder/

• National Institute of Dental and Craniofacial Research https://www.nidcr.nih.gov/about-us/mission

• Ouanounou A, Goldberg M, Haas DA. Pharmacotherapy in Temporomandibular Disorders: A Review. J Can Dent Assoc. 2017 Jul;83:h7. PMID: 29513209.

• Yoda T, Ogi N, Yoshitake H, Kawakami T, Takagi R, Murakami K, Yuasa H, Kondoh T, Tei K, Kurita K. Clinical guidelines for total temporomandibular joint replacement. Jpn Dent Sci Rev. 2020 Nov;56(1):77-83. doi: 10.1016/j.jdsr.2020.03.001. Epub 2020 Apr 15. PMID: 32612715; PMCID: PMC7310689.
• List T, Jensen RH. Temporomandibular disorders: Old ideas and new concepts. Cephalalgia. 2017;37(7):692-704. doi:10.1177/0333102416686302

• Dimitroulis G. Management of temporomandibular joint disorders: A surgeon’s perspective. Aust Dent J. 2018 Mar;63 Suppl 1:S79-S90. doi: 10.1111/adj.12593. PMID: 29574810.

• Stepan L, Shaw CL, Oue S. Temporomandibular disorder in otolaryngology: systematic review. J Laryngol Otol. 2017 Jan;131(S1):S50-S56. doi: 10.1017/S0022215116009191. Epub 2016 Oct 27. PMID: 27786149.

• Image by Sammy-Williams from Pixabay 

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