The jaw joint and facial pain

How does the jaw joint work?

The lower jaw is attached to the skull on each side of the face, just in front of the ear, by a joint. Temporomandibular disorders (TMD) are a group of more than thirty conditions that, according to NIDCR, affect the joint and the chewing muscles. The institute divides them into three groups: problems of the joint itself (including the disc), problems of the muscles, and headache that comes with the disorder. It estimates that about 5 percent of US adults are affected, and that it is roughly twice as common in women, especially those aged 35 to 44.

Symptoms

• pain in the chewing muscles or the joint, which is the most common sign and sometimes spreads to the face and neck,
• stiffness or limited movement of the jaw, or it locking,
• clicking, popping or painful grating when opening and closing the mouth,
• sometimes ringing in the ears, hearing loss or dizziness,
• a feeling that the upper and lower teeth fit together differently,
• headache around the temples and poor sleep (NHS).

A noise that does not come with pain is usually normal. NIDCR writes that a click or pop without pain is common and is not counted as a sign of disease.

What causes it?

In most cases the exact cause is not known. Sometimes an injury to the joint is the cause. The NHS names teeth grinding, wear of the joint, a blow to the head and face, and stress. NIDCR says a mix of genetic factors, stress and the way pain is perceived play a part in how it starts and persists, and that the evidence does not support the belief that a bad bite or orthodontics is the cause.

Checks and diagnosis

There is no single test that everyone accepts. The doctor or dentist usually asks where the pain is, when it started and what makes it worse. They feel the head, face and jaw, listen to the joint and measure how far the mouth opens. Sometimes an X-ray, MRI or CT scan is needed. Part of the work is ruling out other causes of jaw and facial pain. The guide to jaw imaging explains these images.

Treatment: the simplest things first

All three sources say to begin with conservative treatment, because most problems are temporary.

Home care. Eat soft food. Try a cold or warm compress, whichever feels better, and gentle massage of the sore muscles. Avoid chewing gum, chewing pens, biting with the front teeth, very wide yawns and nail biting, and keep your teeth apart except when eating. Relaxation exercises for stress are also recommended. The NHS and NIDCR also name over-the-counter pain relievers, but check this with your own doctor or pharmacist.

If it does not improve. Physiotherapy with massage and jaw exercises, behavioral approaches such as cutting down jaw habits, cognitive behavioral therapy and biofeedback, and sometimes medicines on a doctor’s prescription. The evidence for medicines is limited, and some carry serious side effects or a risk of dependence, so they should not be taken on your own. A night guard or splint protects the teeth, but the evidence for reducing pain is limited. Acupuncture and electrical skin stimulation also have limited evidence.

Permanent treatments. NIDCR advises avoiding treatments that permanently change the joint or the teeth, unless there is no other way left. On changing the bite (crowns, grinding teeth or orthodontics), it says the evidence is not sufficient and things may get worse. On Botox injections, which are not approved for this problem in the US, the evidence is mixed.

Where does surgery fit?

NIDCR lays out interventions from gentle to hard: washing out the joint (arthrocentesis) and arthroscopy, which looks into the joint with a camera and sometimes removes adhesions, and then open surgery. About open surgery it writes that the changes are permanent and there are no long-term studies of its safety, so it is considered only for joint damage that has no other way or for severe, persistent symptoms that have not improved with other methods. Some older joint implants have had serious complications, and the long-term effect of current implants is still being studied.

The institute’s advice is clear: do not rush, ask about the reason for the suggestion, the alternatives, the benefit and the risk, and get a second opinion, for example from an orofacial pain specialist or a surgeon who has experience with these disorders.

Some jaw misalignments also come with chronic jaw or joint pain and appear in the list of signs for corrective jaw surgery. If you have this concern, read jaw misalignment and orthognathic surgery.

When to act urgently

The NHS says in these situations see a doctor promptly, the same day, or call a health advice service:

• you cannot eat or drink,
• your mouth is locked or will not open fully,
• you have pain around the jaw or ear or the side of the head, or frequent severe headaches,
• the side of your skull or your scalp is tender to the touch,
• you have a vision problem such as double vision or loss of sight in one or both eyes.

These may be signs of a serious problem that needs urgent treatment. Jaw pain while eating or talking, with pain at the temple and a tender scalp, may come from temporal arteritis. The NHS says this disease can lead to stroke or blindness if not treated quickly, and that vision problems with it need a same-day visit to an eye specialist. If your sight suddenly gets worse, do not wait: go to a hospital emergency room.

In these situations, call 115 and look at the list of urgent signs:

• chest pain or pressure that spreads to the jaw, neck or arm,
• a mouth that is stuck open and will not close,
• after a blow to the face, the jaw will not close, the bite has changed, or you have double vision or vomiting,
• breathing or swallowing has become difficult.

This page is for general information and does not replace an examination.