Temporomandibular joint and muscle disorders (commonly referred to as TMJ or TMD) are very common.  The most common symptoms include pain, clicking, and popping in and around the temporomandibular joint.  Ear pain and headaches centered around the temple, jaw, and cheek are also common.  Pain in the muscles of mastication (the chewing muscles) can also trigger migraine headaches in some patients.

 

What Causes TMJ?

Some people have a known trauma that causes the initial onset of pain, but for most people, the exact cause is unknown.  Genetic and anatomic factors play a role.  Gum chewing, grinding the teeth (bruxism), overuse of the chewing muscles by eating a lot of hard or chewy foods, chewing gum, and stress are all modifiable risk factors for TMD.  Given the relationship between stress, tooth grinding, and temporomandibular pain, it makes sense that the incidence of these disorders increased throughout 2020.1  In my practice I saw many times more TMD patients in 2020 than in any year prior.

 

What Can We Do About It?

Most TMD treatments aim to the muscles of mastication through dietary changes, relaxation techniques, therapy exercises, and finally, chemodenervation of the muscle.

Conservative Treatments

Thankfully, the symptoms of TMD often resolve with conservative treatment alone.  This includes short term use of non-steroidal anti-inflammatory medications like ibuprofen or naproxen, switching to a soft diet for a few weeks, avoiding gum chewing, and trying a night time mouthguard to limit grinding.  A high-quality mouth guard at night is important.  Though it may not alleviate TMJ pain, it will reduce the damage done to the teeth from grinding.

Physical Therapy

If these interventions do not improve or resolve TMD, physical therapy is helpful for many patients.  Simple changes to posture and working habits can help as well.  For example, forward or slumped posture can exacerbate TMD pain by putting upward pressure on the joint.  Sitting with your computer screen at eye level, or at least consciously remembering to look up, not down at a screen, throughout the day, can help improve posture.  This keeps the neck elongated and the head level rather than tilted down.

Improve Nasal Breathing

Mouth breathing can exacerbate TMD.  When the mouth is held in an open position, tension is created in the muscles that lower the jaw. This can push the joint further into the capsule, causing stress and pain in the jaw and in the muscles around it.  Some people chronically mouth breathe because they cannot breathe through their nose.  In these cases, improving nasal breathing can also improve TMD.  If you have nasal obstruction due to allergies, structural issues, or sinus conditions, Dr. Irvine can help find treatments that are right for you.  Read more about nasal airway surgery here.

Botox Injections

When pain is bothersome and interferes with daily life despite these treatments, botulinum toxin (such as BotoxÒ) injections can be an excellent choice and, in my personal experience with hundreds of patients, can provide significant relief.  You can read more about Botox for TMJ pain here.

 

What Next?

If these do not work, the next target area is the temporomandibular joint itself.  Surgeries for the joint have generally not proven useful in the majority of patients. Newer techniques, such as Platelet Rich Plasma (PRP) to the joint may help to reduce inflammatory factors, possibly helping to regenerate damaged bone or cartilage in the joint.

 

1 Emodi-Perlman A, Eli I, Smardz J, Uziel N, Wieckiewicz G, Gilon E, Grychowska N, Wieckiewicz M. Temporomandibular Disorders and Bruxism Outbreak as a Possible Factor of Orofacial Pain Worsening during the COVID-19 Pandemic—Concomitant Research in Two Countries. Journal of Clinical Medicine. 2020; 9(10):3250. https://doi.org/10.3390/jcm9103250