What is temporomandibular disorder (TMD&TMJ)?

 

Often called TMJ disorders, TMD is a group of disorders that affect the two temporomandibular joints – in other words, the jaw joints. You may also have heard it referred to as TMJ dysfunction, but TMD is the preferred term these days since it doesn’t just affect the jaw joints but also the muscles that control the movement of the joint (the masticatory muscles) and their associated structures.
 
Your temporomandibular joints are located at the two points where your lower jaw connects with your skull. Often called the most frequently used joints in the body – some experts estimate it’s normal for them to be used more than 2,000 times a day (i) – these joints are found just in front of your ears. The bones of the joints and the skull are connected by ligaments and muscles, surrounded by a joint capsule and lubricated by synovial fluid. Inside the joint parts of the bones are covered with smooth cartilage, plus there’s a cartilage disc that sits between the two bones that moves forwards and backwards as you open and close your mouth. 
 

How common is TMD disorder?

TMD is fairly common, with about one in four people thought to experience jaw joint problems at some point or other (ii). Some experts, however, say it’s difficult to estimate the exact number of people with TMD, since most people don’t see a doctor or another healthcare professional when they’re affected by it – indeed, studies suggest that just five percent of adults with TMD symptoms seek any medical advice or treatment (iii).
 
Other things we know about people who have TMD include that, while it can affect anyone of any age, it’s more likely to develop when you’re older (2.5 per cent of people aged 18 - 24 years have TMD compared with 4.5 percent of those aged 34 - 44 (iii)), and your risk tends to be higher if you’re female rather than male (iii). TMD symptoms are also common in musicians, particularly those who play some stringed or woodwind instruments, arguably because of the way they have to hold their jaw in an awkward position (iv).
 

What are the symptoms of TMD?

If you’re affected by TMD, you may experience one or more of the following symptoms:
 

• Jaw pain, soreness or aching that may be worse when you wake in the morning, during the evening or when you’re under a lot of stress (this pain is typically felt immediately in front of the ears as well as in the temples, cheeks and along the jaw itself)

• Jaw pain while moving your jaw – while chewing, yawning or talking, for instance

• Neck ache

• Problems with chewing and swallowing (this may lead to unintentional weight loss)

• Clicking, popping or grating noises that come from one or both sides of your jaw when you open and close your mouth, with or without pain (though clicking can also be common in people who don’t have TMD – you only have TMD if you have other symptoms such as jaw pain in addition to joint clicking)

• Persistent headaches with pain most often felt around the temples and forehead

• Ear pain or earache that’s not caused by an infection, often with a feeling of fullness in the ear

• A stiff or tight jaw with limited movement – for instance, you may not be able to open your mouth fully

• Jaw locking (an inability to open or close your mouth)

• Sleep difficulties

• Ear symptoms such as dizziness, tinnitus or sensitivity to sound

• Speech problems

• Dental problems (wearing down or breaking your teeth, for example, your upper and lower teeth not fitting together properly – also known as dental malocclusion – or tooth sensitivity)

• Mental health symptoms including stress, anxiety and depression

 

What causes TMJ?

Health professionals don’t fully understand what causes TMD, but it’s widely thought the causes may be complex and involve a number of different factors. In fact there is often no obvious cause, though overusing the joint and muscles of the jaw is thought to be responsible for much of the discomfort that comes with TMD.
 
You need your jaw joints and muscles for essential functions such as talking, eating and swallowing. Some of the things that can lead to overusing them include the following:
 

• Clenching your teeth: your upper and lower teeth shouldn’t touch unless you’re eating, however many people consciously or subconsciously clench their teeth when they’re angry, stressed or concentrating. Very rarely, excessive jaw clenching can be caused by certain types of movement disorders (orofacial dystonias).

• Grinding your teeth: this can happen subconsciously during the night while you’re asleep or during the day when you’re under stress (find out more by reading our guide to bruxism). If you regularly grind or clench your teeth it can break down the cartilage in your jaw joint as well as affect the synovial fluid in the joint.

• Chewing gum: this and other types of chewing behaviours – biting your nails, for instance, or chewing pencil or pen tops – can make the jaw joint and surrounding muscles tired. Even eating hard foods or foods that need a lot of chewing can put pressure on the jaw joint and muscles.

• Poor posture: if you hold your head too far forwards with your shoulders hunched or rounded, it can change the way your jaw joints work (i). Other bad postural habits such as holding a telephone between your neck and shoulder can strain your jaw joints and muscles too.

 
There are other possible causes of TMD including trauma to the face, head or neck – for instance, falling onto your chin or face, having a sports injury, being involved in a car accident or even having surgery. Wear and tear of the jaw joint – specifically the cartilage in the joint – caused by osteoarthritisis also thought to cause TMD symptoms, though because osteoarthritis is a wear-and-tear condition it tends to affect more older people than younger adults. Other types of arthritis – including rheumatoid arthritis and gout – may also affect the jaw joints.
 
Meanwhile certain conditions have been linked with chronic TMD, including chronic fatigue syndrome, fibromyalgia, migraine and irritable bowel syndrome. Experts have suggested people with these conditions may have a condition called central sensitisation – that is, increased sensitivity to generalised pain (v).
 
Some studies have also uncovered a link between TMD pain and hormonal fluctuations that happen during the menstrual cycle – but because not all studies examining the issue have established a connection, the jury’s still out where periods and TMD is concerned (v).
 
The good news is that TMD isn’t usually a progressive condition, which means your symptoms – though they may fluctuate for a while – should eventually improve. 
 

When should I see my GP about TMJ?

There are several reasons why you may want to see your GP for TMD symptoms. For instance, the pain may affect you so badly that you cannot carry on normally with your daily life. TMD symptoms may make it difficult for you to get a good night’s sleep, or you may find yourself feeling nervous, anxious or on edge a lot of the time. Depending on your symptoms you may also find it hard to eat or drink properly, or you may keep having flare-ups of TMD pain and discomfort.
 

What is TMJ disorder treatment?

If any of these things affect you, your GP can suggest you try one or more treatments. These include medication such as painkillers, muscle relaxants (usually a short course lasting no longer than two weeks) or a type of antidepressant medicine that helps with pain relief. They may also refer you to a facial pain management service if one is available in your area.
 
Your GP may also suggest that you see a physiotherapist for treatments such as ultrasound and to learn exercises that may be helpful (for more about jaw exercises, read on). If you have TMD caused by an underlying condition – arthritis, for instance – you may be offered steroid injections, which can help relieve the inflammation in your jaw. Botox injections are sometimes used in people with severely overactive jaw muscles (usually caused by an orofacial dystonia), though experts are divided on how effective they may be.
 
If you grind your teeth or clench your jaw muscles frequently, your GP may refer you to a dentist to have a bite guard fitted (also called an occlusal splint). Usually worn overnight, a bite guard can help reduce tension in the muscles around the face. On the other hand if your symptoms are causing severe stress or anxiety, your GP may decide to refer you to a mental health service that offers cognitive behavioural therapy (CBT) to help you cope with and manage your feelings. Surgery may be an option in a small number of cases, with the type of surgery dependent on the cause of your symptoms (this may, for instance, involve a ‘washing out’ of the joint called arthrocentesis or manipulation of the joint under general anaesthetic).
 

How can I manage TMD?

If you have milder and less frequent TMD symptoms you shouldn’t have to visit your doctor because there’s lots you can do yourself to feel better. Taking over-the-counter painkillers such as paracetamol or ibuprofen for short periods of time, for instance, can help reduce jaw pain. Here are some of the other things you can do that may relieve as well as prevent TMD symptoms:
 

Eat soft foods instead of hard, crunchy foods to give your jaw a rest 

Try eating things like pasta, eggs, porridge, soup, cooked fruits and vegetables, yoghurt, cottage cheese and fish. Also try to avoid eating anything that requires you to open your mouth wide and take big bites. It is, however, important to go back to normal eating once the pain starts to ease or if you don’t see any improvement after a couple of weeks, since only eating soft foods could restrict your diet and cause dietary deficiencies.
 

Find other ways to rest your jaw joint

Try not to chew gum or bite your nails. Trying to stifle a yawn to avoid yawning too widely can also be helpful (alternatively try putting your hand under your chin when you yawn to stop your mouth opening too widely). If it’s possible, try to take a break from talking whenever you can to see if this also helps.
 

Use hot or cold therapy

Hold an ice pack or heat pack against your jaw, where it feels painful. You can make your own ice pack by wrapping a packet of frozen peas in a tea towel and holding it against your jaw for five minutes. If heat gives you more relief, try placing a covered hot water bottle on the painful area twice a day for 15 - 20 minutes at a time. Massaging the muscles in your jaw area may also feel soothing.
 

Try to improve your posture

This is especially important if you tend to spend long periods sitting in front of a computer screen. You may, for instance, ask your employer or manager for a workstation assessment to help make sure your desk set-up is encouraging good posture during your working day. Some of the things you can do yourself include avoiding holding your phone between your neck and shoulders, or resting your chin on your hand when you put your elbow on a desk or a table.
 

Reduce stress

Find ways to relax that you can practise easily every day. There are several meditation apps you could try, such as Calm or Headspace, or you could do something simple like having a relaxing bath or listening to soothing music. Deep breathing is an effective way to calm yourself down quickly whenever you feel wound up – here’s one you can try anywhere:
 

• Breathe in slowly and deeply, counting one, two, three.

• Breathe out slowly, counting one, two, three, and feel your body relaxing.

• If you prefer, instead of counting, stay a word silently to yourself such as ‘calm’ or ‘relax’.

• Keep going for as long as you can (anything from two to 20 minutes).

Your GP can also advise you about stress-relieving activities that may be available in your local area.
 

Try to be more aware about the way you’re holding your jaw

For instance, if your jaw is relaxed the front part of your tongue should be in gentle contact with the roof of your mouth, just behind your front teeth, and your upper and lower teeth should be apart. Try to be mindful of your jaw’s position as often as possible throughout your day, making sure you’re not clenching it or grinding your teeth. If it helps, work out a system that will help remind you to check your jaw frequently – for instance, at work, try to get into the habit of checking your jaw position each time you get an email or a phone call (or similar).
 

Get a better night's sleep

If TMD is affecting your ability to sleep well, try to improve your sleeping habits. Some of the things you could do include avoiding stimulants such as smoking, caffeine and alcohol during the evening (in fact stimulants like these can make pain seem worse, so try to avoid them as much as possible if you’re having a pain flare-up), and try not to eat a big meal too close to bedtime. Read more about getting a better night’s sleep in our guide to sleep and insomnia.
 

Exercises for TMJ

A physiotherapist can teach you how to practise jaw strengthening exercises safely. Here are a few simple moves to get you started. Repeat each exercise three times:
 

1. Place the fingers of one hand on the front of your chin. Using your fingers as resistance, try to move your lower jaw forwards. Hold for a few seconds then relax.

2. Place your thumb or the fingers of one hand under your chin. Using your thumb or fingers as resistance, try to open your jaw. Hold for a few seconds then relax. 

3. Place the fingers of one hand along the edge of one side of your jaw. Using your fingers as resistance, try to move your lower jaw sideways against them. Hold for a few seconds then relax. Repeat on the other side. 

4. Open your mouth as wide as you can comfortably. Place your index finger just below your lower lip, and push inwards while slowly closing your mouth.

 
Do these exercises a few times every day until your symptoms start to ease.
 

Natural remedies for TMJ

If you tend to experience TMD symptoms when you’re under stress (or indeed if stress is causing your symptoms in the first place – by making you clench your jaw, for instance), certain natural remedies and supplements may be helpful. Using traditional aromatherapy oils could help you unwind. Try lavender oil to help with relaxation and anxiety relief, or choose a blend of relaxing oils such as lavender, geranium and clary sage.

In addition to aromatherapy there are several nutritional and herbal supplements that may help with stress relief:
 

Valerian

This herbal remedy has a long history of use in relieving insomnia, which is often strongly related to stress. Indeed, there is some evidence that, when taken an hour before bedtime, valerian may be effective at relieving insomnia if taken for 28 days or longer (vi). Experts writing a review of 16 studies suggest valerian may improve sleep quality without causing any side effects (vii), while researchers reporting in the Journal of Evidence-Based Integrative Medicine also conclude valerian could be a safe and effective herb to promote sleep (viii). 
 

Magnesium

When you’re under a lot of stress your body’s level of magnesium may be lower than usual, with high levels excreted in urine (ix). Some researchers even suggest magnesium deficiency could make your body more susceptible to stress, in what they call a magnesium and stress vicious circle (x). There’s also some evidence to suggest taking magnesium may help you sleep better if stress is keeping you awake at night (xi).
 

Theanine

Found almost exclusively in green, black, oolong and pekoe tea, theanine is a non-protein amino acid. Also available in nutritional supplements, it’s thought to make you feel calmer by helping your brain produce alpha waves. And while some conventional medicines that help you relax can also make you feel sleepy, studies suggest theanine supplements can calm you down but still keep you feeling awake and alert (xii). Indeed, some researchers believe theanine helps you feel calm when faced with a stressful situation by slowing down your heart rate (xiii).
 

Ashwagandha

Natural practitioners often recommend this traditional Ayurvedic herb to help relieve the effects of stress. Scientists have also found it may help reduce levels of cortisol, a stress hormone (xvi). If you’re feeling the effects of stress and aren’t getting much sleep, studies suggest ashwagandha may improve your sleep quality significantly (xiv).
 

Acupuncture

You may also want to try a natural therapy such as acupuncture, which is thought to relieve stress by stimulating your body’s natural feel-good hormones. Called endorphins, these hormones may also help with pain relief – though according to the NHS, a course of acupuncture usually creates longer-lasting pain relief than a single session (xv). 
 

Natural pain relief for TMJ

If pain relief is a particular concern certain natural supplements may be helpful, including a supplement called PEA. Also known as palmitoylethanolamide, PEA is a type of fatty acid made naturally by the body and found in all cells, tissues and fluids including the brain (it’s also found in foods such as soya beans, peanuts, eggs, flaxseed and milk). Described as an endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides (xvi), PEA is an alternative to CBD, since both substances are thought to have similar properties including the ability to reduce pain and inflammation. However researchers suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (xvii) with no known side effects (xvi).

Your body naturally increases its production of PEA when your cells are damaged or threatened. But in certain situations – such as when your body is experiencing chronic inflammation – the level of PEA in your cells drops (xvi). When this happens, PEA supplements may be helpful. In fact a review of 16 clinical trials and meta-analysis of PEA suggests it does have analgesic actions – in other words it helps to relieve pain (xviii).
 

Does TMD go away?

TMD can be a painful and often distressing condition. But it’s not usually a progressive one, which means that, in time, your symptoms should get better. There are also lots of self-management techniques you can use to make you feel more like your old self again – though if you have severe pain, pain that doesn’t go away or keeps coming back, it’s best to see your GP to find out what your medical options may be. To find out more about a wide range of general health conditions, why not visit our pharmacy health library?
 

References:

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11. Held K. et al., Oral MG(2+) supplementation reverses age-related neuroendocrine and sleep EEG changes in humans. Pharmacopsychiatry. 2002;35:135-143. Available online: https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-2002-33195

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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