TMJ and Jaw Pain: What Causes It and What a Primary Care Visit Can Sort Out

What it involves

MedlinePlus describes temporomandibular joint and muscle disorders, called TMJ disorders, as problems that affect the chewing muscles and the joints that connect the lower jaw to the skull. It says the joints sit just in front of the ears, and that the abbreviation TMJ is often used to mean any symptoms in that region.

Who this is for

• Adults with pain or tenderness in the jaw or just in front of the ear
• Patients whose jaw clicks, pops, grates or locks when they open or close the mouth
• Adults with headaches or an earache that do not seem to have an ear cause
• Patients who find chewing uncomfortable and are not sure whether to start with a doctor or a dentist

What to expect

• Questions about when the pain started, what makes it worse and whether you clench or grind your teeth
• An exam of the jaw, face and neck, including how the jaw opens and closes
• A look at other possible causes, such as an ear problem, a tooth problem or a headache condition
• A referral to a dentist or an ear, nose and throat specialist if the pattern points to the joint itself

What the jaw joint problem feels like

MedlinePlus lists biting or chewing difficulty or discomfort, a clicking, popping or grating sound when opening or closing the mouth, a dull aching pain in the face, earache, headache, jaw pain or tenderness, locking of the jaw, and difficulty opening or closing the mouth. Not everyone has all of these, and the sounds alone are not always a problem. What tends to matter to a provider is whether the jaw hurts, locks or limits eating. Noting which side is affected and whether it is worse in the morning or after a long meal gives the visit something concrete to work from.

Why it happens

The MedlinePlus encyclopedia says many TMJ-related symptoms come from physical stress on the structures around the joint, including the cartilage disk, the muscles of the jaw, face and neck, nearby ligaments, blood vessels and nerves, and the teeth. For many people the cause is unknown. It adds that some commonly given causes, such as a bad bite or braces, are not well proven, and that many people with jaw problems do not grind their teeth. Poor posture, such as holding the head forward at a computer all day, poor diet and lack of sleep can make symptoms worse.

When pain in the jaw is not the jaw

Referred pain is the reason a primary care visit can be useful before anyone looks at the joint. MedlinePlus notes that tight trigger points in the jaw, head and neck muscles can cause a headache, an earache or a toothache. The headache and migraine page explains the headache side, and the ear pain and ear infection guide covers pain that starts in the ear. Jaw pain that comes on with exertion, together with chest pressure, sweating or shortness of breath, can be a heart warning sign and should be treated as an emergency.

How it is looked at

MedlinePlus says you may need to see more than one kind of professional for TMJ symptoms, which can include a health care provider, a dentist, or an ear, nose and throat doctor. A thorough exam involves feeling the joints and muscles for tenderness, pressing around the head to find sore areas, and watching, feeling and listening as the jaw opens and shuts. It says X-rays, CT scan or MRI may be used, and that your provider also has to consider infections, nerve problems and headaches. At Serenity By A Dr. Sareen the visit covers the exam and ruling out other causes. Any dental, imaging or specialist testing would be a referral.

Simple steps MedlinePlus suggests first

MedlinePlus says simple, gentle therapies come first: a soft diet to calm the joint, gentle stretching or massage of the jaw muscles, avoiding yawning widely, singing and chewing gum, moist heat or cold packs on the face, stress-reducing techniques and regular exercise. It lists short-term anti-inflammatory pain relievers and, in some cases, muscle relaxants or mouth guards, and notes that mouth guards help some people and make others feel worse. Ask your provider before starting any medicine, especially if you take other prescriptions or have stomach, kidney or blood pressure problems.

Call 911 and when to book

Call 911 for jaw pain with chest pressure, shortness of breath, sweating, nausea or pain spreading down the arm, and use the chest pain guide if you are unsure. Jaw swelling after an injury, a jaw that will not open or close, or swelling with fever also should not wait. For ongoing pain that limits eating or sleep, a visit is reasonable. MedlinePlus says that for many people symptoms come and go, tend to fade with little treatment and can return later, so tracking how often they flare helps your provider judge whether more is needed.

Sources

• MedlinePlus — TMJ disorders (medical encyclopedia)
• MedlinePlus — Temporomandibular Disorders (health topic)