Temporoman­dibular Joint (TMJ) Disorders

Your temporomandibular joints connect your lower jawbone to your skull. Located in front of your ears on both sides of your face, they help you open your mouth to chew, yawn and speak. When people talk about “having TMJ,” it really means they have temporomandibular joint disorders or dysfunction (the joint’s not working right). This means the muscles and ligaments around their jaw become inflamed or irritated, which causes sudden or lingering pain. These disorders may start with:

• Teeth grinding and clenching (bruxism).
• Dislocation of the discs between your jaws’ ball-and-socket joints.
• Arthritis in the joint.
• Tension and stress.
• An improper bite.

TMJ dysfunction — also called temporal mandibular dysfunction (TMD) — can cause all kinds of symptoms. You may have jaw pain, earaches, tooth pain, dizziness and headaches. Or maybe you have neck and shoulder pain. Often you can feel popping in your jaw or have ringing in your ears (tinnitus).

Other conditions like a broken or dislocated jaw, joint degeneration, malocclusion (bad bite), bony lesions, trigeminal neuralgia or migraine headaches can have the same symptoms. So we want to make sure we’re treating the right problem the right way.

What to expect at your first visit

Because temporomandibular joint disorders can be confused with other conditions, it’s important we quickly find out what’s causing your pain. That’s why your provider will ask you to share your story when you come to your first appointment.

They’ll want to hear about your symptoms — what they are, how long you’ve had them and how they’re affecting your life. Knowing these things can help us make the right diagnosis and put together the most personalized treatment plan for you.

You’ll also have a physical exam. Your provider will ask you to move your mouth and jaw in different directions. They’ll listen for cracking and popping sounds. They might also feel around the area to see how well your jaw moves. You may also have some imaging tests.

Imaging tests

Imaging tests are an important part of diagnosing temporomandibular joint disorders. They help us look at your jaw joints, sinuses, teeth, soft tissues and facial bones up close so we can see if there’s any damage. And, if so, how much. These tests could include:

• Panoramic dental X-rays.
• Cone beam computed tomography scans (CBCT) or medical CT.
• Magnetic resonance imaging (MRI).

Meet Our Temporomandibular Joint (TMJ) Disorder Team

At Cleveland Clinic, we believe in a team-based approach to care. That’s why you’ll meet with different healthcare providers from different specialties, depending on your needs. These experts work together to confirm a diagnosis and craft the most personalized treatment plan for you. Your care team could include:

• Dentists.
• Surgeons specializing in maxillofacial surgery.
• Pain management
• Physical therapists.
• Neurologists.
• Otolaryngologists (ear, nose and throat doctor).
• Nurse practitioners.
• Physician assistants.

We’ll start your TMJ disorders treatment with less invasive therapies first — like lifestyle changes and stress management — before turning to surgery. That’s something we recommend only as a last resort.

Lifestyle changes

Making simple behavioral changes can sometimes be enough to relieve TMJ pain. We help you recognize and stop daytime habits that make your jaw pain worse. We might suggest putting moist heat or cold packs on the side of your face and temple area, eating soft foods, yawning and chewing less and avoiding sudden or forceful jaw movements.

Jaw massage and exercise

Tense or imbalanced muscles often cause jaw pain. Physical therapists can press on tight tissue to release tension and provide other therapies to lessen pain. They can also teach you exercises and stretches that relax your jaw.

Medication

Nonsteroidal anti-inflammatory medications (NSAIDs), like aspirin, ibuprofen (Motrin^®, Advil^®) or naproxen (Aleve^®), can relieve TMD pain and swelling. For really bad pain, your provider may prescribe stronger pain relievers or muscle relaxants. Anti-anxiety and antidepressants may also help reduce pain and stress.

Devices and orthodontics

We offer customized mouth guards, splints and other devices to help with bruxism (teeth grinding) or mild bite problems. You provider will let you know if you need orthodontics, like braces, retainers or clear aligners for misaligned teeth (bad bite).

Electrical stimulation

Transcutaneous electrical nerve stimulation (TENS) and radio wave therapy use gentle, low-level electrical currents to relax your jaw muscles. These treatments may also increase endorphins (hormones that naturally block your feeling of pain).

Injections

We may recommend mandibular (jaw) trigger point injections for pain relief. Your provider inserts a thin needle into knots of muscle around your jaw, face and neck to break up tight tissue. Botox^® injections and dry needling may also help with pain.

Radiofrequency ablation

During radiofrequency ablation, we use a needle to send a low-level electrical current to nerves causing pain. The current’s heat destroys the nerves, so they can’t send pain signals.

Alternative treatments

Your healthcare provider may talk with you about using alternative therapies in combination with traditional treatments. These include:

• Meditation.
• Acupuncture.
• Biofeedback.
• Pain management.
• Pain psychology.

Surgery for temporomandibular joint (TMJ) disorders

If you’ve tried other treatment options and you still have severe pain, it may be time to consider surgery. Most jaw orthognathic surgeries aim to remove, reshape or relocate damaged tissue or bones that are out of place. Some are more invasive than others. Your provider may recommend:

• Arthrocentesis.
• Arthroscopy.
• Open-joint surgery.
• Total TMJ replacement.

Taking the Next Step

Occasional jaw popping might not seem like a big deal. But it shouldn’t be ignored. The painful pop could be the sign of a bigger problem, like temporomandibular joint (TMJ) disorder. And that can mess with how you bite, chew, speak and sleep. If you’re having a painful problem with your jaw, we can help. Our expert providers treat lots of people with TMJ dysfunction. They’ll find the right treatment for you — and your jaw pain.