Jaw joint problems

The temperomandibular joints (TMJ's) are located just in front of your ears, where your lower jaw meets the skull. All joints in the body have two bones which 'articulate' (hinge) together, with the ends of the bones covered by smooth cartilage - and the whole joint is encapsulated in a bag of fluid (the joint capsule). The jaw joints are slightly unusual in so far as you have two joints which need to work together, and that they have a complete cartilage disc within the joint. They are also a bit unusual in that they don't just 'hinge' - they slide too, but to do this (and give you a full range of mouth opening movements) both joints need to be working efficiently together.

Problems with the jaw joint are very common, but will often only be temporary and last a few months before getting better. Sometimes it is only the muscles which cause a problem - we can call this myofascial pain, but other patients suffer problems with the cartilage and ligaments - we call this internal derangement of the TMJ.

Patients will commonly complain of:

  • Clicking, cracking, crunching, grating or popping noises
  • Pain around (sometimes in) the ear which can also cause discomfort in the lower jaw and down the neck
  • Headache
  • Reduced mouth opening

If the muscles around your jaw joint tighten up, this will cause pain. Noises in the joints are caused by the disc of cartilage moving out of its normal position and slipping backwards and forwards as you open and close. The noise appears to be very loud, because your ear is just behind the joint - but other people don't always hear it. If the ligaments and muscles spasm, or your jaw joint cartilage sits further forward than it should, then you may get both pain and limited mouth opening.

The cartilage in the jaw joint may slip forward because the joint/muscles are being over used or used inappropriately. Chewing habits (gum), grinding your teeth at night (bruxism), clenching your teeth (often in times of stress), biting your nails, posturing your lower jaw forward or even biting pen tops may cause jaw problems. Other causes are rarer, and might include an 'unbalanced' bite (with missing back teeth) or trauma. In some patients, there is no obvious 'cause', but we know that jaw joint problems can be associated with stress or stress related diseases.

Often patients arrive in clinic having being told that they have 'arthritis of the jaw' - which is obviously a huge concern. Fortunately, arthritis of the jaw joint is unusual - although we do see it in some patients. Most problems with the jaw joint are amenable to some simple treatments, but they do require significant 'input' and effort from you in order to help you along the road to a pain free (or manageable) jaw joint.

The treatments for jaw joint disorders depend on the cause, but may include;

  • A soft diet - not 'baby food', but food that is sufficiently soft so as not to over exercise your joints
  • Painkillers - anti inflammatories are probably best (but ensure you read the medicine information leaflet or consult your pharmacist/GP to ensure these medicines are safe for you) - either in tablet form or (probably better) gel which you rub over the outside of the jaw joint
  • Heat - in the form of special heat packs which you can buy from the pharmacy and heat (according to the manufacturer's instructions)
  • Identifying and stopping any habits which might be causing your symptoms
  • Stress reduction - difficult, but you might like to consider 'alternative' remedies to help, including aromatherapy or massage
  • Jaw joint exercises (see the separate sheet of instructions)
  • Physiotherapy
  • Balancing your bite by replacing missing teeth

It is very unusual for patients to require surgery, only a tiny proportion of the patients we see every year require any surgical intervention. Rarely, patients might be offered medication for anxiety - but this will only be done in discussion with their GP.

Investigations for TMJ problems might include simple x rays or an MRI scan. A simple x ray is used as a 'screening' tool in some patients, but it is not always necessary to have an x ray before TMJ problems are diagnosed. Patients with prolonged problems which fail to respond to simple treatment measures or patients with acute restriction of mouth opening may be referred for an MRI scan. The scan is painless, but is a bit noisy and some patients find the scanner a bit claustrophobic. If you think an MRI scan might be a problem for you, please let your surgeon know.

Jaw joint problems are usually self limiting, but can cause great concern and once they've settled it is possible that you could have similar problems in the future. Treatment can take several months of concerted effort involving the methods above - the joints are unlikely to get better 'on their own' by ignoring the problem.