TMD (Tempero-mandibular disorder) is a condition that affects your TMJ (Tempero-mandibular joint, aka ‘jaw joint’) and the muscles around it.
TMD can range from being very mild to very severe. Most of the time it can be managed at home by yourself and it will ease on its own but if you are worried, speak to a dentist who will be able to help.
It’s important to know that there is rarely a quick-fix solution to TMD. This guide will go over what TMD is, how you can manage it and when you should consider seeing your dentist or even a specialist.
What is TMD?
TMD can present itself in a few different ways:
Pains or aches in joints themselves
Headaches and migraines (usually around your temples)
Clicking, popping, or grating noises from the joint
The inability to open your mouth fully
The inability to close your jaw (locked jaw)
Sometimes TMD can be mistaken for earache or toothache because the jaw joints, molar teeth and the ear canal are all located close to each other.
Self-care for TMD pain
If you have pain from your jaw joints or the muscles around them, 95% of the time it will go away on its own and can be managed with some self-care. To manage the short-term pain:
Apply an Ice-pack to the area for 15 minutes or until the area feels numb
Take some anti-inflammatories such as Ibuprofen (or an alternative if your GP has advised doing so)
Do the massages and stretches shown below 3-4 times per day
Contact a dentist or your GP if your symptoms don’t get better after 4-5 days, or if you have any of the following:
Very sudden, severe pain
Swelling or redness in the area
Inability to open your mouth to the point where you can’t eat anything
Swollen lymph nodes
Loss of hearing, smell, or impaired vision
Nose-bleeds
Enlarged or tender areas around your eyes or ears
Resting your jaw joint
You need to treat TMD like you would any other injury of your limbs. Rest and physiotherapy are extremely important to reduce the pain from TMD and also prevent it from occurring.
Stick to a soft diet for 1 week
Avoid chewing gum and any other chewing habits (pencils, nails etc.)
Reduce your caffeine intake
Avoid clenching your teeth, remember that your teeth should be apart except for when you are eating
Massaging your muscles
There are 2 main muscles that can contribute to TMD, your temporalis and masseter. When overworked they can become painful and tender.
Place a warm pack or a hot water bottle over the muscles for 15 minutes
Whilst they are warm, use your fingers to gently massage the temporalis and masseter muscles
If you really want to treat yourself then consider booking in for a professional massage by a physiotherapist and tell them you would like to focus on your TMJ.
Stretching the joint
Along with the muscles, the ligaments around your joint may require some relief, the following stretches can be done alongside the heat pack and massages. Both of the following stretches can be done 3-4 times per day.
Resistance Stretch
Place a warm pack or a hot water bottle over the joint for 15 minutes
Place your thumb under your chin
Open your mouth whilst gently resisting the movement with your thumb
Hold for 5 seconds before closing
Repeat 10 times
You can also reverse the exercise by using your thumb and finger to pinch your chin and provide resistance on closing instead of opening
Ligament Stretch
Place a warm pack or a hot water bottle over the joint for 15 minutes
Touch the roof of your mouth with your tongue and keep it there
Slowly open as wide as you can, pausing at maximum stretch
Slowly close (keeping your tongue in place)
Repeat 10 times
Managing stress
TMD is very commonly associated with high stress and can become worse whenever you are going through a stressful life experience. Managing your stress levels is extremely effective in preventing and reducing TMD pain. Consider the following:
Diaphragmatic breathing
Mindfulness / meditation
Yoga / exercise
Lifestyle changes (personal and work life)
Counselling / professional coaching
A few sessions with a therapist or a professional coach will have a huge positive impact on your overall wellbeing, not just your TMD!
Professional care for TMD pain
If you are still struggling with TMD pain despite following the self-care advice, you may require some professional intervention by a dentist.
Checking your bite
Your dentist will have a look to see if there are any issues with your bite that may be causing your TMD. This is more common if you have had recent dental treatment that requires adjusting. It’s very unusual for your bite to change naturally to the point of causing TMD.
Mouthguards
If you are clenching or grinding your teeth, using a professional mouthguard can give you a lot of relief from TMD pain. Your dentist will take an impression or scan of your teeth and the mouthguard will be made in a lab to fit your teeth and mouth. Mouthguards are mostly used at night while you sleep but can also be used in the day if you notice yourself clenching or grinding during certain tasks.
There are 3 main types of mouthguards dentists routinely use:
Soft Splint
Soft splints work by providing some bio-feedback to your mouth when you clench and grind your teeth. They are the cheapest kind of mouthguard and are most likely the guard you will get from an NHS dentist.
Some people may end up grinding more with a soft splint and these mouthguards require replacing more regularly (every year)
Guide price £150
B Splint
A B splint is made from a harder material and has a ramp at the front of it. This stops your back teeth from touching and reduces the forces on your muscles and jaw joints.
They last a lot longer than soft splints (2-3 years) and are extremely effective.
Guide Price £350
Michigan Splint
A Michigan splint is a hard splint that helps produce a ‘perfect bite’ where all of your teeth are touching the splint. They can be difficult to make and require a dentist with the correct technical skill.
They last just as long as a B splint but there is no evidence to suggest they are any more effective in reducing TMD pain.
Guide price £550
Botox injections
Botox injections help reduce TMD pain by reducing the muscle activity of the masseter and temporalis muscles.
Botox is really quick and easy to administer by a trained professional but its effects do not last permanently. Typical treatment involves 3 injections, 3 months apart and may be required up to twice per year. Ask your dentist if they provide botox treatment or if they have a practitioner they can refer you to.
Guide price: £500
Clicking and popping jaw joints
TMD isn’t always painful. You may notice that your jaw makes a clicking or grating noise and you may even feel a slight popping sensation. These usually occur when there is some kind of misalignment of the disc that is found in the middle of your jaw joint.
It is extremely difficult to eliminate these noises completely. Most people who experience these issues will learn to live with them over time and they are usually not loud enough to cause an issue in your social life.
The self-care methods described above may help relax your joint and improve your symptoms. In the rare case where the noises are so loud where they are impacting you and those around you, or if you are experiencing severe long-term pain, then your dentist may consider referring you to a specialist for advanced treatment.
Advanced care for TMD
If you and your dentist have exhausted all other options for your TMD and you are still experiencing issues, then you may require some advanced treatment carried out by a maxillofacial surgeon or a dentist with enhanced training in dealing with facial pain.
Assessment by a facial pain clinic
A facial pain clinic consists of a team of dentists with varying specialities who will assess your symptoms in more detail. They may also take some X-rays, MRI or CT scans of your jaw joints and head to get a clear picture of how healthy the joint is as well as screening for any other issues.
The facial pain clinic may also work with an ENT consultant to check the health of your ears as well.
Counselling and CBT
Dealing with chronic pain can be very difficult and the specialist team may advise that you undertake some psychological support with a counsellor to help deal with your pain.
Medication
You may be advised to take stronger painkillers such as Benzodiazepines alongside other medications such as anxiolytics and anti-depressants.
Surgery
In very rare cases, the specialist team may advise undertaking surgery. Surgery for TMD ranges from minimally invasive procedures to open joint reconstructions.
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