Dr. Donald Littlewood
Everything you need to know about jaw pain
Updated: Jul 22, 2022
Did you know that your jaw is the most used joint in your body?
Yep, that’s right. With all the chewing and talking we do, the jaw clocks in at the most used joint in the body. That also means that it is subject to wear and tear.
Before I get to what goes wrong in the TMJ, it is important to know what it looks like when everything is functioning properly. The TMJ is actually a pretty complicated joint, but bear with me, I am going to make it as simple as possible.
Anatomy of the TMJ
First off, where is it? The TMJ is located right in front of your ear, connecting your mandible to the rest of your skull. It has a few different functions, but as I said above, its main ones are speech and chewing.
On either side of the mandible, there is a condyle that fits into a space just beside the cheekbone to create the TMJ, one on each side. Surrounding the TMJ are a bunch of different ligaments that form a capsule and provide stability to the joint.
In between the two bones is a disc which provides shock absorption and nutrients to the bones & ligament. The disc itself has no nerve or blood supply, but where it attaches to the bone has tons of nerves and blood supply. More on what that means in a second. Anatomically, this disc is the most important part of the joint, and let me tell you why.
In order for the TMJ to move properly, two actions are required: hinging & gliding. The first movement that occurs is hinging, or rotation, between the articular disc and the mandible. Then gliding takes over, which happens in the upper part of the joint, between the articular disc and the skull.
This disc is attached to the joint capsule and has no blood or nerve supply. However, the disc attaches to the skull via the retrodiscal tissue. This piece of tissue has lots of blood supply and lots of nerve tissue in it. This means that it plays a huge role in the pain we feel when our jaw hurts.
The discussion of the anatomy of the jaw is not complete without talking about the muscles. Why? Well ~80% of TMJ pain can be at least partially contributed to the muscles.
The main muscle at play is the masseter. This one starts below the temple and extends down to the angle of the jaw. Its job is to close the mouth & it is the main muscle that performs that job. The other two muscles that close the jaw are the medial pterygoid and the temporalis muscle.
The lateral pterygoid muscle is the only muscle that opens the jaw; the rest of the opening is done by gravity. It also is in charge of doing side-to-side motions when only one side is contracted. The lateral pterygoid muscle actually passes through the joint itself and usually has some attachment to the articular disc. This relationship means that the lateral pterygoid is responsible for proper disc movement and coordination when closing the jaw.
Temporomandibular Joint Disorder
Okay, so before I start talking about what can go wrong in the jaw, we need to get some semantics out of the way. People often tell me that they were diagnosed with TMJ and that it hurts. And their right: they do have a TMJ and it does hurt, but the acronym TMJ refers to the joint, and we all have them. When talking about pain or dysfunction in the joint, it is referred to as TMJD – temporomandibular joint disorder.
TMJD is defined as: ‘pain & tenderness due to a dysfunction of the TMJ or surrounding musculature & soft tissue’ [Vizniak 2015]. Generally, the disorder is further subdivided into three categories: myofascial (muscular), internal derangement (articular disc issues) and degenerative joint disease (arthritis). These three subtypes often coexist in the same patient.
So what causes TMJD?
This is a super tough question to answer because the cause of TMJD is what we call multifactorial which is just a fancy word for saying that lots of different things can cause TMJD and it is almost impossible to narrow down anything specific. With TMJD, there is often more than one reason you are experiencing it.
Now I know that information isn’t super useful, but there is one risk factor that seems to reign supreme in causing TMJD.
Bruxism is the medical term for grinding or clenching of the teeth and is one of the major causes of TMJD. On the surface, you might be thinking: okay, so don’t clench, got it; but bruxism is so much more than that. Bruxism can happen when you are asleep or awake. When awake, we worry more about clenching the jaw and when you’re asleep, it’s the teeth grinding that poses a problem.
There are new studies showing that sleep bruxism activates a group of neurons called the MTN which in turn ensures that there is enough adrenaline, dopamine, and serotonin in your system when you sleep. The MTN also supports the functioning of the cardio and respiratory systems. This means that sleep bruxism may provide an important role in keeping your vital organs going while you are sleeping. There have also been studies showing that those with improper or insufficient bruxism are more likely to have dementia going forward.
Our bodies are weird and wonderful creatures and new information is becoming available to us every day. Recently, researchers have been discovering that sleep bruxism and awake bruxism have two completely different sources. Awake bruxism is seen as a side effect of stress or another psychological condition, whereas sleep bruxism is considered protective for life. The best part about the new research: awake bruxism is causative of TMJ disorders, whereas sleep bruxism is not.
That’s right – grinding & clenching your teeth at night is no longer considered a risk factor for TMJD.
Treatment for TMJD
The first line of defense for treating jaw pain is conservative therapy, which essentially means non-surgical. Let’s go through some of it.
Soft tissue work
Soft tissue is a fancy term for anything that isn’t bone, mainly muscles, tendons & ligaments. As I said earlier, ~80% of TMJD has at least some muscular component, so I like to start there. Treating trigger points that lie the masseter, medial & lateral pterygoid, and temporalis are all really important to help decrease the pain you are feeling.
The soft tissue work can be really painful, but it’s worth it for the relief you get after.
There are some adjustments that can be done for the TMJ, but I don’t like to start there because there are other things that work just as well (or better) and aren’t as painful. That being said, I do like to mobilize the joints and provide traction in the TMJ so that some space can be made for the disc to reduce if it needs to.
There is almost always some pain in the muscles and joints of the neck in conjunction with TMJ problems. The two are too closely related both anatomically and functionally for there not to be neck pain happening. Soft tissue work and adjustments to the neck usually help to decrease the pain and get some healing chemicals into the area to work their magic.
If you are a follower of mine on Instagram, or a patient, you’ll know how much I love magnesium. Magnesium is a micronutrient that we need in our bodies to perform 300+ processes from muscle relaxation, to nervous system modulation, energy production, blood sugar levels, etc. It is an incredibly important mineral.
In the context of jaw pain, magnesium helps by calming down the nervous system and helping the muscles relax.
Now obviously I am not a talk therapist, but studies are showing that some of the main risk factors for TMJD are stress, anxiety & depression. This is goes back to awake bruxism; when you are stressed, your subconscious reaction is to clench the jaw. Having someone to help you work through the stress of life or whatever you are going through is really important in mitigating TMJ pain and stopping the clenching.
Before signing off on this blog post, I wanted to give you something that you can do on your own to help with your jaw pain. The jaw is one of the few places you can actually do some of your own soft tissue work to help decrease your pain.
I mentioned earlier that the masseter muscle is the one that is most active during jaw movements and is generally the one that is the most sore during TMJD. So today, I will walk you through the steps of how to do some soft tissue work on it all by yourself.
Find the masseter muscle by falling off the cheekbone just in front of your ear. The muscle will feel squishier than the bone.
Move your fingers around a little bit until you find a hard nodule or a painful spot. That is where you want to press.
Gently press down on that trigger point & slowly open your mouth. This is likely going to increase your pain and you will likely not be able to do your full range of motion, and that is okay!
Release the pressure and close your mouth. Repeat this 4-5 times.
NB: you can do both sides at the same time if you really want to, but it will be super painful. I would suggest doing them one at a time.
TMJ pain is common, painful and not the best understood condition out there, but that doesn’t mean you have it for life. The pain, catching, and locking you are feeling can be resolved with time, patience, and the right team of healthcare providers on your side. If you have any questions or if you would like someone to help with your jaw pain, let me know and we can figure out a solution together!