Your jaw locks when you’re chewing gum. You hear a clicking sound when you eat. Just opening your mouth can be painful, and the pain often extends through your face, ears, and neck.
Sound familiar? Then you may have a temporomandibular joint and muscle disorder, more commonly known as TMJ.
TMJ isn’t a single condition. Instead, it encompasses a range of disorders that affect the movement of one or both of the temporomandibular joints (the joints that connect your jawbone to your skull on either side of your face). Since these joints control the movement of your jaw, making it possible to eat, speak, laugh, and more, you rely on them a lot. And if something goes wrong, the pain can linger for months or even years.
Although more than 10 million Americans experience TMJ, these disorders are often misunderstood, and their symptoms can be mistaken for signs of bruxism (teeth grinding). After all, both bruxism and TMJ cause jaw and neck pain, and both can make it difficult to open your mouth. It doesn’t help that some patients with bruxism also have TMJ, and the symptoms of one may disguise the other.
But while bruxism and TMJ can sometimes go hand in hand, these conditions are not the same, and they often require a different approach to treatment. An accurate diagnosis is essential to help you identify the root cause of your condition and find the relief you deserve.
Understanding TMJ: what is it, and how does it develop?
Think about the last time you bit into an apple or crunched on a stick of celery. Those simple actions take a lot of force, and that force is possible thanks to the muscles and joints in your jaw.
The human jaw is a lot more powerful than most people realize—but it’s also extremely delicate and prone to damage. To understand why, let’s take a closer look at the joints themselves.
The temporomandibular joints are sliding hinge joints. They enable you to open your mouth wider than a typical hinge joint (like the ones in your knees) would allow. They’re also flexible, letting you move your jaw from side to side.
A layer of cartilage protects the bones and prevents them from grinding together when you open and close your mouth. A cushioning articular disc also lies between the bones, acting as a shock absorber and helping your jaw move smoothly.
Unfortunately, there’s a lot that can go wrong with these complicated joints. The soft discs can slip out of place, and the cartilage can become worn down. Degenerative conditions like arthritis are often the culprit, but some diseases and infections can play a role as well. It’s also believed that for some patients, TMJ is hereditary, and it may develop as a result of genetics or bone deformities at birth.
Of course, a blow to the face can also damage or misalign the joints—from a serious accident like a traffic collision to being struck by a baseball or fist.
The result of this damage? A TMJ disorder.
This is distinct from bruxism, where symptoms stem from the patient unconsciously grinding or clenching their teeth, usually while they sleep. Bruxism tends to develop as a result of sleep disorders, dental issues, and psychological factors like anxiety and stress, rather than an accident or injury.
Although bruxism and TMJ are very different, studies show that prolonged teeth grinding and clenching can contribute to TMJ, or make symptoms worse after it’s developed. So it is possible to experience bruxism and TMJ together, but not all patients have both.
Telltale signs: how to spot if your bruxism symptoms are really TMJ
It’s easy to see why people mix up bruxism and TMJ—many of the symptoms are near identical! Jaw pain or tenderness? Aching neck and facial muscles? Difficulty chewing or swallowing? Lockjaw? Headaches? It could be either.
So, how can you tell these conditions apart?
The most obvious sign of bruxism is damage to your pearly whites. You might notice your teeth are chipped, cracked, or loose, and they may feel more sensitive than usual when you eat hot food or sip a cold beverage. There’s also a good chance that your partner will complain about hearing a grinding sound at night—a telltale sign that you’re a bruxer.
TMJ can cause noises, too, but these will be more noticeable to you, not the people around you. You might hear a sharp clicking, snapping, or popping sound when you open your mouth, or a rough grating noise whenever you move your jaw or try to chew food. These sounds are often accompanied by pain, but even if they’re not, you may have TMJ.
You might also experience toothache with TMJ. But if there are no signs of damage to your teeth, the pain is probably originating from one of your temporomandibular joints, not the tooth itself.
Other symptoms of TMJ include dull aches or searing pain in and around the ears, facial swelling, difficulty opening or closing your mouth, and difficulty opening your mouth wide. The pain and discomfort tends to get worse when you talk, chew, or yawn, and it might flare up at night, making it difficult to enjoy a restful sleep.
Since bruxism can also disturb your sleep and eating habits and cause all kinds of facial pain, it can be hard to pinpoint exactly where your pain is stemming from. But as a rule of thumb, if there’s no tooth damage or complaints from your partner about noise, it’s probably TMJ.
Know your risk: who experiences TMJ the most, and how can you prevent it?
It’s not always possible to prevent TMJ from developing. You may have a genetic predisposition, or be involved in an accident that wasn’t your fault. But there are some risk factors that can help you assess your likelihood of developing a TMJ disorder.
Multiple studies have found that women have a higher risk of experiencing TMJ. One study even found that women are almost three times more likelyto develop these conditions than men. Women can also experience TMJ pain longer, and the pain may be more intense.
It’s not yet known exactly why this is the case, although researchers speculate that it may be related to biological, anatomical, or hormonal differences. Hormonal factorswould help to explain why TMJ is most common during a woman’s childbearing years (ages 20-35), when estrogen and progesterone levels rise and fall throughout the month.
Regardless of your sex or age, there are a few simple steps you can take to support healthy joints and help protect your teeth.
Massaging your jaws and cheeks regularly—especially during times when you feel stressed or anxious—may help relieve tension in your jaw. This is also a good way to calm yourself down before you start unconsciously grinding or clenching your teeth.
When you’re eating your lunch or enjoying an afternoon snack, try to focus on how you chew your food. Chewing with both sides of your mouth can help to equally distribute the force you’re placing on your temporomandibular joints. And to reduce this pressure you put on them, take smaller bites, cut down on really hard foods (like peanut brittle or hard candies), and avoid crunching on ice. You should also avoid biting things that aren’t edible, from pens to fingernails to straws.
There’s also evidence linking TMJ pain with poor posture, so try not to slouch! Ergonomic furniture can help, especially if you sit in one position for long periods of time while at work. And if you find you often cradle your phone between your neck and shoulder—a great way to strain the joints in your neck and jaw—then consider using speakerphone, headphones, or a hands-free headset to resist the bad habit.
Accurately diagnosing TMJ: when to see a professional, and how these disorders are diagnosed
In some cases, TMJ will go away on its own. So if you suspect you’ve developed one of these disorders, you may not need to see a doctor right away, especially if you’re not experiencing any pain.
But if your face, mouth, or jaw feel sore or tender for several days in a row, visiting a doctor or dental professional is the first step toward getting the treatment you need. If your jaw locks and you can’t open or close it, you may need to visit the emergency room first.
Let’s say you visit your dentist first. They may inspect your teeth for signs of chips or cracks, take an x-ray to look at your joints, or make a cast of your teeth to examine your bite. They may also look at your dental history.
Of course, you might visit your doctor first. They will probably perform a physical exam, looking at your neck, jaw, and face. Then, they’ll look for signs of muscle rigidity, listen for telltale sounds (like those clicks and pops), or try to see if your jaw’s range of motion is limited. If your doctor suspects that another condition might be causing your discomfort, then they may order blood tests. Although there is no way to diagnose TMJ through your blood, these tests can rule out conditions like arthritis and lupus.
But regardless of your first point of call, the healthcare professional in question will ask you a series of questions. Since there is currently no simple, guaranteed way to test for TMJ, your description of your pain and jaw dysfunction will play a vital role in your diagnosis.
Be sure to describe your symptoms as clearly and completely as possible during your visit. This will help your doctor or dentist to distinguish the subtle differences between TMJ and bruxism to provide an accurate diagnosis. It may help to write down your symptoms over the course of a week before your appointment, allowing you to give as much detail as you can.
Remember that TMJ is sometimes misdiagnosed, so it may be best to gather a few independent opinions before undergoing any treatment. If you don’t actually have TMJ but are treated for it, the true cause of your pain and discomfort will remain hidden. Plus, you may experience more jaw problems later as a direct result of the treatment you don’t need. It never hurts to get a second opinion!
Finding relief: what can you do to treat TMJ, and will you need surgery?
Since there are many different causes of TMJ pain, your treatment will depend on the exact nature of your condition.
In some extreme cases, surgery is used to repair damaged temporomandibular joints, such as using surgical implants to replace the damaged jaw joint. But generally speaking, the National Institute of Dental and Craniofacial Research recommends againstany kind of treatment that can cause permanent changes to the positioning of the teeth and jaw, except as a last resort. If your dentist recommends surgery, discuss other options with them before making your decision.
So, what other treatment options are there?
For mild to moderate TMJ pain, the best solutions are often the simplest. Home remedies like holding a hot pack to your face, avoiding chewing gum, and eating a soft food diet can relieve your pain and discomfort. Try to limit how much you yawn, laugh, or perform other gestures that involve extreme jaw movements. Over time, your symptoms may disappear completely and without further treatment.
Your dentist may recommend that you take over-the-counter pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen. Or, if your pain is more intense, they may prescribe you a stronger pain medication, muscle relaxant, or tricyclic antidepressant.
Physical therapy and exercises that strengthen your jaw muscles may also be effective. Steroid and Botox injections can sometimes be used, too, although their effectiveness remains inconclusive.
Night guards and TMJ: are they effective, and when should you use one?
Night guards—protective guards that are worn over the teeth—are often recommended for patients with bruxism. But because TMJ pain can resemble the symptoms of bruxism, patients with TMJ often purchase a night guard they don’t need, thinking it will make their symptoms go away.
So should you use a night guard if you have TMJ? Maybe—if you also grind your teeth.
First, it’s important to note that night guards don’t cure TMJ or bruxism. That’s not what they’re designed to do. Night guards protect your teeth from further damage if you regularly grind and clench in your sleep, but they don’t address the underlying issue of why you grind and clench. If you’re bruxing because you’re stressed, for example, you may want to practice stress-relieving techniques during the day, like exercise, meditation, and deep breathing.
If you have TMJ but you’re also a bruxer, a night guard can protect your teeth from chips and cracks. It may also help to prevent your TMJ pain from getting worse—you certainly don’t want to add the pain caused by teeth grinding to your already sensitive jaw! But it won’t magically make your TMJ pain disappear. You’ll still need to take steps to address the root cause of your TMJ if it doesn’t go away on its own.
When choosing a night guard, the best thing you can do for your jaw is to avoid an over-the-counter option, like one of those boil-and-bite models or a bulky sports mouthguard that will make you feel like a football player! These are not designed for TMJ patients, and since they’re unlikely to fit snugly around your teeth, they may actually make your jaw pain worse.
A custom-fitted night guard from your dentist or dental lab is usually the best option, since these are designed for your unique mouth.
Getting a custom night guard from your dentist or orthodontist comes with a level of personal assistance and support that no at-home kit can match. But it also comes with a much heftier price tag. If your dental plan covers night guards, this might not be a concern for you. But many plans don’t, so the out-of-pocket costs can be substantial.
Still, there are good reasons to consider going this route, especially if you have complicated bite alignment issues. Your dentist can use a diagnostic tool called articulating paper to carefully adjust your night guard for a better fit. But if your dentist doesn’t have a lot of experience handling night guard cases, or if the dental lab they use to create the guard isn’t up to par, then you may not enjoy these benefits. Look at reviews and ask your dentist about their experience with TMJ and bruxism cases before making the investment.
You also have the option of buying directly from a dental lab. Choosing an expert lab ensures the same precise fit and high-quality materials that you get from your dentist, but at a much more affordable cost. You will have to take the molds of your teeth yourself, but the lab will send you detailed instructions and all of the materials you need, making it easy and even fun. After sending your molds to the lab, you’ll be sent a custom night guard straight to your door, usually in under two weeks. In fact, some labs—including J&S Dental Labs—even employ tools similar to the articulating paper used by dentists, for a night guard that fits like a glove!
Don’t let TMJ pain rule your life
TMJ pain can significantly impact your quality of life. But by understanding the symptoms and choosing the treatment option that’s right for you, you can relieve your pain and discomfort and get on with life.
If you grind your teeth when you sleep—with or without TMJ pain during the day—J&S Dental Labs can help. Contact us today to learn more about our custom night guards, or to get fitted for your own.