My Unbearable Jaw Pain Turned Out to Be a TMJ Disorder—Here’s How I Finally Got It Under Control

By Alisa Hrustic Feb 26, 2021 (Prevention)

I was used to frequent headaches, but this slew of symptoms felt like something else.

My first symptom—a swollen, achy neck—could’ve been anything. But as spring bloomed into summer, stranger things cropped up. A recurrent pinching sensation in my ears. Sharp pains all around my face. And, far worse than a tension headache, it felt as if a power drill were chiselling away at my temples. I was used to frequent headaches, but this slew of symptoms felt like something else.

It all began in March, just as COVID-19 hit the U.S. After a useless telehealth call with a general physician, I tracked down an ear, nose, and throat specialist (ENT) for another virtual appointment. At the time, I was convinced I had an ear or sinus infection. But she told me it might be a problem with my temporomandibular joint (TMJ). We each have two of them, and they connect the lower jaw to the skull, allowing the mouth to move. 

I’d never had issues with my jaw, so I was skeptical. But the very next day, the pain struck again—hard. It felt as if a rubber band had been tied around my jaw and it was going to snap at any minute. I could barely brush my teeth. Chewing solid food was a struggle. I tracked down a dentist who agreed to see me in person even during the pandemic, and I left with a pricey mouth guard and a prescription for 1,800 mg of ibuprofen a day. He told me to de-stress by “taking a walk outside or reading a book,” which made me feel totally dismissed. As another month passed, my jaw pain grew worse.

That spring, I felt extremely anxious and alone, but it would later become clear that I wasn’t the only one suffering through painful dental issues as the world was seemingly falling apart. In September 2020, New York City dentist Tammy Chen, D.D.S., wrote an article for The New York Times, and she revealed that she had “seen more tooth fractures in the last six weeks than in the previous six years.” She theorized that collective stress, a sudden shift to working from home, and a disrupted sleep schedule was spurring teeth clenching and grinding for many people—yeah, ouch.

Shuchi Dhadwal, B.D.S., D.M.D., assistant professor at Tufts School of Dental Medicine and former director of the Tufts Cranofacial Pain Center tells Prevention that she also saw an uptick in patients complaining of clenching and tight jaw muscles around June. “I think [the pandemic] affected all of us in a way that we were never prepared for,” she says.

For me, it all started to click—literally. I started to hear clicking sounds in my jaw when I spoke for long periods of time and my bite felt all wrong. After seeing the dentist, I started to feel some improvement after a month. But then, one day, I yawned without thinking about it and heard an unsettling crack. The pain rushed back worse than before, and I was terrified that I’d caused serious damage. Determined to find a more empathetic medical professional, I did some digging and landed in the office of Nojan Bakhtiari, D.D.S., F.A.A.O.P. a board-certified TMJ and orofacial pain specialist in New York City and an assistant clinical professor at Columbia University’s College of Dental Medicine. Here’s what I’ve learned about our finicky temporomandibular joints about a year after my symptoms first hit.

What are temporomandibular joint disorders? 

TMD (temporomandibular joint disorders) is an umbrella term for problems in the muscles, joints, and ligaments that involve functional jaw motions such as chewing and yawning. (It’s often simply referred to as “TMJ,” even though that’s just the acronym for the joint.) Certain TMD issues are purely muscle related, others are joint disorders, and some people can suffer from both. These disorders are most common in people between the ages of 20 and 50, and are twice as common in women than men, says Dr. Dhadwal.

When I first met with Dr. Bakhtiari, he spent more than an hour examining every aspect of my jaw, observing the way my mouth opened and closed, pinpointing pain spots along the way. Yes, my TMJ was acting up, but it wasn’t a simple case that ibuprofen could fix. He used an anatomical skull to show me what was happening: The thin piece of cartilage that sat between the head of my jawbone and my skull was slipping out of place. 

Because of that, I had a closed lock—meaning my jaw couldn’t open with full range of motion—that was likely aggravated by my unconsciously clenching my teeth during periods of stress and while sleeping. That triggered spasms in my facial muscles, which was why I’d felt so much pain and my headaches had worsened. And while these are not common, TMD can cause stuffiness, pain, ringing, and popping in the ears. 

Usually, TMJ symptoms are pretty straightforward: pain in the jaw muscle or joint area, headaches in the temple area, and limitation of mouth opening or pain when chewing. But other times, they can be referred from other areas, and that’s when symptoms like pain behind the eye, tension in the neck or shoulders, dizziness, and ear ringing or popping can come into play, says Dr. Dhadwal.

Dr. Bakhtiari calls these “peripheral” symptoms. So, if you have ear symptoms, it’s because the ear canal and jaw joint only sit about 2 millimeters apart from each other. “If you have inflammation in one, it can affect the other,” he explains.

What causes TMJ issues? 

Like any musculoskeletal pain in your body, TMD can have various causes and triggers, says Dr. Bakhtiari. It could come down to a physical trauma from an accident that caused a direct injury to the face or head, or overusing the jaw muscles—say, from constantly chewing gum (or that sticky caramel sweet tooth), yawning too wide, anxiously biting your nails, or clenching or grinding your teeth under periods of stress.

It could even be biological in the form of an underlying condition, such as lupus or rheumatoid arthritis, autoimmune disorders that directly impact the joints.

As for sitting at that desk all day? There aren’t any conclusive studies to link a poor posture to TMD, says Dr. Dhadwal, so experts can’t call it a direct cause quite yet. However, she says that people who develop neck or back pain from posture imbalances also tend to experience jaw symptoms, so there is a correlation there that’s still being explored.

In my own case, as a health editor trying to keep up with the ever-changing news cycle in a global health crisis, I was mentally exhausted when my jaw first locked up. I was constantly hunched over my laptop in my tiny one-bedroom apartment. I wasn’t sleeping well due to heavy anxiety, and Dr. Bakhtiari could see clear signs of clenching when he examined the inside of my mouth. Day by day, I could physically feel the stress manifesting in my face, neck, and shoulders—and my body was finally signalling the alarm.

How are TMJ disorders diagnosed?

Figuring out if you have a TMJ disorder is really tough do on your own, but pretty straightforward for a specialist (look for one through the American Academy of Orofacial Pain). “As a clinician, I can identify exactly where the issue is coming from,” says Dr. Bakhtiari. There are many ways a pro can go about this, but reaching a diagnosis could include:

• Getting a detailed history of your symptoms, including headaches or sleep issues.
• A clinical exam, which includes palpating the muscles and tendons around the TMJ, as well as the joint itself, to identify affected areas.
• A diagnostic nerve block injection to rule out a nerve problem as a trigger.
• X-rays if a problem with facial bones is suspected.
• An MRI if the soft tissues need to be examined more closely.

In mild cases, a history of symptoms and a physical exam is likely all that’s needed, but for complicated or chronic cases of TMD, thorough testing may be necessary to get to the root of the problem. “Unless you can identify the true source first, you can’t direct the proper treatment that goes along with it,” says Dr. Bakhtiari.

Can you treat TMJ disorders at home?

Because TMD can have so many causes, it also has a ton of potential treatments. That said, seeing a doctor for your TMJ pain can bring on another one: insurance issues. “It’s a very important roadblock right now,” says Dr. Dhadwal. “A lot of times you do want to just get started and you know a patient can get better with a specific treatment, but neither their dental nor their medical insurance is willing to cover it.” As TMJ research evolves, experts hope treatments backed by scientific evidence will convince insurance companies to offer more access for patients with coverage.

But it is possible to try and find some relief on your own if your TMD is mild enough. If the home remedies are successful, you’ll experience a “pretty dramatic improvement within two to four weeks,” says Dr. Bakhtiari. Just like any other joint injury, you want to be gentle with it. Try these tips for relief: 

• Rest the jaw by eating a soft diet—no crunchy or sticky foods that require a lot of chewing. Soups, smoothies, and pastas are a good place to start.
• Cut your food into smaller pieces to avoid opening your mouth widely.
• Avoid yawning widely until your symptoms improve.
• Use warm or cold compresses on areas of pain, whichever feels best for you.
• Take OTC pain relievers, like ibuprofen or acetaminophen, per the dosage instructions.
• Get genuine rest. Find some time to relax after stressful periods, stretch your body if you feel stiff, and prioritize a good night’s sleep.

Dr. Bakhtiari also recommends avoiding TMJ exercises you can find online if you haven’t been evaluated by a pro. “Exercises are fantastic in the right case,” he says, emphasizing that minimally invasive therapies are definitely the way to go. “But I’ve also seen them cause more damage. For example, if your disc has slipped and you’re doing an exercise that’s meant to open your jaw more, you can actually damage the disc attachment more.” 

When should you seek professional TMJ treatment?

If you’ve been trying home remedies for a month—or it’s been two weeks since you’ve experienced a sudden loss of range of motion and you still can’t open your mouth fully—it’s time to see a doctor. (A normal opening range is about the width of three fingers stacked on top of each other, or 45 millimeters, per Dr. Bakhtiari.)

“This isn’t a mechanical problem only—there’s a body attached to this person, to this jaw,” says Dr. Bakhtiari. “So, sometimes you need to take multiple approaches. I have identified people who have rheumatological problems, like lupus, that they never knew about. I’ve had people who had nighttime seizures that they didn’t know about.”

Depending on your personal case, your doctor may recommend an orthotic (like a specialized mouth guard or splint) to protect the teeth or relieve pressure on the joint and surrounding muscles. Medications that have been shown to be helpful in TMJ patients, including muscle relaxants (like cyclobenzaprine or baclofen), certain seizure medications, and even antidepressants, may also be prescribed. 

When appropriate, your doctor may recommend steroid injections to tamp down inflammation or Botox injections to help relax the jaw muscles. “Botox injections are popular, but should not be the first-line treatment,” says Dr. Bakhtiari. “In some people, it can be life-changing.”

Physical therapy, massage, and even acupuncture can also be explored for those dealing with muscle-related issues. If anxiety or other mental health conditions are playing a big role in your TMJ flares, Dr. Dhadwal says she’ll also talk to her patients about seeing a therapist, whom she would work with to find the best solution.

Should you consider surgery for a TMJ disorder?

If your doctor recommends making any irreversible change to the structure of your teeth or jaw—say, like shaving down your bite or surgery—you should really get a second (or third) opinion. “Usually, conservative methods are the first line,” Dr. Dhadwal says. “A lot of patients come to an understanding that this could be an ongoing pain and we will manage it as it comes.” In her own practice, she may only see one or two patients in a year, if that, who would truly benefit from surgery.

Do TMJ problems ever go away for good?

My TMJ symptoms have waxed and waned in severity for the past year. It’s totally normal to have flare-ups (especially right after a big, initial onset of symptoms), but you should be able to find some relief in between.

“If I see a 12-year-old with a click or pop or a locking episode, I tell them this may resolve in a few months—but when you’re 40 or 50, it might come back,” says Dr. Dhadwal. For example, you can accidentally injure your TMJ again. “I recently saw a patient who had TMD issues when she was in her 30s and she was pain-free with a good treatment plan,” she recalls. “Then, when she was 45, she had a car accident that brought on all of the symptoms.”

Bottom line: It might take some time to find the best TMJ treatment for you, but don’t give up.

Dr. Bakhtiari prescribed me a specialized mouth guard; muscle relaxers to ease the spasms in my face, neck, and back; and 12 weeks of physical therapy, which included intense myofascial massage (yep, your PT goes right into your mouth to massage the joint!); and strengthening exercises for my upper body. I also used magnesium oil on my shoulders, neck, and jaw for relief before bed. A massager and lumbar support pillow also helped a lot when my upper back felt its worst.

During my first physical therapy consultation I cried, because I finally felt like I had support from experts who took my struggle seriously. “It’s very personal,” Dr. Bakhtiari says. “When the jaw stops working, it can get to you.”

But I quickly felt a new surge of hope after my first PT session (even though it was pretty painful). “You may feel pain again, but the goal is to make sure it never happens like this first flare,” Amy DelVecchio, D.P.T., O.C.S., my physical therapist at Pivotal Physical Therapy in New York City told me during one of our sessions. “And next time you’ll be more prepared to manage it.” 

Nearly a year after my jaw first locked up I’m mostly pain-free. I can now (carefully) eat a bagel, floss my teeth, wake up without headaches, and laugh without worrying. There’s lingering tension in my jaw and back, and my ears crackle occasionally, but my face is finally starting to feel like my own again. 

At Pain Spa, Dr Krishna is highly experienced in treating patients with TMJ pain. Dr. Krishna is a pioneer in the use of Botox for pain management in the UK, with over 15 years of experience in the field. For further information please contact us at clinic@painspa.co.uk.

Please click the following link for more information on Botox injections for TMJ pain: https://www.painspa.co.uk/procedure/botox-tmj-dysfunction/