Experiencing jaw pain? It could be a TMJ disorder

This story first appeared in Healthy You - January 2025, The Gazette’s quarterly health publication.

Humans often take body functionality for granted — until it starts to cause pain.

This can be the case with a painful jaw that is hard to ignore. Your temporomandibular joint, or TMJ, is the sliding, hinge-like joint that connects your jaw to your skull on either side of your head.

“The temporomandibular joint is really two joints, there's the left and the right side and they both have to function together. And no other joint in the body does that,” said Dr. Clark Stanford, dean of the University of Iowa College of Dentistry and professor of prosthodontics. He teaches the TMJ curriculum and also sees patients dealing with TMJD, or temporomandibular joint disorders.

TMJD are a group of disorders that impact the function of those joints and the surrounding muscles, causing pain — often chronic — for millions of Americans. Symptoms can include pain in the area of the jaw joint, limited movement, and clicking and locking of the jaw.

Another unique feature of TMJ, Stanford noted, is a disk of tissue that cushions the lower jaw against the base of the upper skull.

“When you go to open your jaw, it rotates for the first roughly 15 millimeters of opening at your incisors,” he said. “At that point, in a very complex dance, the muscles and ligaments dictate the disc as your jaw continues to open to follow the pattern of your lower jaw … If it doesn’t do that in a highly coordinated manner, you start to get the inevitable snaps, clicks and pops that people will talk about getting with their joint.”

“As things become uncoordinated and the muscle that’s moving the ligament forward is no longer coordinated with the muscle that’s moving your jaw forward, it makes a bad ballroom dance, because they’re not dancing together anymore. That’s why they start stepping on each other's feet, so to say,” he said.

To add to the complications, when TMJ is associated with pain, it could be one of 36 different types of TMJ disorders. This is another part of the reason TMDJ can be particularly challenging to deal with, both as a patient and medical professional.

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Stanford said there are studies that have been done to help understand the fundamental underlying risk factors so that providers like himself can help better serve their patients.

“There are some conditions that are more common than others,” he said. “And there are some medical conditions that put you at a much higher risk.”

He pointed out that genetic disorders related to collagen in the body and being double jointed are one example of a condition that can put you at a higher risk of TMJD. He noted that fibromyalgia, lower back pain, chronic pelvic pain, TMJD and migraine headaches can be connected.

Other times, he said, TMJD can be pinpointed to a specific cause, such as a motor vehicle accident that caused a fractured jaw and challenges with reconstruction.

TMJD does tend to strike women about two to one over men, impacting women in their 20s commonly. “We don't know exactly why, but we think it's a combination of genetic and hormonal components,” Standford said.

As patients get older, TMJD tends to be more complex and involve multiple kinds of pain. Taking the proper diagnostic steps is very important in the process, Stanford said, to discover where the pain is coming from, as sometimes jaw pain can also be referral pain from cervical issues.

“Diagnostics is so important because we don't want to be mistreating someone for something that they may not have. And you want to make sure to have a thorough health history,” he said.

According to Stanford, treatment for TMJD, in general, is always as conservative as possible and minimally invasive.

“For the vast majority of patients, I can actually manage their condition with jaw stretching, exercises, habit awareness and avoidance,” he said. He noted that oftentimes, patients may have habits they don't even realize are impacting their jaw.

“When I'm working with a patient, I want them to use gentle jaw stretching exercises,” he said. “I want them to be focused on a daily habit that they may be doing that could be making it worse.”

He shared examples of holding a telephone with your head and shoulder or sleeping on your back and not on the side of their face.

“Your head is a 30-pound instrument that's sitting on your neck, not designed to be hanging forward,” he added. “So not having good posture can actually make the pain worse when you're hanging your head forward. That's why I work a lot with physical therapy. We do a lot with posture, positioning and stretching exercises.”

Stanford also advises using non-steroidal anti-inflammatory medications to deal with acute pain to keep it from turning into chronic pain. TMJD patients dealing with chronic pain face more of a challenge because of the neurological connection to the pain experience.

Stanford did caution that not all pops and clicks are bad. “If your joint pops and clicks but it’s not painful, there’s no data to show that it is going to become a painful joint,” he said.

“Overall, the issue is there’s not one easy magic solution,” Stanford said, explaining that there are artificial joint replacement options, but those are used in worst case scenarios. “We do use those often as they are not like a knee or hip partly because of the complexity of the joint.”