TMJ (jaw joint) disorders
The temporomandibular joints connect the lower jaw to the skull. Pain, clicking, locking or limited opening are common and most people improve without surgery. Will leads the TMJ service at Homerton, with a particular interest in TMJ arthroscopy.
Who it may help
- Jaw, face or temple pain, often linked to clenching or grinding
- Clicking, catching or locking of the jaw
- Limited mouth opening
- Joint damage from arthritis, injury or a displaced disc
- Severe joint disease or fusion (ankylosis) where other treatment has failed
Recovery
After arthrocentesis or Level 1–2 arthroscopy most people go home the same day, eat a soft diet for a few days and return to work within a few days. After Level 3 arthroscopy a soft diet is needed for longer, usually a few weeks. Daily jaw exercises are important afterwards. Joint replacement needs a recovery of several weeks.
What is involved
Treatment is stepped. It starts with supported self-management and jaw exercises, then other non-surgical treatments if symptoms persist. An MRI scan is arranged only when it will change your treatment. Minimally invasive procedures – arthrocentesis and arthroscopy – are offered when the joint itself is the problem and simpler measures have not helped. Open joint surgery and total joint replacement are reserved for a small number of patients with severe joint disease.
Self-care that helps most people
These measures are recommended for all types of TMJ disorder. Give them time – most people notice benefit over several weeks.
- Keep your teeth apart except when eating, and rest the jaw
- Eat a softer diet during flare-ups – foods like pasta or omelettes
- Avoid chewing gum and chewing pens, pencils or nails
- Cut down on caffeine, which can increase muscle tension
- Apply warmth or ice to the sore muscles for 15–20 minutes twice a day – try heat for three days, then cold for three days, to see which suits you
- Gently massage the temple and cheek muscles for a minute each, three times a day
- Practise slow diaphragmatic breathing for five minutes every couple of hours to help relaxation
- Watch your posture at a desk – head up, shoulders back – and take regular gentle exercise such as yoga or Pilates
- Use simple pain relief such as paracetamol or ibuprofen (if suitable for you); ibuprofen gel can be rubbed over the joint
- If you clench or grind, your dentist can make a night guard to protect the teeth and reduce muscle strain
Jaw exercises
Specific exercises are prescribed according to your diagnosis. Only do the ones you have been advised to do:
- Coordination training (the “N-stretch”) to help the jaw open and close straight
- Gentle resistance (isometric) exercises for muscle pain or a clicking joint
- Static stretching when the mouth does not open fully
- Mobilisation exercises for a jaw that locks closed
Non-surgical treatments
If self-care is not enough, Will may suggest:
- Physiotherapy with a physiotherapist who specialises in TMJ disorders
- A custom bite splint
- Medicines for pain, muscle tension or sleep, often in partnership with your GP
- Injection treatments for overactive jaw muscles or for the joint itself – these use prescription medicines and are considered only after a face-to-face assessment
- Acupuncture for some people with muscle pain
TMJ arthroscopy: Levels 1 to 3
Arthroscopy is keyhole surgery: a camera less than 3 mm wide is passed into the joint through a small incision in front of the ear, under general anaesthetic. It is graded by how much is done inside the joint. Arthrocentesis – washing the joint out through two fine needles – is a simpler option that is sometimes tried first.
- Level 1 – diagnostic arthroscopy with lysis and lavage: the joint is examined, washed out and gently freed, which often improves pain and opening
- Level 2 – operative arthroscopy: adhesions, inflamed joint lining or roughened surfaces are treated and the disc is released so it can move more freely
- Level 3 – advanced arthroscopy: a displaced disc is repositioned and secured in place (arthroscopic discopexy)
Risks and side effects
All surgery carries some risk. The main ones for this treatment are listed below; your own risk depends on your health and the details of your operation.
- Swelling and soreness in front of the ear
- Temporary ear discomfort or a blocked feeling
- Temporary weakness of the forehead or eyelid from bruising of a facial nerve branch – uncommon
- Change in the bite
- Symptoms not improving, or returning, sometimes needing further treatment
Alternatives
Many people manage well with self-care, exercises, a splint and physiotherapy alone, and symptoms often settle with time. Where stress, sleep or wider pain conditions play a part, support from your GP, a psychologist or a pain service may help more than surgery.
Trusted resources
- TMJ exercise videosNewcastle Dental Hospital demonstration playlist
- Orofacial Pain UKPatient information on face and jaw pain
- Find a TMD physiotherapistAssociation of Chartered Physiotherapists in TMD
- Live Well with PainSelf-management tools for persistent pain
- TMD self-management manualUniversity of Leeds pain manual
- The TMJ AssociationIncluding a guide to diet and nutrition
Guidance and standards
The self-care and exercise advice follows the Homerton Oral & Maxillofacial TMD patient booklet. Imaging is requested only when it will change management – the focus of Will’s audit of MRI selection for TMJ problems – and surgery is offered only after appropriate non-surgical care.
Questions worth asking at your appointment
- Benefits – what will this treatment do for me?
- Risks – what could go wrong, and how likely is it for me?
- Alternatives – what other options are there?
- Nothing – what happens if I wait, or decide not to have treatment?
Based on the Choosing Wisely UK BRAN questions.