TMD: What You Should Know

What is TMD?

TMD describes a variety of conditions affecting the jaw joints and muscles. Problems may occur on one or both sides. Many people have some sign of TMD, but only a small number suffer pain.

What causes TMD?

The exact cause is not known. For years, dentists thought TMD was caused by the way the jaws and teeth lined up. Research has shown that misalignment of the jaws and teeth is not a major cause. TMD is now understood to involve several contributing factors, some of which may have little or nothing to do with the teeth. Much discomfort is related to overuse of the joints and muscles.

• Clenching your teeth, which may happen when concentrating, feeling busy or worried, or in cold winds.
• Grinding your teeth, often at night but sometimes during the day.
• Straining the joints and muscles by chewing pencils, biting nails, holding things in your mouth, or holding a telephone between your neck and shoulder.
• Overworking the muscles with constant chewing, such as chewing gum.

Will it get worse?

TMD does not usually keep getting worse. The problem tends to come and go, often feeling worse during times of stress. The handout notes that studies show it does not generally worsen with age and may improve over time.

Symptoms you may experience

• Jaw pain or soreness that may be worse on waking or in the evening.
• Jaw pain when biting, chewing, or yawning.
• Clicking from the joint when moving your jaw.
• Stiffness or locking of the jaw joint.
• Earache without an infection.
• Difficulty opening or closing your mouth.
• Frequent headaches.

How is TMD treated?

There are many effective and simple treatments, although there is no single cure. The handout says studies show up to 90% of patients get better with self-care, exercises, and a splint (bite guard) to reduce tension in the facial muscles. Other possible treatments mentioned include laser therapy, physiotherapy, adjustment of the biting surfaces of the teeth, or medication. Orthodontics or surgery is indicated only very rarely.

What you can do

The handout emphasizes that your participation is important for treatment to be effective.

• Keep your teeth apart when you are not wearing your splint. The proper resting position is with your teeth slightly apart and your lips gently together. Your teeth should touch only during chewing, swallowing, and sometimes speaking.
• Avoid opening your mouth very wide.
• Avoid habits such as chewing fingernails or gum.
• Avoid straining your neck and shoulders with poor posture.
• Eat nutritious meals that do not require hard or prolonged chewing. A soft diet may help when symptoms are more intense.
• Avoid caffeine and smoking. The handout notes that stimulants can make pain seem worse and increase muscle fatigue.
• Painkillers you would normally take for a headache, such as paracetamol or ibuprofen, can be taken for short periods if pain is particularly intense.

Exercise program

The original handout recommends setting aside 10–15 minutes each day, or at least five minutes three times per day, for exercises. Always move slowly and gently, relaxing the muscles as much as possible. All movement should be relaxed and pain-free. Practice regularly. If the exercises seem to make your jaw problem worse, stop. Your dentist may prescribe other exercises for your needs.

• Exercise 1 — Smooth opening: In front of a mirror, place your fingers over your jaw joints and curl your tongue back to the roof of your mouth. Keeping your tongue in place, open slowly and smoothly in a straight vertical line. Repeat 5 times, twice a day.
• Exercise 2 — Balanced opening: Begin with your jaw at a comfortable resting position and teeth slightly apart. While opening your mouth, use your hand to balance the pressure of your jaw. Hold for 5 seconds and repeat 5 times each day.
• Exercise 3 — Side stretch: Apply slight pressure with your hand as you move your jaw to one side. Hold for 5 seconds, then repeat on the opposite side. Repeat 5 times per day.
• Gentle facial massage may also help. Use three fingers and slowly work from beside your ear down toward your chin.

A note from the handout

Symptoms may come and go and can flare during times of stress. If symptoms return, the handout advises resuming your nightguard and exercises.