Jaw Pain and Limited Opening - Causes of TMJ Disorder and Self-Care

TMJ Disorder Is Rising Sharply Among Modern Adults

Temporomandibular joint disorder is a collective term for conditions in which pain or functional impairment arises in the jaw joint and the muscles around it. Typical symptoms include a clicking jaw when you open your mouth, being unable to open wide, and pain around the jaw. Once you include the sounds and the catching sensation that appear when the jaw moves, the range of severity is very wide, from people who only occasionally hear a click to people for whom eating and talking become difficult.

It is seen especially often in women in their twenties and thirties, and the number of patients is trending upward as society grows more stressful. TMJ disorder often eases on its own, but if it is left alone it can become chronic and interfere with daily life.

The Four Types of TMJ Disorder

TMJ disorder is classified into four types according to cause and symptoms. Type 1 is masticatory muscle disorder, in which excessive tension and pain in the muscles that move the jaw (the masseter and the temporalis) are the main symptoms. This is the most common type, and clenching brought on by stress is its main cause.

Type 2 is joint capsule and ligament disorder, a state in which inflammation has developed in the capsule or the ligaments of the temporomandibular joint. You feel a sharp pain in the joint area when you open your mouth. Type 3 is articular disc disorder, a state in which the cushion inside the joint (the articular disc) has shifted out of place. Opening and closing the mouth produces a clicking or popping sound.

Type 4 is osteoarthritis, a state in which the bone of the joint has become deformed. Long-term loading wears down the joint surfaces, and a gritty, grating sound (crepitus) is characteristic. It is not unusual for several types to be present at the same time.

What Causes TMJ Disorder

TMJ disorder does not come from a single cause; it develops when several factors overlap. The largest factor is clenching and teeth grinding (bruxism) brought on by stress. Unconscious clenching during the day puts a sustained load on the masticatory muscles and brings on muscle fatigue and pain. Because teeth grinding habits cause not only TMJ disorder but also tooth wear and dentin hypersensitivity, taking action early is important.

A poor bite (malocclusion) is one factor as well, but a growing body of research holds that its influence is not as large as was once thought. Rather, everyday habits act in combination: resting your chin on your hand, chewing on only one side, sleeping face down, and posture that deteriorates during long hours of desk work.

In some cases the trigger is an injury (a blow to the jaw, or opening the mouth too wide), or having to keep the mouth open during lengthy dental treatment. As for why it is more common in women, one reason is that female hormones (estrogen) affect the laxity of joints, and another is that the temporomandibular joint is smaller in women than in men, so it is structurally easier to load.

Improving Symptoms with Self-Care

In many cases TMJ disorder eases with self-care and improvements to daily habits. The first thing to be conscious of is correcting TCH (Tooth Contacting Habit). TCH is the habit of letting the upper and lower teeth touch outside of mealtimes, and it is seen in many people with TMJ disorder.

Normally the upper and lower teeth do not touch except in the moments of eating and swallowing. Total tooth contact of roughly 20 minutes a day is normal. Check consciously whether you are clenching your teeth while doing desk work or using your smartphone. Make "lips closed, teeth apart" your watchword, and sticking a note on your computer or phone as a reminder works well.

A warm compress also helps. Holding a steamed towel against the painful part of the jaw for 15 to 20 minutes eases muscle tension. Use a cold compress for acute inflammation (when there is swelling or a feeling of heat) and a warm compress for chronic muscle pain. For meals, avoid hard foods, cut food into small pieces, and chew soft food evenly on both sides. If you have a habit of chewing gum, stop it.

Self-Massage Around the Jaw

Massaging the masseter has the effect of easing the pain of TMJ disorder. The masseter runs from below the cheekbone to the angle of the lower jaw, and it is the part that hardens when you clench your teeth. Press the masseter lightly with the pads of your fingers and massage it in small circles. Do this for 2 to 3 minutes at a time, 2 to 3 times a day.

Massage the temporalis together with it. Put your fingers on your temples and loosen the muscle with the same circular motion. The temporalis is a muscle that becomes especially tense from clenching. The jaw muscles also stiffen up under prolonged tension, in a pattern similar to that between shoulder stiffness and desk work.

Opening exercises help improve symptoms too. Open your mouth slowly and widely, and hold it at the widest point that does not hurt for 10 seconds. Repeat this 5 times. Forcing the mouth open wide makes symptoms worse, so it is important to stay within a range that produces no pain.

Treatment at the Dental Clinic

If self-care does not bring improvement, see a dentist (or an oral surgeon). The most common treatment is splint therapy, in which you wear a mouthpiece (a splint) while you sleep to reduce the load on the jaw joint. A splint evens out the contact pattern between the upper and lower teeth and distributes force that would otherwise concentrate on particular teeth or on the joint.

As drug therapy, nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce pain and inflammation. Muscle relaxants are sometimes prescribed as well. In severe cases, joint cavity lavage (injecting physiological saline into the joint to wash it out) or arthroscopic surgery may be performed, but the cases that reach surgery are only a small minority.

Physical therapy (ultrasound therapy, low-frequency therapy) is also effective for easing muscle tension and promoting blood flow. An approach that uses cognitive behavioral therapy for managing stress and for correcting TCH is effective for long-term improvement as well.

In most cases the symptoms of TMJ disorder improve over a few months to about a year. Rather than impatiently starting several treatments at once, a stepwise approach is recommended: first keep up self-care for 2 to 4 weeks, and see a dentist if you see no improvement. Improving small everyday habits brings a large benefit for preventing and improving TMJ disorder.

Key Points of This Article

• Most cases of TMJ disorder improve with self-care
• Correcting TCH (the tooth contacting habit) is the most important measure
• Self-massage of the masseter and the temporalis can ease the pain
• Use a warm compress for chronic muscle pain and a cold compress for acute inflammation