Introduction

The jaw joint otherwise known as temporo-mandibular joint is located in front of the ear where the skull and lower jaw meet. The joint allows the lower jaw to move and function. The joint itself is made up of two bones that are separated by a disc of cartilage. Ligaments and muscle surround the joint.

Problems with the jaw joint are quite common but typically last a few months before getting better. In some cases only the muscles are affected (myofascial pain dysfunction) whereas in others the cartilage and ligaments may also be at fault (internal derangement). Some people may have a combination of both.

The most common symptoms are:

  • Joint Noise – clicking, cracking, crunching, grating or popping
  • Pain – usually a dull ache in front of or in the ear. This may spread up or down the side of the face
  • Headache (at the side of the head)
  • Limited mouth opening (very rarely with locking of the joint)

Most jaw joint problems are made worse by chewing and are aggravated at times of stress.

What causes jaw joint problems?

Pain is caused by the muscles in and around the jaw joint tightening up.

The disc of cartilage can slip out of its normal position between the bones of the jaw joint and noise is heard when it returns to its normal position.

The noise can be quite loud as the joint is just in front of the ear.

The ligaments and muscles surrounding the joint can in turn go into spasm, producing pain and limited mouth opening.

Why have I got jaw joint problems?

Over-use of the muscles surrounding the jaw can cause tightening of the muscles as well as allowing the cartilage disc to slip forward.

Causes of over-use include

  • Grinding & clenching of teeth (when asleep or at times of stress)
  • Stress / anxiety
  • Nail biting
  • Regularly holding things between the teeth (hair grips etc.)
  • Loss of a significant number of back teeth
  • An uneven bite
  • Sometimes there is no obvious cause

Are my problems anything to worry about?

Jaw joint problems are not usually serious and do not lead onto other problems. They can be a nuisance however but usually respond to simple treatment.

What treatment is available?

Treatment is aimed at trying to reduce the workload of the muscles so allowing the cartilage disc to return to a normal position in the joint.

  • A soft diet that requires little chewing (allows muscles to rest)
  • Resting the joint as much as possible – avoid yawning, wide opening & biting hard on the front teeth
  • Painkillers – anti-inflammatory medication, this helps to reduce the muscle cramp / spasm
  • Heat – pressed to the affected area also helps reduce muscle cramp & spasm e.g. a warm towel
  • Habits – reducing or stopping any teeth clenching or teeth grinding habits often leads to a swift resolution of the problem. Remember however that these habits may be “subconscious”
  • Relaxation therapy – to control stress & tension
  • Jaw joint exercises – As described later
  • “Gumshield” or “Night guard” – a clear plastic splint may be recommended to act as a shock absorber & habit breaker if you clench / grind your teeth
  • Physiotherapy (if required we will refer you)
  • Replace missing teeth – if this is appropriate it will have been discussed with you
  • Muscle relaxants – may be prescribed

What happens if these methods do not produce an improvement?

Following the above advice may stop or reduce the problem to a point where you can manage the symptom. In a very small number of cases further treatment or surgery may be required.

Jaw joint exercises

The purpose of these exercises is to prevent clicking of the jaw and to strengthen the muscles which pull your jaw backwards. They will relax the muscles which pull the jaw forwards or to one side as you open your mouth, thus taking the strain off your jaw joints.

Set aside 4 to 5, 5 minute periods a day when you have time to relax to do the exercises.

Sit in an upright chair and carry out the following procedure.

  1. Close your mouth on your back teeth, resting the tip of your tongue on your palate just behind your front teeth.
  2. Run the tip of your tongue backwards on the palate as far back as it will go, keeping the teeth in contact.
  3. Force the tongue back to maintain contact with the palate and slowly open your mouth until you feel your tongue just being pulled away from the palate. Do not try to open your mouth further. Keep it in this position for 5 seconds and then close your mouth. Relax for 5 seconds.
  4. Repeat this procedure slowly over the next 5 minutes in a firm but relaxed way.

As you open your mouth you should feel tension in the muscles at the back of your jaw and beneath the chin. For the first few times that you do the exercise you should check in front of a mirror that the lower teeth move vertically downwards – that is, there is no slight movement from side to side as you open your mouth. If the exercise is being carried out correctly there will be no clicks or noise from the joints.

At first it may seem that these exercises make the pain worse. This is as a result of unaccustomed exercise.

However if you carry on doing these exercises several times a day, this will help to strengthen the ligaments around your joints.

If the exercise is carried out correctly and regularly over a 2 or 3 week period, you will retrain your jaw muscles so that your jaw opens and closes smoothly without (or with reduced) clicks or jerks and any pain you are experiencing should reduce.