It seems like all of my friends are having jaw pain.
As we trudged deeper into our 30s, I was prepared to hear about bad backs and tricky knees. But the mouth stuff was unexpected. Some were grinding their teeth at night and needed mouthguards. Others had doctors inject botulinum toxin, commonly referred to as Botox, into aching jaws. And we are all now extremely familiar with a new body part: the TMJ, or temporomandibular joint, which connects the jawbone to the skull.
TMJ is a common, convenient shorthand for jaw pain, but the correct term for the condition is temporomandibular disorder or TMD. There are several types of TMD, all of which relate to jaw bones and muscles.
Roughly 10% to 15% of adults have some form of temporomandibular disorder, estimates Dr Thomas P Sollecito, professor and chair of oral medicine at the University of Pennsylvania School of Dental Medicine. “The vast majority don’t require treatment,” he says. TMD can clear up on its own, or may be painless and not require intervention.
So how do you know if the clicking sound your jaw makes is a problem? Do you have TMD or did you just sleep weird? We asked experts.
What are temporomandibular disorders (TMDs)?
TMDs are “disorders or symptoms related to the structure and function of the jaw system”, explains Dr Karyn A Kahn, a dentist at the Cleveland Clinic.
According to the National Institute of Dental and Craniofacial Research, TMDs fall into three main categories: disorders of the temporomandibular joint, disorders of the muscles used for chewing, and headaches associated with jaw strain.
Because TMD encompasses a range of disorders, symptoms can vary. “There are a lot of different signs and symptoms that may suggest a patient is experiencing a temporomandibular disorder,” Kahn says. These include a clicking or popping sound in the jaw, facial pain, tooth fractures from grinding, limited jaw movement, and even seemingly unrelated issues such as headaches and ear pain.
Women tend to experience TMDs more than men, though no one’s exactly sure why. Some studies have found a connection between estrogen and temporomandibular pain, Kahn says. Sollecito says others have also suggested that women experience stress differently, and are more likely to grip their jaws. “And some people think women just seek [medical] care more than men,” he says, which means more recorded cases in women.
What causes TMDs?
TMDs have a variety of causes. They can result from physical trauma (being hit in the jaw, for example), genetics, anatomical factors such as how your jaw lines up, and lifestyle habits such as chewing gum or eating lots of chewy food such as bagels.
Temporomandibular disorders have also been found to overlap with some chronic pain conditions such as migraine headaches, fibromyalgia, chronic back pain and chronic pelvic pain in women, says Dr Clark Stanford, professor of prosthodontics and dean of restorative dentistry at the University of Iowa.
TMDs can also be the result of emotional distress. Stress can lead to jaw tension and teeth grinding, both of which strain the muscles of the jaw, causing pain. Stanford’s diagnostic process involves an exhaustive clinical exam as well as a psychological assessment. One recent patient had been struggling with acute jaw pain for a couple of months. As they spoke, he learned she had recently lost a close friend, and as a result had been juggling work stress and personal grief.
“It sounds weird for a dentist to be asking about what’s going on in your life,” Stanford says. “But a lot of times, once [patients] understand why they’re gripping their teeth all the time, they understand the need for an intervention to reduce that habit.”
How are TMDs treated?
Generally, experts advise starting small when it comes to TMD treatment. For those who grind their teeth at night, doctors often prescribe a night guard – a plastic, retainer-like device – to help protect their teeth.
So-called self-help therapies are also useful tools. Stanford says these can include daily exercises to loosen the jaw, awareness of sleep habits and education about which foods may exacerbate pain. In some cases, cognitive behavioral therapy and other stress reduction techniques can also be helpful.
In cases where TMD is primarily a result of jaw clenching, doctors may recommend botulinum toxin, commonly referred to as Botox. When injected into the masseter muscles on the sides of the jaw, it reduces the amount of muscle contraction in the area and reduces clenching and pain, Kahn explains.
In some advanced cases, open joint surgery on TMJ may be required, Kahn says. But that’s only if “all conservative therapies have been tried and failed” and the jaw pain “inhibits their quality of life”, she says.
If you are experiencing jaw pain, consult with a doctor or a dentist. But if your jaw makes a clicking noise sometimes and you don’t have any pain, you’re probably fine. Sollecito estimates that a third of people have a jaw click.
“I don’t get excited by pops and clicks,” Stanford says.
