What is causing my jaw pain? Common causes of TMJ pain

By: John Crawley, PT, DPT, OCS

Temporomandibular joint (TMJ) pain is a common and often debilitating condition that affects the jaw joint and surrounding muscles. This complex joint, responsible for essential functions like chewing, speaking, and yawning, can become a source of significant discomfort and pain that can negatively affect function. Individuals experiencing TMJ pain may report a variety of symptoms, including jaw pain, headaches, earaches, clicking or popping sounds in the jaw, and difficulty opening or closing the mouth. Understanding the underlying causes of this pain is crucial for effective management and treatment. Three causes of TMJ pain are internal derangement of the articular disc, myofascial pain, and osteoarthritis.

Internal derangement of the TMJ itself can cause significant pain. This typically involves displacement or dysfunction of the articular disc, the small cartilage pad that cushions the joint. Disc displacement can occur due to trauma, joint laxity, or degenerative changes due to poor biomechanics. Specific risk factors for internal derangement include: macrotrauma (such as a direct blow to the jaw), microtrauma (repetitive overuse injuries from clenching or grinding), hypermobility (excessive joint movement), connective tissue disorders, and certain anatomical variations of the joint. When the disc is out of its normal position, it can lead to clicking, popping, locking, and pain during jaw movement. Knowing which type of joint dysfunction can help to create a targeted treatment plan.

Myofascial pain dysfunction (MPD) is a leading contributor to TMJ pain. Studies have shown that MPD accounts for 40-50% of all TMJ related pain.1 This involves pain and dysfunction in the muscles that control jaw movement, such as the masseter,temporalis, and pterygoids. Overuse, clenching, grinding (bruxism), and stress are often implicated. This type of TMJ related pain often has local and regional factors contributing to a patient’s presentation. These factors lead to muscle tightness, trigger points, and referred pain, not just in the jaw but also in the head, neck, and shoulders. Identifying and addressing all of the underlying factors contributing to the TMJ pain is essential to creating a successful treatment plan.

Osteoarthritis is a degenerative joint disease that can affect the TMJ, and contrary to common beliefs about general osteoarthritis, TMJ osteoarthritis can present in a younger population, with the average age of onset often falling between 20-40 years of age.2 It involves the breakdown of cartilage and bone within the joint, leading to pain, stiffness, and decreased range of motion. Risk factors include previous joint injury, genetic predisposition, and increasingly, research is pointing to associations with other pain conditions such as headaches, low back pain, and sleep disturbances.3,4 Osteoarthritis in the TMJ can cause chronic pain and significantly impact chewing and speaking. 

Seeing a physical therapist can help to identify the underlying causes of TMJ related pain. Being able to determine the nature of the TMJ pain is essential to creating an effective treatment plan that will reduce pain and increase function. Once the nature of the TMJ pain is identified, a physical therapist will create an effective treatment plan based on the individual needs and goals of the patient. These plans include manual therapy, therapeutic exercise, and activity modifications.

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References:

1. Kuć J, Szarejko KD, Gołębiewska M. The Prevalence and Overlaps of Temporomandibular Disorders in Patients with Myofascial Pain with Referral-A Pilot Study. Int J Environ Res Public Health. 2021;18(18):9842. Published 2021 Sep 18. doi:10.3390/ijerph18189842
2. Manfredini D, Guarda-Nardini L. Ten years of research in temporomandibular disorders: a systematic review of PubMed papers. J Orofac Pain. 2009;23(1):9-24.
3. Stegenga B. Osteoarthritis as a common denominator in chronic temporomandibular joint pain and dysfunction. J Orofac Pain. 2001;15(2):128-142.
4. Lobbezoo F, van Selms MK, Visscher CM, Naeije M. Orofacial pain and temporomandibular disorders: bridging the gap between clinical and basic science. J Orofac Pain. 2011;25(1):7-19.