ON ORAL CARE
Everything You Should Know About Jaw Pain, TMJ, and Orthodontic Treatment
Can straightening your teeth relieve jaw pain? It's complicated.
Molly S. went 15 years without a decent night’s sleep. The now 36-year-old creative director had a nagging pain in her jaw that led to other frustrating symptoms, as jaw pain often does. “It started as pressure on the left side of my face, in the joint of the jaw,” Molly tells The Impression. “Sometimes, it turned into headaches and it caused neck tension. I could never find a comfortable pillow and never slept well.”
When it first started in her early 20s, Molly consulted her dentist, who recommended surgery to correct her bite. But she felt that was too extreme. “Since I have to talk so much for my job, that was going to be a no,” she says. So, for more than a decade, Molly just lived with the pain.
Until finally, she stumbled upon a solution: Just 10 months of clear aligners, which straightened her teeth and consequently helped align her bite. “I feel fantastic,” Molly says. The best part: “I woke up one morning after a good sleep, and realized I didn't have neck pain for the first time.”
Molly’s story is the kind of story every person who’s struggled with stubborn and confusing jaw pain for years hopes for (finally, sweet relief!). But sadly, Molly is far from alone in how long she suffered. Many people with jaw issues — meaning all of the (many) variations of temporomandibular joint and muscle disorders that’s commonly referred to as “TMJ” or TMJ disorder — will spend years trying to crack the case of their pain. Also, while Molly was able to arrive at a pretty straightforward solution (long overdue as it may have been), for others solving the riddle of their TMJ pain requires a lot of trial and error, with multiple treatments along the way.
The Impression spoke with patients and experts to answer everything you need to know about jaw pain. Ahead, everything you should know about and TMJ disorders.
What is TMJ?
Although people sometimes refer to “TMJ” as a diagnosis, TMJ really only refers to the medical name of your jaw joint. TMJ stands for temporomandibular joint, which connects the lower jaw bone (the mandible) to the bone at the side of your head (the temporal bone). If you open your mouth, the rounded ends on either end of your mandible, called condyles, glide along the joint socket. In between the condyle and the temporal bone is a soft disc, which serves as padding in between the bones. It absorbs the shock of all jaw movements and keeps the movement smooth.
The temporomandibular joint is maybe the most complex joint in the body. Unlike load-bearing joints like your hips and knees, it is made of smaller, more sensitive parts. It doesn’t just bend one direction, like your elbow, it opens and closes and swings side-to-side. It’s also one of the most used joints in your body. You might not realize it (until you have jaw pain, anyway), but you do a lot of chewing and talking.
Over time, though, “TMJ” has become shorthand for every jaw pain issue, mild to severe — kind of how people use “OCD” to describe everything from an attention to detail to actual obsessive compulsive disorder.
“What people refer to as TMJ is a hundred different things,” Dr. Dan Sletten, an orthodontist based in Minneapolis, explains to The Impression. “It’s such a highly variable problem.”
What’s the difference between TMJ and TMD?
TMD stands for temporomandibular joint disorder. It’s also sometimes called temporomandibular joint dysfunction or simply TMJ disorder. These acronyms are the more accurate medical terms used to describe the spectrum of problems that can cause jaw symptoms. According to the National Institute of Dental and Craniofacial Research, there are three main categories of TMD.
The first type is characterized by pain in the muscles in the face, head and neck that control the jaw. The second involves problems with the function of the actual joint, so that could be a dislocated jaw, a displaced disc or injury to the condyle. Finally, the third type is characterized by arthritis, meaning there is some kind of degenerative or inflammatory joint disease affecting your jaw.
It’s possible to have more than one of these conditions at the same time. It’s also not unheard of for people with TMD to also have other health problems, such as chronic fatigue syndrome, fibromyalgia, or a type of arthritis (like rheumatoid arthritis) that may or may not affect other joints as well. These issues all have symptoms in common, but scientists have yet to determine the exact relationship between them.
What are the symptoms of TMD?
The main symptom is radiating pain in the face, jaw, neck, ears, or head. “Probably the root cause of a lot of different types of headaches is jaw muscle imbalance,” Dr. Sletten says. Other symptoms include, muscle stiffness, locking of the jaw or not being able to open or close the jaw fully, or popping or clicking of the jaw.
How is TMD diagnosed?
For a majority of patients, the problem goes mostly undiagnosed, explains Dr. Kevin Winters, a Physiologic Dentist who treats many TMD patients in Austin, Texas tell The Impression. “Most of the people I see they’ve been to a physician, like an ENT, or just their general dentist who’s told them they have TMJ.” Dr. Winters says. “Okay, but what doesTMJ mean? It’s a catch-all phrase.”
TMD is never a simple yes or no diagnosis. “In dentistry, TMD is probably the least black and white thing we deal with,” Dr. Sletten says.
Rather, a TMD diagnosis is one of exclusion, meaning your dentist or specialist should do a full exam, and go over all of your symptoms with you, to rule out all other issues. From there, he or she should order scans and do various other tests, like muscle palpitations to further investigate and diagnose what type of TMJ problem you have.
Is there a normal course of treatment for TMD patients?
Sort of. The good news is for a majority of patients, symptoms are mild and can be corrected and dealt with relatively mild treatments (like Molly’s orthodontia). But for some, the problem can be very severe.
This is another thing that vexes experts who study and treat TMD: Why is it that most people with TMD have minor symptoms, while others can experience chronic and sometimes debilitating pain that requires complex treatment?
Take Kirsten Blum’s story, for example. Blum, a lawyer based in Florida, first started experiencing jaw pain in college. Her dentist at the time performed arthrocentesis, which is a procedure to flush the joint of inflammatory fluids that cause pain. For years, she had no problems — until 2017, when she started a stressful new job. For some reason, her jaw pain came back with a vengeance. “It got worse and worse with jaw spasms and pain when biting. It was on the other side this time,” Blum tells The Impression. “I could hardly open my mouth. It went on for months.”
From there, Blum saw a TMJ pain specialist, who recommended non-invasive treatments that unfortunately didn’t help her (and only seemed to make her pain much, much worse). Until finally she found her way to a surgeon she trusted, who was recommended by her dentist. It turned out, she had severe arthritis of the jaw on both sides, and the surgeon recommended an operation to replace her deteriorated discs. “The healing process is at least 9 months and could require additional intervention after,” she says. “The braces I have are surgical braces and have little bars on them. I have to wear a splint in between my mouth to stabilize my jaw and it is held in by rubber bands attached to the braces.”
Blum is now on the road to recovery. She’s had setbacks, including a flare-up of intense pain after she got the go-ahead to chew soft foods a little too soon, but she’s hopeful for the future.
What causes TMD?
The cause of most cases of TMD is unknown. For some people, their TMD is related to an injury—perhaps a fall or car accident in which their jaw is hit or injured. In these cases, healing the injury will solve the TMD.
For others, especially those whose symptoms are muscle pain and tightness, alignment of the teeth and the bite seem to play a role. “In a lot of cases, it’s really a muscle problem—the muscles are trying to protect your joint. This overworks the muscles so you get chronic muscle fatigue,” Dr. Sletten says. “That’s why as orthodontists, we are always focused on making your teeth fit together as best as possible. That tends to keep your muscles relaxed. If your teeth fit great, your muscles are happy, then your jaw problems are likely to be reduced.”
Another major cause is teeth grinding, according to the Cleveland Clinic. People who grind their teeth, especially at night, inadvertently put an enormous amount of pressure on the TMJ.
Finally, there is also good evidence that there is an underlying hormonal cause. TMJ disorders are twice as common in women as it is for men, and roughly 80% of the people seeking TMJ treatment are women. Research has revealed the driving force behind the higher incidence in women is the hormone, estrogen. In addition to being a reproductive hormone, estrogen also has a side-job of pain regulation, which may explain why women tend to experience pain differently than men, and why their TMJ symptoms may be more severe. It may also be why TMJ pain relief sometimes comes with pregnancy, and why it can otherwise wax and wane throughout women’s lives.
Can straightening your teeth be a TMJ pain treatment?
For some people, yes. For Molly, sorting out her bite issues with invisible aligners seemed to take some of the pressure off her jaw, which relieved her pain. But treatment for TMD or any kind of TMJ pain is extremely individual, and depends on exactly what’s going on in your case.
The good news is that extensive research has been done to determine that generally, orthodontic treatment does not seem to increase your risk for TMD or TMJ pain. But unfortunately, more research is needed before we can say for sure that teeth straightening can relieve jaw pain. As a 2010 Cochrane review of 55 studies put it, “it is essential to reflect the seemingly random development/alleviation of TMD signs and symptoms.” In many cases, finding out how to fix TMJ issues requires trial and error.
What other kinds of TMD treatment are there?
Treatment for TMD is as variable as the diagnoses. What’s right for you won’t be right for another person, so it’s really important you see a specialist who can evaluate you and your pain holistically.
With that said, the most common treatments are those that simply alleviate pain symptoms, like muscle relaxant drugs or even Botox. Your dentist or orthodontist will also likely recommend you try eating soft foods, managing your stress, and focus on resting your jaw, either with TMJ stretches or other lifestyle techniques. More recently, physical therapy has grown in popularity. “Some physical therapists have become focused on helping TMD patients by managing the muscular dysfunction associated with their symptoms,” Dr. Sletten says. “We have seen more and more people get relief from physical therapy above and beyond conventional therapies.” In general, most experts recommend starting with very conservative treatments, only trying more invasive ones as needed.
Other treatments include splints or mouthguards to keep your teeth from grinding, give your jaw a rest from involuntary clenching, and otherwise force your bite into a better position that will help relax the muscles. Dr. Winters says you can get a TMJ mouthguard over the counter at many pharmacies (or off the internet), but often those don’t work or make it worse. But one made for you by your dentist or a Physiologic Dentist who uses scanning technology to design a bite splint for you and your jaw specifically tends to work much better.
From there, your dentist or orthodontist may also recommend dental work, such as porcelain crowns that change your bite, or braces or other orthodontic treatment. Finally, in the case of severe deterioration of the joint or other specific circumstances, surgery may be warranted.
What should you look for when consulting specialists for TMJ?
Unfortunately, despite the fact that many dentists and other providers market themselves as TMJ specialists, in reality there’s no such thing. “There are a lot of practices that only see TMJ patients, so they’re looked upon as a kind of specialty, but they’re typically a general dentist who just has an interest in it,” Dr. Winters says. That doesn’t mean they’re bad, or they can’t help necessarily, but it’s just good to know that “TMJ specialist” doesn’t really have a set definition or set qualifications the same way, say, being a periodontist (who specializes in gum disease) does. You can ask if the provider has done any extra training in treating TMD. Dr. Winters says trainings with the Las Vegas Institute (where he is also a teacher) and the Pankey Institute in Florida are generally respected.
But in the end the best advice for evaluating a doctor is simple: Find someone who takes your symptoms seriously, and is interested in not only treating your pain but finding the root of it. “A lot of dentists, because they’re unfamiliar with the problem, can often make some of these people feel like they’re crazy, like their pain is just in their heads,” Dr. Winters says. “That literally happens every day. It’s just ridiculous.”
Blum seconds this advice from a patient-perspective, and adds that because it’s so individual you also need someone who is truly interested in the specifics of your case. “There are a lot of specialists out there who claim to be experts and know what they are doing — but they don’t even look at your charts! I went to three doctors before I found my surgeon,” she says.
In the end, no matter how complex your case might be, don’t fret: Help is out there. ✧
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