How to Manage TMJ Pain

What is TMJ pain?

The temporomandibular joint (TMJ) connects your lower jaw to the side of your skull, just in front of the ear. A small disc of cartilage lets the jaw glide when you talk, chew and yawn. Pain can come from the joint itself, when the disc slips out of place or the joint is strained, and from the chewing muscles around it, which can tighten and spasm.

Common symptoms:

• Ear pain or fullness, with normal hearing and a normal-looking eardrum
• Sore jaw muscles, or pain in the temple or cheek
• Clicking, popping or grinding when you open your mouth
• Trouble opening your mouth all the way, or a jaw that locks
• Headaches or neck aches, and sometimes ringing in the ears

Many people come to us sure they have an ear infection. When the ear and hearing are normal, the jaw joint is often the source.

What causes it?

• Clenching or grinding your teeth, often during sleep
• Chewing gum or tough foods
• Stress, which often shows up as jaw clenching
• An injury to the jaw
• Arthritis in the joint
• Bite problems, though changing the bite is rarely the answer

What can I do at home?

• Rest your jaw: eat soft foods for about 2 weeks, then add firmer foods back slowly as pain allows. Cut food into pieces about the size of your thumbnail. Avoid gum, chewy or hard foods (such as jerky, bagels, hard candy and ice) and very wide bites.
• Keep your jaw relaxed: lips together, teeth apart, tongue resting on the roof of your mouth. Set reminders, such as a phone alert every hour or sticky notes where you work, to check that your teeth are apart and your jaw is loose.
• Moist heat: a warm, damp washcloth or moist heat pack on the sore side for about 30 minutes, at least 2 times a day. After a fresh injury, use ice instead for the first day or two: 10 to 15 minutes at a time, wrapped in a thin cloth, a few times a day.
• Gentle stretches: slowly open and close your mouth 5 to 10 times, 3 times a day, stopping before it hurts. A physical therapist can teach you specific jaw exercises.
• Support big yawns by placing a fist under your chin.
• Pain medicine: an anti-inflammatory such as naproxen or ibuprofen, taken on a schedule for a short time. See how to take it below.
• Lower stress with regular exercise (about 30 minutes of brisk walking or similar activity on most days), relaxation and at least 7 hours of sleep a night. Avoid resting your chin on your hand or cradling a phone between your ear and shoulder.

How should I take pain medicine?

Anti-inflammatory pain relievers (NSAIDs) help most with pain from the jaw joint itself, and less with long-lasting muscle pain. Naproxen has the best research behind it for TMJ pain; ibuprofen is a good alternative. For a flare of TMJ pain, take one on a regular schedule for a set time, rather than only when the pain is bad.

• How long: about 2 weeks, then stop. Pain often starts to ease within the first week or two. If you still need medicine after 2 weeks, call us rather than keep taking it every day.
• If one does not help, call us. Some people do better on a different anti-inflammatory.
• Use one at a time. Do not take naproxen and ibuprofen together, or add aspirin. Acetaminophen (Tylenol) can be taken along with either one, but on its own it does little for long-lasting TMJ pain.
• Check with your doctor first if you have had a stomach ulcer or stomach bleeding, have kidney disease, heart disease or high blood pressure, take a blood thinner or blood pressure medicine, or are pregnant. If these medicines have upset your stomach before, ask us about taking a stomach-protecting medicine with them.
• Stop and call us if you get stomach pain, black or tarry stools, or swelling in your legs.
• Medicine works best alongside jaw rest, moist heat and stretches, not in place of them. For pain that has lasted 3 months or more, daily anti-inflammatories are not the answer; the treatments below help more.

What if it does not get better?

If home care is not enough after 2 to 3 weeks, other treatments can help. These include physical therapy with jaw exercises and hands-on treatment, a muscle relaxant at bedtime for a few weeks when the jaw muscles are in spasm, and seeing your dentist or an oral surgeon, especially if you grind your teeth or your bite has changed. If you grind your teeth at night, your dentist may suggest a night guard (splint). It can be taken out and may ease muscle pain for some people, but it works best alongside the other steps, not as a cure on its own.

For pain that has lasted 3 months or more, the treatments that help most are cognitive behavioral therapy, supervised jaw exercises and stretching, posture exercises and hands-on therapy from a physical therapist. Permanent changes to the teeth or bite and joint surgery are not recommended for long-lasting jaw pain.

Do and don't

When should I call?