Diagnosis and treatment of jaw joint and facial pain, starting with conservative care such as splints, therapy and Botox, and surgery only when needed.
The temporomandibular joints (TMJs) connect your lower jaw to your skull, just in front of each ear. They are among the most used joints in the body. Temporomandibular disorders, often shortened to TMJ or TMD, cover a range of problems with these joints and the muscles that move the jaw. Common symptoms include jaw pain, aching around the ear, headaches, clicking or popping, a jaw that feels stuck or locks, and difficulty opening wide.
Getting the diagnosis right
Most jaw pain comes from the chewing muscles, not the joint itself, often linked to clenching, grinding, stress or poor sleep. Some comes from the joint: a displaced disc, arthritis or inflammation. Pain can also come from teeth, sinuses or nerves. Getting the source right is the most important step.
At Molly, your evaluation is done by an oral and maxillofacial surgeon or an orofacial pain specialist. It includes a detailed history, an exam of the joints, muscles and bite, and imaging where it will change the plan: a 3D cone-beam CT (CBCT) scan shows the bony parts of the joint, and an MRI, arranged through an imaging center, shows the disc and soft tissues.
Conservative care first
Most people with TMD improve with simple, reversible treatment. Your plan will usually start with some combination of:
- Self-care: a softer diet for a while, avoiding gum and wide yawns, and heat or ice
- Anti-inflammatory medication or a short course of muscle relaxant
- A custom oral appliance (splint) worn at night to reduce the effects of clenching and grinding
- Physical therapy for the jaw, posture and neck
- Stress management and sleep improvement, which make a real difference for muscle pain
- Botox injections into the chewing muscles for persistent clenching-related pain
Grinding down the teeth or major bite changes are generally not recommended as a first step.
When procedures help
If symptoms persist despite good conservative care, or the joint is locking, your surgeon may recommend a procedure. Arthrocentesis flushes the joint with sterile fluid through small needles, often under IV sedation, and can reduce pain and improve opening. Arthroscopy uses a small camera to examine and treat the inside of the joint. Open joint surgery and total joint replacement are reserved for a small number of patients with severe joint damage, and are performed in a hospital.
Your surgeon will be candid about what each option can and can't do, and you'll get one written quote before any treatment. Many TMJ treatments can be billed to medical insurance, and we check both your medical and dental plans.
