What causes temporomandibular joint (TMJ) pain?

TMJ pain can be caused by the TM joint itself, nearby muscles, nearby ligaments, nearby tendons, and nearby nerves.

The initial visit to treat TMJ is to determine where the pain comes from and then offer appropriate treatment.

Several muscles help open and close the mouth. They control the lower jaw (mandible) as it moves forward, backward, and side-to-side. Both temporomandibular (TM) joints are involved in these movements. Each TM joint has a disc between the ball and socket (see diagram). The disc cushions the load while enabling the jaw to open widely and rotate or glide. Any problem that prevents this complex system of muscles, ligaments, discs and bones from working properly may result in a painful TMJ disorder.

Randall D. Stastny, DMD
Oral & Maxillofacial Surgery
Temporomandibular joint (TMJ) pain usually comes from two basic sources.

The first is pain from the joint itself. Joint pain can be caused by inflammation of the tissues that make up the TMJ itself. These tissues can be strained or sprained just like any other joint in the body. Most people associate these sprains or strains with "popping or clicking" when opening and closing the mouth. However, it is important to understand that "popping and clicking" alone do not mean that there is something wrong with the TMJ. It is only when there is pain or limited function or "locking" of the jaw that the "popping and clicking" become an issue. Other causes of TMJ pain can be from arthritis of the bones that make up the joint. This is most commonly associated with a sensation of "grinding" or "sandpaper" in the joint when opening and closing.

The second source of TMJ pain sometimes called TMD (temporomandibular disorder) is not from the joint at all, it is from the muscles that the body uses to control the TMJ and lower jaw. In many cases of TMJ/TMD patients experience grinding, clenching or posturing of their teeth and jaws. Many patients are completely unaware that they are doing this. This causes overuse of the muscles which in turn causes the muscles to become tender, sore and painful just like what happens a couple of days after exercising too vigorously for the first time. The problem is that since these muscles are used for talking and eating the pain continues to build leading to chronic pain and sometimes muscle spasms.

Patients may experience pain from either or both sources when it comes to TMJ/TMD, and determining the reason for pain is not always simple.
Matthew F. McCarty, MD

Temporomandibular joint pain or TMJ pain can be caused from teeth clenching or bruxism, over-opening or abnormal movements of the jaw, trauma, misalignment of the teeth, excessive gum chewing, and osteoarthritis can be causes. Overtime chronic muscle spasm develop in these patients as the jaw attempts to close normally but the muscles overwork and go into chronic spasm and fatigue. This can then lead to headaches, tinnitus or ringing in the ears, face, neck and shoulder pain even dizziness.

Ned Nippoldt
The causes of TMJ pain can be simple to very complex. TMJ pain most often occurs when the relationship of your jaw joint, your teeth, and your muscles of chewing function are in disharmony. Trauma, such as a hit to the jaw, could cause disharmony in one or more of these three areas, as could health conditions such as arthritis that involve the joints. Clenching of the teeth (bruxism) brought on by stress can cause TMJ. Posture problems that affect the muscles of the neck and upper back may also result in disharmony between the jaw joint, teeth and muscles of chewing function resulting in TMJ pain.

When the jaw, your teeth and muscles are working together as they should, your muscles are relaxed, and there is little to no stress on the TMJ. If your teeth don't bite together correctly because of missing teeth, worn dentition, or poor occlusion your muscles will try to accommodate by causing the jaw to close in ways that fatigue your muscles over time. This can result in symptoms such as pain in the jaw (TMJ/TMD), headaches, popping or clicking in the jaw joint, ear congestion or ringing in the ears, loose or worn teeth, clenching, neck pain, sensitive teeth and even excessive snoring or sleep apnea.

Depending on your particular situation, determining the correct treatment can range from very simple solutions, such as minor adjustments to your bite, to more complex solutions involving a variety of specialists.
Temporomandibular joint and muscle disorder (TMJ) is a common condition of the jaw and face. You may develop TMJ problems as the result of an injury, grinding or clenching your teeth excessively, or stress, particularly if you tighten your facial muscles frequently. Rheumatoid arthritis can also contribute to TMJ problems. TMJ affects your ability to eat, speak, and move your head; it can cause pain or discomfort for a brief time or for years.
In many cases, dental problems and bite abnormalities can cause temporomandibular joint (TMJ) pain. If there is any imbalance in the way the teeth come together, there may be higher pressure in one or both jaws and temporomandibular joints. Or if you are missing teeth on one side, leading to an abnormal chewing motion, it creates higher pressure on the other side of the mouth and TMJ pain. TMJ pain may be due to arthritis in the jaw joint itself (the temporomandibular joint) from osteoarthritis or rheumatoid arthritis. If you’ve had an injury to the jaw, the cartilage of the joint may be damaged, which can result in osteoarthritis of the TMJ.

Ear infections and diseases can also cause TMJ pain, even though the problem is in the ear. Specific treatment of the ear disease is needed in this case to help the jaw pain. Stress is a major cause of jaw pain, which can result in even more tension in your face, neck, and jaw. Clenching the teeth during the day or grinding the teeth at night (bruxism) can result from stress and increase the tension on muscles around the jaw. This is a common cause of TMJ pain. Sometimes TMJ pain is part of a much larger area of pain in the muscles, tendons, and ligaments (soft tissue). With the "soft tissue" pain and fibromyalgia, there may be trigger areas around the jaws, face, and neck, which may trigger headache pain. In addition, the pain associated with an inadequate blood supply to parts of the heart may occasionally be experienced in the neck and/or jaw.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.