Jaw joint problems

The temporomandibular joint (jaw joint) is located in front of the ear where the skull and the lower jaw meet. The joint allows the lower jaw (mandible) to move and function. The joint itself is made up of two bones that are separated by a disc of cartilage. This soft disc allows the smooth movement of the jaw joint and absorbs shocks from every day functions, such as chewing and talking. Ligaments and muscles surround the joint.

Problems with the jaw joint are very common but typically only last a few months before getting better. In some instances only the muscles are affected (myofacial pain dysfunction) whereas in others the disc can also become displaced. The most common symptoms are:

• Joint noise such as clicking, cracking, crunching, grating or popping.
• Joint pain.
• Muscle pain or tenderness in the face, ear, neck and shoulders.
• Limited mouth opening or locking of the jaw.
• Headaches.
• Ringing or pressure blockage in the ears.

Most jaw joint problems are made worse by chewing and are aggravated at times of stress.

Pain is caused by the muscles in and around the jaw joint tightening up. Joint noise occurs if the disc of cartilage moves out of its normal position between the bones of the jaw joint. Most commonly the cartilage slips forwards and a noise is made when it returns to its normal position in between the bones of the jaw joint. The noise sounds louder to some patients than others because the joint is just in front of the ear. The ligaments and muscles surrounding the joint can in turn go into spasm, producing pain and limited mouth opening.

The cartilage in the jaw joint is thought to slip forwards because of over-use of the muscles surrounding the jaw. This over-use commonly produces tightening of the muscles and may occur as a result of:

• Teeth clenching or grinding.
• Nail biting/ holding things between teeth.
• Missing teeth.
• Injury such as whiplash or blow to the face.
• Degenerative disease such as osteoarthritis.

The majority of jaw joint disorders get better with sustained rest. On the whole treatment is aimed at trying to reduce the workload of the muscles so allowing the disc of cartilage to return to a normal position in the joint.

• A soft diet that requires little chewing  this allows over-worked muscles to rest. It’s best to avoid biting into hard, tough foods such as apples, steak.
• Painkillers  anti-inflammatory medications (e.g. ibuprofen) are good and can be taken as either tables or applied as a gel on the outside of the joint.
• Heat  e.g. warm water in a hot water bottle (avoid boiling water) wrapped in a towel applied to the side of the face.
• Identifying and stopping any habits, such as clenching or grinding. Remember that these may be ‘subconscious’, i.e. you may not be aware of them.
• Relaxation therapy and learning techniques to control tension and stress.
• Jaw joint exercises  the exercises that are best for you will have been discussed by the doctor seeing you. Please remember to carry them out as instructed.
• Resting the joint as much as possible  e.g. avoiding yawning, excessive mouth opening.
• Providing a clear plastic splint that fits over the teeth and is worn mainly at night. This helps support the joint and surrounding muscles.
• Replacing missing teeth to balance the bite  if this is appropriate it will have been discussed with you.

It is important to realise that jaw joint problems, although a nuisance, are not sinister and usually respond to relatively simple measures over a period of time. Patients themselves can manage most of these treatments. Occasionally jaw joint problems may return after several years. It is very rare for jaw joint problems to progress to arthritis.

If you are worried and would like further advice, please do not hesitate to contact us. A doctor is available to deal with your concerns 24 hours a day.

During normal working hours, Monday to Friday 8am until 5pm please telephone the Maxillofacial clinic where your procedure was carried out:

Royal Sussex County Hospital, Brighton.Telephone  01273 696955 extension 64067.

Princess Royal Hospital, Haywards Heath. Telephone 01444 441881 extension 68308.

Maxillo facial secretaries for general queries: 01273 696955, extension 63695 or 64756.

For advice during evenings, weekends and on public holidays, our partner organisation, Queen Victoria Hospital, East Grinstead has a doctor available to assist with any concerns.

Queen Victoria Hospital. Telephone 01342 414000 extension 6635.

Evening hours: Monday to Friday 5pm until 8am.

Weekend hours: Friday, 5pm to Monday, 8am.

Public holidays: 24 hours cover.

Please ensure you have your patient reference number to hand when you contact us.