Jaw joint pain and clicking (TMJ): causes, what you can do at home and treatment

How does the jaw joint work?

The temporomandibular joint (TMJ) is the paired joint in front of the ear that connects the lower jaw to the skull. The cartilage disc between the bones slides forward with the condyle as the jaw opens. The chewing muscles, the disc and the ligaments work together; a problem in one affects the others.

Symptoms

• Pain in front of the ear, at the temple or at the angle of the jaw; more marked in the morning
• Clicking, crackling or grating sounds on opening and closing
• Limited mouth opening, the jaw deviating to one side, locking (open or closed)
• Chewing fatigue, headache, fullness or ringing in the ear, neck pain
• Tooth wear, tight jaw muscles in the morning

Causes

• Muscular (the commonest): Clenching/grinding, stress, one-sided chewing, chewing gum, keeping the mouth open for long (dental treatment, intubation), poor neck posture.
• Disc displacement: The disc has slipped forward; it pops back into place on opening (the click). With permanent displacement, opening is limited.
• Joint inflammation and degeneration: Osteoarthritis, rheumatoid arthritis.
• Trauma: A blow to the jaw, a very wide yawn.
• Bite problems: Missing teeth, a high filling or crown, crowding — may contribute; rarely the sole cause.

Is clicking dangerous?

Painless clicking is present in a large part of the population and needs no treatment. Treatment starts when there is pain and loss of function. Surgery is not considered simply to "get rid of the sound".

A 2–4-week home programme

1. Soft diet: Avoid hard, raw, sticky foods and chewing gum; take small bites, chew on both sides.
2. Warmth: For muscular pain, a warm towel in front of the ear and at the angle of the jaw for 15 minutes 2–3 times a day; cold for acute swelling.
3. Jaw rest position: Tongue on the palate, teeth apart, lips together. Check often during the day.
4. Exercises: Slowly open and close within the pain limit (10×3), slide the jaw side to side, controlled opening with the tongue on the palate; stop if it increases the pain.
5. Limit yawning: Put a fist under the chin when yawning to prevent excessive opening.
6. Sleep: Don't sleep face down or tuck the phone under the chin; manage stress.
7. Short-term painkiller/muscle relaxant: On medical advice.

Treatment in the clinic

• Occlusal splint (night guard): Reduces muscle load and rests the joint; the first choice in most muscular and disc-related cases. See Who needs a night guard?
• Physiotherapy: Muscle relaxation, manual therapy, posture correction.
• Occlusal adjustment: Adjusting high restorations; replacing missing teeth.
• Advanced options: Intra-articular injection, arthrocentesis (joint lavage); surgery in very few cases.

When is further investigation needed?

With a mouth opening below 3 cm, persistent locking, marked deviation on opening, a history of trauma, no response to 6 weeks of conservative treatment or suspected systemic joint disease, a panoramic X-ray, CT or MRI is requested; if needed, a plan is made jointly with maxillofacial surgery and physiotherapy.