TMJ Disorders & Clenching
The temporomandibular joint (TMJ) and the chewing muscles work all day—for speaking, eating, yawning. When they’re overloaded or misaligned, you may feel pain, clicking, locking, ear pressure, headaches, or tooth wear. My approach is anatomy-led and stepwise: we treat the right driver—joint, muscle, bite, or habit—with the least invasive option that can reliably help.
What TMJ care can (and can’t) do
Can help with:
- Jaw pain, morning stiffness, clicking/popping, intermittent locking
- Clenching/grinding (bruxism), masseter hypertrophy, tension headaches of muscular origin
- Limited opening, deviation on opening, painful chewing
- Post-trauma or post-orthodontic TMJ symptoms
Cannot replace:
- Neurological, dental or ENT conditions unrelated to TMJ (we coordinate referrals)
- Structural jaw discrepancies that truly need orthognathic surgery (see Double Jaw Surgery)
The appointment, step by step
- Assessment & diagnosis (history, exam, imaging if needed)
- Explain your driver (muscle vs joint vs bite vs habit)
- Plan selection (conservative first; add injectables or joint procedures if indicated)
- Written home program (exercises, splint use, diet and sleep tips)
- Review at set intervals; escalate only if necessary
Time in clinic: 30–45 minutes for the first visit.
First-line, conservative care (most patients improve here)
- Bite splint (custom night-guard) to protect teeth and unload joints
- Physiotherapy: TMJ mobilisation, posture, cervical release, home exercises, heat/ice protocols
- Medication (short courses): targeted anti-inflammatories or muscle relaxants when appropriate
- Habit coaching & sleep hygiene: tongue-up, teeth-apart, lips-together; reduce late caffeine; jaw relaxation drills
- Dental review for sharp edges/high spots; stress management tools as needed
Targeted injectables (when muscle overactivity dominates)
- Masseter neuromodulation (see Slim Lower Face – Masseter) to reduce clenching force, relieve aches, and slim a bulky lower face over time
- Trigger-point injections for focal myalgia (case-by-case)
Movement and bite remain functional; dosing is conservative and adjusted at review.
Minimally invasive joint procedures (for mechanical or inflammatory drivers)
Arthrocentesis (Lysis & Lavage)
Saline is circulated through the joint to release adhesions, flush inflammatory mediators, and improve disc mobility. Often combined with viscosupplementation (e.g., hyaluronate) or low-dose steroid in selected inflammatory cases.
Day-case, small bandage, rapid return to guided physiotherapy.
Arthroscopy (Diagnostic/Therapeutic)
Through a tiny scope, we visualise the joint, lyse adhesions, and smooth inflamed synovium with direct precision. Useful for recurrent locking or failed conservative care.
Day-case; structured physio starts early.
Open TMJ surgery (reserved indications)
Only for well-defined pathology: persistent mechanical locking with gross disc derangement, ankylosis, severe degenerative change, tumours, or post-traumatic deformity. Techniques include disc repositioning/repair, discectomy with interposition, eminectomy, or prosthetic joint replacement in advanced cases. We time this carefully and discuss expectations in detail.
Recovery & timelines (typical)
- Conservative care: improvement often within 2–6 weeks with consistent splint use and physio
- Masseter modulation: onset 1–2 weeks, peak 4–6 weeks; review at 8–12 weeks
- Arthrocentesis/arthroscopy: soreness 24–72 h; physio begins within days; function improves over 2–6 weeks
(Timelines vary; you’ll receive a personalised roadmap.)
Safety & transparency
- We prioritise reversible measures first
- Nerve-aware techniques for any procedure near facial branches
- Clear consent on risks: transient soreness, bruising, bite awareness changes, rare infection; for joint procedures—temporary swelling, stiffness, very rare nerve/bleeding events
- You get written aftercare, emergency contact pathways, and scheduled follow-ups
FAQs
Do I need a scan?
Not always. Imaging is targeted—MRI if we suspect disc displacement/inflammation; CBCT for bone/structural concerns.
Will a splint change my bite?
A properly designed stabilisation splint protects rather than changes your bite. We monitor closely and coordinate with your dentist/orthodontist.
Can Botox fix bruxism?
It reduces clenching force and muscle pain, but habits and sleep factors remain important. Best results come when combined with splint + physio + habit work.
What if my jaw locks open/closed?
This needs prompt assessment. Many cases respond to manual release and conservative care; recurring mechanical locking may benefit from arthrocentesis/arthroscopy.
Could jaw surgery cure my TMJ pain?
Only when pain is driven by a true skeletal problem; otherwise, surgery is not first-line. We choose the least invasive effective option.
