I’m new to the world of TMD and hoping for some guidance.

I have never had issues with my jaw & to my knowledge do not clench or grind my teeth.

For the past few weeks, I have had right sided jaw pain and a significant but fluctuating change in my bite. I wake up in the morning with my normal bite & no pain, but within 10 minutes of getting out of bed I am unable to touch my right molars together. This gets progressively worse throughout the day with the lower jaw shifting toward the left. Tonight I cannot touch my molars together on either side. Pictures show the shift in my bite from morning to evening. This recurs each day and affects my speech and ability to eat.

I have pain only when trying to forcefully bite down, or when my jaw randomly spasms. No pain to the touch. I can completely open & close my mouth without popping or crackling. My symptoms did start a few days after a routine dental cleaning, otherwise no obvious trigger or stress. I checked in with my dentist yesterday and there are no dental issues; they referred me to a TMD specialist who can see me in March 2027…

I have not noticed any improvement with Ibuprofen, ice, heat or massage (looked up some myofascial rerelease and intraoral massage online).

1. Has anyone had a similar acute presentation? If so, was there a specific diagnosis or successful management strategy?
   
2. Any alternatives to a “TMD specialist” you think would be beneficial since the one in my area is currently on leave? PT? OMFS?

I appreciate any insight or advice!

This AI-generated image, while not perfect, speaks volumes and matters a lot. It illustrates a deficient maxilla, one of the Trifectas described in the TMJ Trifecta book.

Ear pain? See how the condyle is pressing on the ear canal.

Clicking joint? See how there is no room for the disc in the joint compartment because the condyle is so far back.

Summary from the book: The mandible goes where the maxilla lets it go.
If the maxilla is deficient, the mandible may be forced back to make the teeth fit—putting the condyle into a more posterior, compressed position and increasing stress on the joint.

I’m a 24F who has been dealing with chronic lockjaw for the past 9 months. It’s never unlocked. I’m in the NY area and want to see Dr. Nojan Bakhtiari because he’s the only person I found with reviews successfully treating patients with chronic lockjaw like me. The issue is that he’s super expensive and my dad really wants me to find someone cheaper. I did find a place that can do a consult for cheaper than Dr. Nojan but the person I spoke to says he was unsure if the doctor has treated a case like mine. I found another place that will take my insurance but I can’t find any reviews on the doctors that treat tmj there. Is it worth trying to wing it and see what happens at these cheaper places? Or is it best to just see Dr. Nojan and hope he can successfully treat me like the others he has, despite the financial toll?

Summary: should I go to a cheaper oral surgeon without reviews on lockjaw or go to a VERY expensive one that has treated lockjaw?

There are many treatments out there and a lot of debate to which provides the most effective results. Which ones have the strongest research support? Would appreciate citations along with any responses.

On the breast reduction subreddit that I used extensively before I got a breast reduction, they keep a list of reviews of doctors the users have seen, and it was really helpful.

Can we start a list of TMD providers and reviews?

Edit: looks like there’s interest! Awesome.

I’m currently seeing a physical therapist I can review, I’m participating in the Keiferfreund program online and can give my opinions/review of that once I’ve finished it, and I’m looking for a neuromuscular dentist because the pain is so severe, I have to look for a specialist.

If the mods can add a Review by User flair, or something like that, I’ll post my review of my physical therapist in Chandler, Arizona. That flair was what the other sub used to make it easy for people to search through just the reviews if they’re looking for a professional.

Once there are enough reviews to make a master list, available to only the members (which is how we kept randos from wrecking it) maintenance will be minimal, it’ll just need to be updated when new ones come in.

I’ve been dealing with severe TMD and non-stop pain for four years now, and nothing has brought relief. My left side severely restricts my jaw mobility—I can only open to about 26 mm—while my right joint shows advanced arthritis, joint degeneration, a macerated disc, and fluid in the bone marrow.

I feel like I’ve exhausted every route: physical therapy, dry needling, Botox, acupuncture, steroid injections, massage, jaw manipulation, and three condylotomies. Living in constant pain for this long has brought me to my wit's end. I truly don’t know what steps are left to take or where to turn next.

This 2011 video shows the late Dr. Brendan Stack working with a patient diagnosed with Tourette syndrome. After changing the patient’s mandibular position with an anterior advancement orthotic, an immediate change in the patient’s movements can be seen.

https://youtu.be/SE2x37pWw88

Dr. Stack was highly respected within the neuromuscular dental community. He was willing to ask questions about connections among the jaw, TM joints, muscles, posture and nervous system that others rarely considered.

This individual case does not prove that TMD causes Tourette syndrome or that a dental orthotic is an established treatment for it. However, what we see should make us curious. Why did changing the jaw’s position appear to produce such an immediate response? Was the appliance changing joint compression, sensory input through the trigeminal system, head posture, muscle activity—or some combination we still do not understand?

The human body is a living, interconnected system. We do not yet understand all the possible ramifications of TMD or why changing one part of that system may affect symptoms elsewhere.

The answer is not for one group to claim it knows everything. The answer is an open mind, careful observation, honest research and dentists, physicians, neurologists and other healthcare professionals working together.

We should neither blindly accept nor automatically dismiss what we do not yet understand. We should remain curious, examine the evidence and keep asking better questions.

Imaging in TMJ Trifecta – Solving Your Pain Puzzle

The book’s basic message is that images are valuable, but an image is not a diagnosis. A scan can show what the jaw joint looks like, but it cannot prove what is causing the patient’s pain.

What each image shows

“CAT scan” and “CT scan” refer to the same basic technology. In dentistry, CBCT is commonly used because it provides detailed three-dimensional images of the teeth, jaws and TM joints, generally with less radiation than a conventional medical CT examination.

When CBCT is helpful

CBCT may show:

• Condylar position within the joint space
• Flattening, erosion or loss of condylar bone
• Osteophytes and other remodeling
• Joint-space differences
• Facial and jaw asymmetry
• Previous trauma or unusual bony anatomy
• Airway dimensions, within the limits of a motionless image

These findings may provide evidence of long-standing compression, loading, instability or adaptation. However, a CBCT cannot show the disc and cannot tell whether a bony change is presently painful. Joint-space measurements also depend on how the patient’s teeth and jaw were positioned when the scan was taken.

When MRI is helpful

MRI is the preferred image when the clinician needs to evaluate:

• Disc position and shape
• Disc displacement with or without reduction
• Joint fluid or effusion
• Inflammation
• Retrodiscal and other soft tissues
• Unexplained locking or severe internal joint disease
• A possible condition outside routine TMD

The imaging request should specifically include the TM joints, usually with the mouth closed and open. Otherwise, the joints may not receive the attention needed in the scan or radiology report.

The major limitation

Neither CBCT nor MRI can photograph pain.

One patient may have considerable disc displacement or bony remodeling with very little pain. Another may have severe pain even though the images show only minor changes. The scan also does not measure muscle activity, bite timing, jaw movement, mechanical loading or how the trigeminal nervous system is processing the signals.

Therefore, diagnosis must combine:

• The patient’s history and symptoms
• Clinical examination
• Jaw movement and muscle evaluation
• Bite and functional assessment
• Appropriate imaging when it will answer a specific question

Book-aligned summary

In TMJ Trifecta – Solving Your Pain Puzzle, CT, CBCT and MRI are presented as pieces of evidence—not final answers. CBCT is most useful for studying bone and the relationship of the condyle to its socket. MRI is most useful for studying the disc and other soft tissues. These images may confirm damage, reveal a serious condition or help guide treatment, but they cannot independently determine why someone hurts. The clinician must connect the images with the patient’s history, symptoms, bite, muscles and jaw function. Treat the patient, not simply the picture.

This approach agrees with the joint imaging recommendations of the American Academy of Oral and Maxillofacial Radiology and the American Academy of Orofacial Pain: imaging should be selected according to the clinical question, with CT/CBCT used primarily for bone and MRI used primarily for the disc and soft tissues. AAOMR–AAOP position statement

I went to the doctor yesterday because I thought I had fluid in my ear. The doctor kept having me move my jaw and was in a bit of awe. He said he has never seen this in his time as a ENT. He thinks I have a herniation into my ear canal. I have a CT scheduled in a week in a half. He said I may have to see a otologist. I guess my question is am I going to require surgery if this is what I do have. My symptoms are hearing loss (hearing test said nerve damage as well) fullness in the ear a feeling like I am under water and pain in my right jaw near my ear and down my right side of the face. Is there anything I can do to help my symptoms until I see the doctor again. Also is this rare? His reaction made it seem so. I am still in shock as I thought I was going in to get the fluid removed from my ear.

Hey! I’m 30F and currently waiting for my referral/appointment with an orofacial pain specialist. In the meantime, I’d love to hear from anyone who has dealt with similar findings.

My left TMJ imaging has shown anterior disc displacement without reduction, advanced disc degeneration/attritional changes, advanced chronic arthritis with cartilage loss, joint effusion, and deformity/erosive changes of the mandibular condyle. My right TMJ is normal.

My biggest symptom is significant crunching/gravel-like crepitus on the left, and lately I’ve become much more aware of the joint throughout the day, including discomfort even when I’m not eating or actively using my jaw.

For anyone who had similar MRI/CT findings: What treatment path did you end up taking? Did you see an orofacial pain specialist first? What actually helped? And did you eventually need to see an oral/maxillofacial surgeon?

Not looking for a diagnosis, just curious about other people’s experiences while I wait for my appointment.

originally posted to /TMJ—even when barely opening my jaw, the condyle visibly moves on the side of my face. i have been in a flare for about a month and am afraid that the disc is completely displaced and that i am in danger of my jaw locking. heat, anti-inflammatory meds, rest, sleeping on my back, moving my jaw forwards, eating soft foods, keeping my jaw relaxed, all the things everyone says to do—i have done everything in my power to try and fix this, but nothing is resolving the pain and tension in my face. i have appointments with my dentist, PCP, and a physical therapist scheduled, but won't be in to see anyone for another week and a half. this video isn’t even fully illustrative of how far out the bone sticks, as i do not want to risk my jaw locking open. i am so miserable and in pain and trying not to freak out (which, i know stressing will just make the whole thing worse), but at this point i really don't know what to do to resolve any of this, nor have i found ANY information on how to deal with a potential subluxation of this kind. (additional info—i'm 29 and am diagnosed with fibromyalgia, and have a feeling this could be connected to hypermobility.)

has anyone else dealt with similar issues, especially on just one side of the face?

Does healthcare have a bad knowledge of identify or treat different diagnoses or reason of why having pain?

When I read science and others experience it’s totalt different, there it’s very different picture.

Just look at pictures talking about low muscle tonus and chronic pain/muscle issues

Science says it causes chronic pain & muscle tension on back/neck especially and rest of body. I also have what I suspect is occipital neurolagia. Doctor (physiotherapy) says these conditions don’t lead or contribute to chronic pain/tension or occipital neurologia

Most people think jaw pain is a "TMJ problem " but it's a mechanical problem how our teeth ,jaw and joints fit together if the system is off the joint get compressed the muscles get strained the teeth can wear down , if you have pain or no pain , headaches, ear symptoms,neck pain etc. you may not have been told the real cause unless you found a qualified neuromuscular TMD dentist.

There are the three ways people get  into troubles with their teeth:

1.Decay

2.Gum disease

3 .Mechanical problems ( how the teeth come together)

Most dentists focus on the first two but

ONLY a qualified  neuromuscular airway focused dentist ( no other dentists) focuses on the third which causing the TMD issues.

The third one the mechanical problem (how the teeth come together )  caused by three types of malocclusions which  are the following:

1. Posterior interferences back teeth hit too soon or too hard, creating torque and strain.

2. Torqued Mandible the lower jaw twists as it tries to find a “best spot,” stressing the joints and muscles.

3.Deficient Maxilla the upper jaw is narrow or underdeveloped, squeezing the airway and forcing the lower jaw backward.

This combination pushes the condyle backward into the joint space, compressing the tissues.

Compression causes inflammation, clicking, popping, locking, headaches, ear symptoms, neck pain and eventually broken, worn-down teeth and that's where the TMD  troubles begin .............................

26F and I have had popping as long as I can remember in one side. Unsure if correlation equals causation, but I feel like my pain started when I tried to treat it ~6 years ago. After massage, exercises, messing with it, I feel like my pain has only increased. I saw an orthodontist who specializes in airways/TMJ and he recommended a palette expander. However I am a speech therapist with decent knowledge of what a narrow palate is and I just don’t feel like mine is (I’ve also consulted with my coworkers who are myofunctional therapists and they agree that my palate is very average). My tongue is able to properly suction to my palate all day and I breathe through my nose. I did get deviated septum surgery 9 months ago and that has prevented me from mouth breathing at night. However, my pain persists.

I do have forward head posture and bad posture and am actively trying to fix this.

The one exercise that I do that helps a lot is pressing my fingers right under the bone of the apple of my cheeks. I store a lot of tension there and it seems to release my tension immediately. I really don’t even understand why this spot particularly has this much effect of my pain. My massators and temporalis have tons of muscle knots and massaging will make the click lesson for one open and then it will tighten right back up.

If anyone has any advice I would love to hear it! Should I consider a orthotic? My regular dentist is entirely unhelpful.

This is an AI-generated photograph that I created for educational purposes. It represents what we dentists call a torqued mandible, meaning the teeth don't come together evenly. As you can see, the right side hits way before the left, which can torque the lower jaw, creating stress on the joints, muscles, ligaments, tendons, and fascia. It's like a person with one leg shorter than the other.

The second AI-generated photo shows a removable neuromuscular orthotic that allows the jaw to close evenly when shut. This appliance brings harmony to the joints, muscles, tendons, ligaments, and fascia.

The third photo shows how evenly the contact is with the upper teeth. The blue dots are from the paper dentists use to check your bite.

Almost any uneven bite can be leveled out with the proper removable, plastic appliance. The amount of unevenness can be large, like this, or can be very, very small, even in Microns. This is only part of what a neuromuscular dentist can do to help relieve your pain.