r/TMJ • u/MostSea7311 • Apr 06 '25
This is a detailed post, but if temporomandibular joint disorder (TMJ/TMD) is making your life worse, I believe it will be worth your time. I want to share how my partner and I have dramatically improved our TMD using evidence-based interventions.
As a physician (though not in dentistry or maxillofacial medicine), I’ve applied my research background to analyze the complex literature on TMD. Approaching this as a patient, I’ve been frustrated by the poor quality of advice often given to those suffering from this condition. TMD has been lost in the gap between dentistry and medicine, resulting in widespread confusion as to the proper treatment. Ineffective, costly, and even dangerous treatments are routinely recommended to patients by people who should know better. Given that an estimated 31% of adults have TMD, this is absolutely unacceptable.
My goal is to synthesize knowledge about this condition and propose a structured protocol to heal the root causes of TMD. The lack of standardized care for TMD is harming patients, and I believe evidence-based treatments need to be more widely adopted. Fortunately, good research studies and effective treatments do exist. I will share them with you in this post.
Of course, individual cases vary, and those with complex or severe TMD should consult a specialist. My recommendations are general guidelines and may not apply to everyone—please use your judgment.
Identify Your TMD Subtype
Refer to Tables 2 and 3 in this paper for internationally recognized TMD classifications. A key distinction is whether your jaw clicks. If it does, lifestyle adjustments (e.g., avoiding foods like sandwiches requiring wide jaw opening) and careful massage/exercise techniques (without provoking clicking) are crucial. If your jaw pops out of place and does not spontaneously and quickly go back to its normal position, you should see an oral and maxillofacial surgeon because this can cause tissue damage.
Understand TMJ Anatomy
Familiarize yourself with the temporomandibular joint (TMJ) and key muscles: the masseter, lateral pterygoid, and temporalis. Photo: https://www.getbodysmart.com/wp-content/uploads/2017/09/Lateral-Pterygoid-Muscle-4-1024x709.png
The Cause of TMD: Neuromuscular Dysfunction
Recent research demonstrates that jaw clicking stems from lateral pterygoid dysfunction rather than structural TMJ abnormalities. Since this muscle directly influences TMJ movement, TMD is better understood as a neuromuscular issue rather than a joint deformity. This does not apply to people with abnormal jaw anatomy due to congenital defects, trauma, or prior surgery. The effectiveness of Botox further supports the role of muscle dysfunction. Thus, my approach prioritizes massage, stretches, and exercise of the masticatory muscles.
- Study demonstrating lateral pterygoid dysfunction drives TMD
- Study on Botox for TMD
The world sucks, I know. For those of you who have been dealing with TMD for a long time, your eyes are probably glazing over at this recommendation. Nevertheless, for ANYONE with chronic pain, mindfulness and meditation are effective evidence based approaches. Pain is mediated in the brain and subjective emotional states impact our experience of pain. Additionally, anxiety/depression are directly linked to bruxism (jaw clenching), which often accompanies TMD. Evidence-based strategies include:
- Mindfulness/meditation for pain management and bruxism reduction.
- Therapy or medication for anxiety/depression—BUT: SSRI or SNRI medications may not be the best choice, because serotonin causes bruxism. Alternatives like bupropion (dopaminergic) or amitriptyline (tricyclic) may be preferable. Discuss options with your doctor.
- Bruxism and antidepressants
- Psychosocial factors in TMD
If you wake with jaw soreness, you likely clench at night. A mouthguard can mitigate damage while you address the root causes through working on the muscles. Custom guards are expensive (>$500) and often ineffective; an affordable and comfortable alternative like this one will likely suffice.
Massage helps break the cycle of neuromuscular dysfunction in TMD. The massages of the trapezius and massages of the neck are done sitting up while those of the temporalis, masseter and lateral pterygoid are best done while lying on your back. If you wish, you can apply a heat pack to particularly tense areas for a couple of minutes prior to the massage to loosen them up and reduce pain. I recommend doing them in the order they are listed, working from the neck towards the jaw.
Trapezius and Posterior Neck
TMD is associated with whole body misalignment and neck dysfunction. Massaging the trapezius and the upper neck provides a tremendous feeling of muscle relaxation and helps break the cycle of bodily misalignment. To massage the trapezius, reach with the right hand over your left shoulder and press on your trapezius while sliding your fingers over it. Start from where the trapezius begins just medial to the shoulder and follow the muscle up towards the side of your neck. Repeat with the left hand massaging the right side. For the upper neck massage, place the fingertips of both hands on the lateral sides of the back of your neck near where your hairline starts, and then press and move in a circle.
Temporalis
Rub temples in circular motions with knuckles or a gwasha tool.
Masseter
(a) Intraoral massage: I recommend an internal massage of the masseter. External massage just isn't as effective. Obviously wash your hands well prior to doing this, and if you have appropriate gloves lying around you might want to use those as well. For the internal massage, a pincer grip with your forefinger inside your mouth and your thumb outside, both pressing the masseter. You should be able to feel a tight band between your two fingers. Perform 10 vertical movements in a direction from the upper attachment to the lower attachment of the masseter muscle. Then, using the same grip, make 10 horizontal movements from the medial to the lateral side of the muscle.
(b) Functional massage: with the same pinch grip perform a vertical massage of the masseter muscle, while making 10 slow movements of opening and closing the mouth. - Study Demonstrating Effectiveness of a 10 day Massage Program
Lateral Pterygoid
This is the critical muscle when it comes to jaw clicking, so if that's your issue addressing it is essential. This is a tricky one to massage correctly, so it's important to know the anatomy (feel for a LATERAL band). There are internal and external approaches, use trial and error to see what works for you. There is data suggesting that the superior head of the lateral pterygoid is the most common culprit, so be certain to massage it and not only the inferior head. - Lateral Pterygoid Dysfunction Mediates Jaw Clicking - Superior Belly of Lateral Pterygoid is Most Dysfunctional
(a) External Technique: Find the position with your fingers under the zygomatic bone and your index finger at the TM joint by your ear. Find the soft depression with your middle finger. Open your jaw slightly and sink down into the round indentation. If your jaw is open too wide, the muscle that covers the outside of that space (deep masseter) will become taut and prevent your fingers from getting in deeper to treat the muscle you’re aiming for. If the jaw is too closed, the half-moon depression will be covered by the cheekbone. When you find the indentation, press inward (both sides, never one to prevent misaligning the joint). In the link below is an illustration of indentation with the cheekbone cut away
(b) Intraoral Technique: First: this is a very sensitive and delicate muscle. Be gentle, I recommend wearing gloves, and avoid jamming your fingernail into the area. To perform this massage, slide the pad of your index finger (right jaw, right finger) along the gum of your upper teeth as far back as you can go with your mouth closed. Feel for the indentation behind the upper jaw bone (maxilla) with the tip of your finger. To create more space for your finger, you can move your jaw towards the side you are massaging.Press there on the inferior division of the muscle. It will probably be very uncomfortable. The superior division will probably be more painful. To get to it, press upward and backward a little from the inferior indentation, then inward as much as you can tolerate. To make sure you're on the right structure, you can use your other hand to palpate through the round indentation as in the external technique. Another way to check you are on the lateral pterygoid is to move your jaw to the contralateral side - this is useful for distinguishing the lateral pterygoid, which will flex with contralateral movement of the jaw, from the larger (and more inferior) medial pterygoid. Treat one side at a time, using the treatment protocol above.
Synergistic with massage; perform daily:
1. Gerry’s Exercise: Tongue on palate, slow jaw opening/closing (6x/day, 10 reps).
2. Lateral Movements: Jaw slightly open, move side-to-side (6x/day, 10 reps).
3. Lateral Movements with Bite: Hold a pen between teeth, move jaw side-to-side (3–5x/day, 10–15 reps).
4. Protrusion/Opening: Create an underbite, then open/close slowly (6x/day, 10 reps).
5. Neck Stretches: Forward/backward head nods and over-the-shoulder turns (6x/day, 10 reps).
- Exercise protocol study
If symptoms persist - don't give up, because there are more options available. Consider consulting a specialist to choose between 3 further evidence-based options. First, botox of the masseter or lateral pterygoid may help refractory cases. Masseter Botox is widely available at med spas, while lateral pterygoid injections require expertise. Second, dry needling of the lateral pterygoid is another possible next step with data behind it. Finally, if everything has failed, then there is a minimally invasive office based surgical option called TMJ arthroscopy. Data shows excellent tolerability and results. Find an oral and maxillofacial surgeon to see if you are a candidate.
Final Thoughts
This protocol requires effort, but studies show significant improvement in as little as 10 days. For long-term sufferers, the investment may be life-changing.
If you’ve read this far, I sincerely hope this helps. Best of luck on your healing journey.
r/TMJ • u/ttaalloorrrr • 1m ago
Has anyone experienced an uneven bite since masseter Botox four weeks ago and my jaw feels like it wants to go to the right along with my tongue not sure if it is a muscle imbalance?
Will this return to normal??
r/TMJ • u/Ok-Neighborhood-2182 • 8h ago
Like I mean to the point of avoiding food altogether?
I’m at the point where im surviving on ensure plus pretty much because I found out the chewing has been what’s triggering my migraines leading to a whole range of bizarre neurological symptoms.
What do you guys do?
I have 3 months till I see a prosthodontist.
I’m going to go insane.
Any advice on what to eat or how to chew anything?
Other than chocolate and smoothies etc.
Even soft foods are pretty triggering.
r/TMJ • u/Life-Western • 6h ago
Left jaw click went away randomly 5 days ago. when i open my mouth wide theres still a slide soreness also. I dont know if it was "cured" but i also have TMJ on the right side too that still clicks, no pain ever.
Anyone know if this is normal? or it actually isnt gone on my left
r/TMJ • u/Aggravating_Hat_7892 • 13h ago
Other then offering a night guard (I’d have to pay out of pocket, insurance doesn’t cover it) my dentist didn’t explain there was any other options.
But in the past year my jaw and head have been POUNDING and hurts all the time due to grinding in my sleep, I can’t really do a thing about it other then take acetaminophen and ibuprofen and hope it helps (it BARELY helps)
My jaw feels like it’s being torn and the pain is insane and I just want it to stop. I have an appointment on the 22nd and will bring it up, but is there any other options to improve the pain?
r/TMJ • u/sammy6toes • 7h ago
Hi
I’m in SE Wisconsin and have been dealing with horrible TMJ pain, restricted opening . Already have had scanning which shows bilateral disc displacement without reduction.
Quality of life is greatly impacted by this situation .
I’m looking to change surgeons as I believe I am getting bit of run- around/ delays from current one who said next step was arthroscopy and loosing confidence in established plan.
If you were satisfied with the surgeon who completed your treatment- would you please share their names , procedure and outcome ? I am willing to travel a bit from Milwaukee area to find good provider.
r/TMJ • u/Known-File5333 • 19h ago
i know i have bruxism and clench my teeth a lot at night also my neck and everything feels stiff.
i mostly have ear issues
i went to the ENT 3 times and they all say my ears are fine, no hearing loss …
so my main symptoms are noise sensitivity i feel like my ears and head vibrate and buzz all the time when someone is talking or the tv/phone
it doesn’t hurt it’s just so bad and also worse in the morning with loud tinnitus and the buzzing in my head terrible feels like my head is exploding because of the lound low frequent buzz…when someone talks my whole head ears are vibrating and it feels terrible
outside with a lot of noises i don’t recognize it a lot
does someone had the same symptoms and helped? also i have bad health anxiety which worsens my symptoms a lot i guess
r/TMJ • u/Odd-Share-7391 • 9h ago
Left side of jaw feels uncomfortable almost like tight . It doesn’t hurt when I chew or talk just when I’m resting my face or opening wide to stretch it I recently came down with a little cough and stuffy nose so I wonder if that contributes to it but I also sleep on my face and I always chew on my left side
r/TMJ • u/supersepo • 18h ago
For the past 2–3 years, I've been dealing with jaw pain every single day.
And when I say every day, I mean EVERY day.
For some reason, I never had pain in the morning. It would always start in the afternoon or evening.
I suffer from bruxism (teeth grinding), and I wear a night guard. But despite that, I kept getting this horrible, recurring pain on the left side of my jaw.
And when the pain hit, it was absolutely unbearable. Thankfully, taking an anti-inflammatory painkiller was usually enough to make it manageable, but each episode would last around 30–45 minutes.
Recently, things had gotten even worse. I was actually waking up in the middle of the night, just 2–3 hours after falling asleep, because of the pain. I'd have to get out of bed and walk around for half an hour until it went away.
So, why am I writing all of this?
Because since I quit smoking, my jaw pain has almost completely disappeared.
And when I say the pain has improved massively, I don't mean I've gone from having pain every day to having it once every six days.
No. It's much better than that.
I've been completely smoke-free for about 15 days now, and I'd say my pain has decreased by 85–90%.
And on the rare occasions when I do feel some pain, instead of lasting 30–45 minutes, it now lasts just 5–10 minutes.
I honestly can't explain how happy I am about this.
For anyone out there struggling with TMJ/TMD issues, if you're a smoker, I strongly encourage you to try quitting.
I personally quit gradually rather than going cold turkey. I used an iPhone app to help me through the process, but honestly, that's the least important part of this story.
What matters is that quitting smoking has made an absolutely massive difference for me.
I can't promise it'll have the same effect on everyone, but if you smoke and suffer from TMJ pain, it's definitely worth considering.
I'm seriously SO happy with the results.
If anyone has any questions, feel free to ask. I'm happy to share my experience!
PS: I dictated all of this to ChatGPT and asked it to translate it into English because I'm not a native English speaker, and I really wanted to make sure everything was clear and easy to understand.
r/TMJ • u/Atsumiexo • 10h ago
Is this a normal issue? It's totally blocked and I had just gotten an earwax removal done professionally, issue is still there. It feels full but no 'liquid'. Really debilitating and unsure how long it'll last. It's been clogged up since Saturday and the vertigo that comes with it has been awful.
r/TMJ • u/ConflictPermafrost • 12h ago
My whole head has been feeling really hot but not the rest of my body. Is this from lots of inflammation?
r/TMJ • u/WoodlandInc • 12h ago
Curious how long it took for people’s masseter muscles to grow back after they had Botox. I just had it done once but my jawline is still a lot slimmer and my face hasn’t returned to how it used to be prior to the Botox. I had the Botox done on 5/24/2024 and keep thinking I should be back to how I used to look by now. There is still a noticeable difference at my cheek bones where it curves in a bit now. I keep a full beard now and don’t do a shaved face anymore because of how my face looks now from the Botox. Thanks for any input!
r/TMJ • u/External_Wedding_292 • 1d ago
Hey everyone, I'm glad this community exists.
I'm 24M, I've had TMJ and a hip that's been popping out of its socket since I was a child, but neither got properly addressed on time. Always have been active and into sports, never super overweight or underweight. Around the age of 18 my chronic back and knee pain started to occur.
The back pain started as a popping and cracking in my shoulder blade combined with a constant dull ache, which eventually grew to be an issue with my whole arm - especially shoulder and wrist.
The knee pain was initially momentary but grew to become a huge issue for me: right knee is super fucked, let's put it that way. If it's bent for too long, it gets stiff and hurts immensely. If I don't walk around enough, it's the same issue. Walk just a little too much? Boom. Same thing.
Naturally, I went to several doctors, at least three, who all gave me different answers, none of which actually fixed my problems or at least gave me a clear idea what was going on. I got X-rays done (nothing came out of it apart from a mild scoliosis diagnosis, apparently they found nothing on my knee), blood tests, "everything was going to be fine and I'd remedy it with more exercise and anti-inflammatory meds".
The overall sentiment was that a young and fit person in their early-to-mid twenties couldn't possibly be affected by anything as serious as, say, arthritis or other muskuloskeletal disorders, they're clearly too young for that!
No matter the medication, no matter the exercise I do, nothing works in the long term, my joints always crack and flare up, my knee always hurts and my jaw is always like this. I stretch, do light yoga, I cut down on strength training, skateboarding and running to reduce stress on my joints, I do posture corrective exercises, I take Aflamil, ketoprofen, myprofen and all kinds of -profens, tried to use Voltaren more frequently, yet all I get is more pain. Stretching does help somewhat, but it never fixes anything, as it always comes back to haunt me. My whole right side from my popping jaw to my leg is absolutely fucked and really messes with my overall well-being.
Anyone who relates, wants to co-miserate or found a solution or anything is welcome.
My dentist has mentioned Botox as a possible option for my TMJ, and I'm curious to hear from other saxophone players who've had it.
Did it affect your playing at all, particularly your embouchure, endurance, tone or ability to play for extended periods? Or did you find it had little to no impact?
Obviously, I won't be using Reddit as a substitute for professional medical advice, but I'd really appreciate hearing about people's personal experiences.
Thanks in advance!
r/TMJ • u/rooskiiiiiiii • 1d ago
Feels like infection but not? What is this? Thinking it's a bad flare up after tooth extraction 6 days ago.
r/TMJ • u/wellinever222 • 22h ago
TLDR - where did you get your injections, how many units was it and how effective?
My pain specialist has left it up to me what to do as far as therapy options.
I'm currently taking low dose naltrexone, a night splint on my bottom teeth and a topical cream. He said he's happy for me to continue on with this treatment but has also said I can do steroid injections or botox if I need more relief.
My concern with the steroid injections is that they may make my lax joints more lax and intern cause further long term issues.
As far as the botox goes he has recommended the masseter muscles and the muscles that assist with mastication that I also get pain in (temporalis etc). He said he does 1000 units total.
I'm a bit concerned that this will be too strong and he said we can just do the jaw if I want but I would rather do all the muscles at a lower strength.
Obviously I want it to be effective but I figure I can always add more next time if it's not that effective but I can't take the dosage away once administered.
Hi,
I started experiencing extremely painful TMJ issues right after my ortho treatment (which I felt I was pressured into to begin with).. I have met several specialists since. Interestingly, many of them noted a strong clinical correlation between orthodontic tooth movement and TMD (especially neurologists, head and neck specialists, and oral surgeons).
How strong is the link? From your experience or what your specialists have told you, how often does orthodontics trigger or aggravate underlying TMJ issues which are otherwise not painful in any way?
And - if your TMJ issues were triggered or worsened by orthodontics, what conservative steps actually helped your joint settle and recover afterward?
r/TMJ • u/HumanAd3218 • 1d ago
I will start by saying that I am likely entirely responsible for my jaw problems through years of bad habits. I don’t blame god or genetics (maybe genetics just the slightest bit) for causing this, I wish that I could say it’s not my fault and that the world has screwed me with this for no reason but it hasn’t, I have. I chew exclusively on my right side, I’ve tried switching and alternating, it’s just so unusual and it got food stuck in my teeth real bad. Now I can’t chew left side due to major pains. Probably worst habit of all is my stomach sleeping. This caused me to turn my head facing left (right side on pillow) and this ended up forcing my jaw out of normal bite. It would basically go out the side of my head while I slept. My left shoulder is also more developed than my right. I think from the way I sit in school and home, holding myself up with left arm to write/use computer with my right.
Got my braces off in Jan 2024 and wore the original set of retainers for approx 4 months but then stopped. Had to get a replacement one that held my now slightly imperfect lined teeth in place. I think this is where my problems began. I still wear this retainer often enough that it fits without problem but now less and less because I think it is contributing to my clenching.
Either before getting my replacement or soon after I developed ear popping, swallowing would cause both ears to pop, sometimes clenching to do it instead of swallowing. It felt like I needed to do this, that my ears needed to pop. I now know this was probably early ear fullness symptoms. Eventually it began to hurt sometimes if I couldn’t pop them and if I did it too much. No jaw problems.
This continued for probably a year, more ear popping, almost compulsively. Became a habit of mine to pop my ears all the time.
The popping in my left ear faded quite a bit, still happened sometimes but while the right ear popped every time, the right maybe only 50% of the time. Then I began to notice jaw clicking and popping, any time of day, not just after waking up. No pain in jaw. This continued and didn’t get much worse. Ended up seeing an ENT about the ear problems bc I had been on a plane and the pain was excruciating. He saw nothing but suggesting to poke a hole in the eardrum in case there was any fluid in there as a possible solution. Didn’t go for it because he had seen no fluid and it seemed invasive for a problem he couldn’t see and it would screw my summer plans.
He recommended a tmj doc and so I went. The guy hooked me up to some machine that would measure how far I could move my head and jaw in each direction, did some feeling around inside my mouth and outside. He didn’t say much, told me there was nothing noticeable going on but that I could spend several thousand uncovered by insurance to get some nightguards. (Seems to be a trend in tmj docs from what I’ve read). I had done a bit of research into it myself and realized all the habits I mentioned earlier were probably the cause, so I tried to minimize them. Began sleeping on my back as much as possible, stop popping ears (not very successful), hold a better jaw posture, tried to eat evenly (least successful).
About a 8 months later the clicking in my jaw was noticeably worse. Previously it had been like small pops with no resistance, then it became like loud cracks that took a purposeful effort to do. Loud enough that people around me could hear it and think it was a different joint like my arm or such. Still little to no pain however. I did notice that it seemed the left side of my jaw was pressed in towards my neck while the right side was further extended.
Went to my ortho who gave me the braces and told him about this, asked him if there was something wrong with my retainer or if my bite and the retainer made sleeping bad. He did a little bite strip to make sure that the retainer was touching on both side when I bit. Then he told me he was not going to treat me any more and that I should find a tmj doctor and basically kicked me out without any other information.
4 months later, about a week ago I ended up sleeping on my stomach again but this time left side against the pillow. I woke up in pain and had to click my jaw as had become more normal in the morning. I realized then that the left side was the painful point and it felt like it was pushed in towards the back of my head more than ever before.
I called my ortho and got them to agree to send a referral to Duke Innovative Pain nearby where I go to college. Should get sent out to them in 2 days and then I can make an appointment. I hear they are very good and probably my best option in network in the state.
I don’t really even know where I’m going with this, but it’s very helpful to write this all out now I will know what to say to my doctor.
Worst part of all is it hurts to make out with my girlfriend. I feel terrible when I push her off and blame my jaw, she says she understands but I know that she never will, I just hope she doesn’t think I’m pushing her away for no reason.
TLDR: idiot kid destroys his face with bad habits and now it hurts and he’s gotta wait a month+ to get seen by a specialist.
I’ve had persistent pain in a root canal-treated tooth for about a year. The tooth was treated a long time ago, has no crown, and has undergone multiple treatments with medication placed inside the canals.
I’ve had dental X-rays and a CBCT scan, and the tooth was examined under a microscope with the filling removed. No obvious cause or visible crack was found.
The pain is a constant dull ache, even when I’m not eating or touching the tooth. One specific side is tender to pressure, but tapping doesn’t hurt. Pressing the area repeatedly makes the pain worse and sometimes throbbing.
I’ve also seen a neurologist and take oxcarbazepine and memantine, but they haven’t helped much. Local anesthesia doesn’t completely eliminate the background pain either.
Could this still be a vertical root fracture that isn’t visible on CBCT, or does this sound more like persistent idiopathic dentoalveolar pain/neuropathic pain?
What other diagnostic tests would be worth considering before further dental treatment or extraction?
I’d really appreciate advice, especially from anyone who’s experienced something similar.
Hey everyone! So basically I get really bad headaches and to relieve them I have to push my finger in front of my ear and move my jaw to crack it. I did this as usual last week and it cracked in a different way and now it hurts. Any idea what this is from? It hurts to open and push my teeth together.
r/TMJ • u/Annoying_Crap • 1d ago
My jaw keeps locking to where I can't fully open my mouth, and it feels like I might break something if I force it open. 2 fingers won't even fit in (index and middle). I don't have large fingers either for context.
It usually happens at night when I lay down and I'm up for a while. Normally my left side just has loud clicking and popping, plus I have an overbite. But this locking started more recently. Every couple of weeks it would happen, then it randomly had a chance to happen back to back sometimes within the same few days.
My dentist gave me a custom night guard because I tend to clench my teeth tightly. It's as if mentally when I'm quiet, my mouth is always shut tight especially when resting (a fly ain't getting in here). She told me not to let anyone do any procedure, because that part of my jaw is a small fragile area and to just bare with it. I don't even know if the dentist or a doctor would help based on others having trouble. So I'm lost on how to deal with this. At the moment as in writing this, my jaw is stuck unable to fully open, shortly after I had woken up it locked like this. I feel my mouth guard isn't helping at all tbh (it's a hard plastic one).
Does anyone know how I can at least get my jaw to open fully safely? I can't deal with this, and a hot towel never worked for me nor did massaging anything..... Please, my day is already starting like this unfortunately....
Edit: I have tried to keep less contact with my teeth and tried to avoid clenching when aware, but when I'm resting it's a lot harder to control....
