Ask the Doctor: ‘I suffer with terrible jaw pain — could this be TMD, and how do I treat it?’

”I have been suffering with terrible pain in my jaw for a number of years and was told I could be suffering from TMD. I have been taking painkillers and anti-inflammatories for a number of years on and off for this. Taking tablets so often is not something I want to do. Are there any other treatment options for me? Thank you.”

Answer from Mr Deepak Thomas, Consultant Oral Surgeon, Beacon Hospital

TMD, or Temporomandibular Disorders, is a term used for a group of conditions which involve pain and/or dysfunction in the jaw joints, masticatory (chewing) muscles and other surrounding structures. Most TMD conditions are treatable and patients notice significant improvement in their quality of life when the condition is appropriately managed.

TMD is not uncommon. Each year, almost 20% of adults develop painful symptoms. Disorders of the TMJ are indicated by the following:

• Tenderness or jaw pain with, or without, clicking
• Joint pain (could be in one or two joints)
• Pain radiating to the patient’s ear, temple and face. Sometimes also causing occasional headaches
• Pain on chewing
• Difficulty in opening or closing the mouth
• Clicking and occasional locking of the jaw

To be diagnosed with TMD, you could have one, any combination of some, or even all of the above-mentioned signs and symptoms.

Some other painful symptoms leading to TMD include headaches, fibromyalgia, Irritable Bowel Syndrome (IBS), depression and sleep disturbances.

A TMD diagnosis combines a number of tools before a diagnosis can be given.

These include a thorough history, the use of a screening questionnaire, a physical examination as well as in some cases, X-rays, CT and MRI scans, and less commonly, blood tests.

Although common, Temporomandibular Disorders are not life threatening. There can be significant, yet rare, clinical entities which mimic this condition, hence the importance of seeking medical or dental help for suspected TMD. These conditions can include infections, autoimmune diseases and more rarely, malignant tumours.

Managing Temporomandibular Disorder conditions is focused on addressing pain, jaw function and subsequent related disability.

Management may include the use of reversible and conservative treatments and self-care techniques such as diet, massage, fitting and use of intraoral appliances (mouth guards), medications and occasional psychological therapies.

Physical therapies sometimes used for treatment can include a combination of jaw exercises and sometimes even the use of Botox injected into certain affected muscles.

Most patients suffering from TMD will notice significant improvements with these non-invasive techniques. Less often, some patients may require surgical interventions which can include joint scopes, washouts, joint injections and in more extreme cases, may require complex jaw joint surgery.

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