Jaw joint and facial pain
Assessment and treatment of temporomandibular joint (TMJ) disorders and related facial pain, starting with the simplest measures that work and offering arthrocentesis where it is likely to help.
A common problem that is often over‑treated
The temporomandibular joints, just in front of each ear, are among the most used joints in the body. Pain, clicking, locking, limited opening and aching in the temples or jaw muscles are common, particularly during periods of stress, and are grouped together as temporomandibular disorders (TMD). Most settle with time and simple measures. A smaller number don't, and those are the patients Chris sees.
He also assesses facial pain that isn't obviously coming from the joint, where the first task is to make sure nothing else is being missed.
Assessment
Chris will take a detailed history, examine the joints and jaw muscles, check your bite and look for signs of tooth clenching or grinding. Imaging isn't always needed; where it is, an X‑ray, CT or MRI scan can be arranged.
Treatment
Chris's approach follows the evidence: conservative treatment first. That usually means clear advice on jaw rest and a soft diet, exercises, help with clenching and grinding (including a bite splint made by your dentist), and appropriate use of anti‑inflammatory medication. For many patients that is enough.
Where symptoms persist, particularly with a joint that locks or has restricted movement, Chris offers TMJ arthrocentesis: a minimally invasive procedure in which the joint is washed out with sterile fluid through two fine needles, freeing the disc and reducing inflammation. It is done under a short general anaesthetic and takes around thirty minutes. Most patients go home the same day. Recovery is usually about seven days.
Arthrocentesis is for internal derangement of the joint, with or without a displaced disc that no longer reduces. More complex jaw‑joint problems, including the small number that may need open surgery, are referred by Chris to a colleague with a special interest in the jaw joint. He will tell you if that applies to you.
Where the pain is coming from the jaw muscles rather than the joint, usually because of clenching or grinding, see the page on teeth clenching and myofascial pain.
Do I definitely need treatment?
Not necessarily. Chris will first establish whether treatment is needed at all and whether there are reasonable alternatives to surgery. He may recommend leaving things alone when:
- the symptoms are recent, mild and likely to settle with rest, a soft diet and simple exercises
- clenching or grinding is the underlying cause, when a splint and habit changes do more than any procedure
- the joint clicks but does not lock or hurt, which is common and needs no treatment
What does the next week look like?
A typical recovery. Yours will be discussed with you individually before you decide to go ahead.
- That evening
- After arthrocentesis, the joint feels sore and the side of the face may be numb for a few hours. Painkillers and soft food.
- Day one
- Mild swelling in front of the ear. Start the gentle opening exercises Chris has given you; they matter more than anything else.
- Days 2 to 3
- Opening improving day by day. Exercises three or four times a day.
- By one week
- Most patients notice easier, wider opening and less pain. Keep the exercises going for several weeks.
- Practicalities
- Driving
- Not for 48 hours after the general anaesthetic.
- Work
- Usually about a week.
- Eating
- Soft food for a few days, then build up gradually. Avoid very chewy food for a couple of weeks.
Chris's view
"Jaw joints are over‑treated. Most of what I see settles with the right advice and a splint. Arthrocentesis is for the joint that has stopped moving properly, and for that it works well."
Mr Christopher VinallWhen should I get advice?
Arrange an assessment if your jaw locks, if you cannot open your mouth as wide as you used to, if pain in front of the ear has lasted more than a few weeks despite rest and painkillers, or if you have facial pain that nobody has been able to explain.