Temporomandibular Joint (TMJ) Disorders

TMJ Disorders, TMD Diagnosis and Treatment

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Jaw and facial pain, difficulty opening and closing your mouth (jaw lock), clicking, and popping may all be signals of a temporomandibular disorder (TMD), also called temporomandibular joint (TMJ) disorders. While pain and other TMD symptoms are often temporary, a TMJ specialist can help if your jaw and facial pain persist or if you are unable to completely open your mouth.

Duke Health has a range of TMJ specialists, from dentists who specialize in noninvasive treatments for facial and jaw pain, to oral and maxillofacial surgeons who are trained and skilled in corrective jaw surgery, if your condition has progressed. Together, our goal is to identify the factors that may be responsible for your TMJ disorder and help you improve your quality of life.

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Causes of TMJ Disorders (TMDs)

The two temporomandibular joints (TMJs) – one on each side of your face – connect your jaw to your skull and are responsible for your jaw’s ability to open and close. A variety of conditions can cause jaw pain that can travel throughout your face and surrounding areas. They include:

  • Oral habits (chewing gum, biting nails, and daytime or nighttime clenching or grinding)
  • Jaw joint injury
  • Arthritis (like knee and hip joints, painful arthritis can also affect your jaw joint)
  • Psychosocial factors (anxiety, depression, stress, and other issues)
  • Genetic predisposition 
  • Environmental factors

When to See a TMJ Specialist
Clicking, popping, and grating sounds are common among people with a TMJ disorder, but they aren’t a reason for concern on their own. You should seek care if these noises are accompanied by facial pain or limited jaw movement.

Often, TMD or TMJ disorders may cause other symptoms, such as ear pain, headaches, and even muscle spasms in the jaw. The pain can spread to your tongue, teeth, and surrounding areas, like your cheeks, chin, neck, and shoulders.

Duke Offers Care for Every Stage of TMJ Disorders/TMD
Our dentists specialize in TMJ disorders and facial pain. They offer a wide range of noninvasive treatment options to treat your condition.

If you are diagnosed with end-stage joint disease, our oral surgeon is one of the few in the area to offer several surgical options, from minimally invasive procedures to total joint replacement.

We also work closely with other specialists, including rheumatologists who treat people with conditions like arthritis and lupus, in which joint problems such as TMJ frequently occur.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

Diagnosing TMJ Disorder

Comprehensive Exam


The first step toward diagnosing a TMJ disorder is a comprehensive examination. Your doctor wants to determine if there is an underlying cause for your pain and what other problems you may be experiencing. You will be asked several questions such as:

  • When did your pain start?
  • What is its location, quality, intensity, duration, and frequency?
  • What makes your pain better or worse?
  • Do you have any other symptoms with your pain, like nausea or light sensitivity?
  • Do you have pain elsewhere? Are you experiencing facial pain, ear pain, headaches (including migraines), neck pain, or shoulder pain?

Physical Exam


During a physical examination of your jaw, your doctor will evaluate the jaw joint, its surrounding structures, the jaw muscles, oral tissues, and teeth.



Your doctor may request imaging tests if they learn something during the consultation and physical exam that requires a closer look. These tests may include:

  • X-rays
  • CT scans
  • MRI
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Non-Invasive TMJ Disorders/TMD Treatments



Your doctor will educate you about lifestyle habits you can adapt and self-care measures you can practice at home if they believe these efforts can be effective in reducing your pain.

Over-the-Counter and Prescription Medicines


In some cases, over-the-counter pain relievers may be recommended to relieve TMJ pain. If your doctor doesn’t think they will be effective for your condition, they may prescribe prescription-strength pain relievers, such as ibuprofen or other medications like muscle relaxants, antidepressants, or antiepileptic medications to manage your pain.

Oral Appliances


Hard, acrylic mouth guards, also called “splints” can serve two purposes. They may help stabilize your jaw in a comfortable position. They may also protect your teeth from nighttime clenching and grinding. Usually, they are most effective when your dentist creates a custom oral appliance for you.


  • Trigger Point Injections. Trigger points are sensitive taut muscle bands in your muscles that can cause referred pain. A trigger point injection with local anesthesia can help break down these taut bands, relax the muscles, and alleviate pain.
  • Steroid Injections. A steroid in the TMJ may help alleviate pain.
  • Botulinum Toxin A (Botox) Injections. Botox may be injected to relieve and relax the muscle.

Physical Therapy


Your doctor may recommend physical therapy, which incorporates exercises that strengthen and stretch your jaw muscles. They may also perform dry needling, a procedure in which fine needles are inserted in the area to help relieve pain and reduce inflammation.

Cognitive Behavioral Therapy


Our psychologists offer techniques to reduce distress, tension, and negative thoughts that exacerbate TMJ symptoms. We also help you learn to cope with pain to lessen its impact on your life.

Massage Therapy


Our licensed massage therapist uses medical massage on the muscles, tissues, and structures surrounding the jaw to relieve pain and TMJ symptoms.



In some cases, you may be referred for a series of acupuncture treatments to relieve pain. Sterile acupuncture needles inserted at various points in the body are thought to stimulate the body’s natural, pain-relieving abilities.

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2023–2024.

TMJ Surgical Procedures

Treatments Overview

While nonsurgical treatments are often effective, surgery may be recommended if we fail to see improvement in your jaw function, movement, or pain after non-invasive treatment. In most cases, nonsurgical treatments must be tried first in order for insurance to consider coverage of a surgical procedure. Please check with your insurance plan to determine your coverage.

If you are a candidate for surgery, our oral surgeon will meet with you to review your condition and recommend one of the following surgical approaches.

TMJ Arthrocentesis


This minimally invasive procedure may be performed to alleviate joint stiffness that results from fluid buildup. After administering a local anesthetic, your surgeon will inject a sterile fluid to rinse away excessive fluids that may cause inflammation. During the procedure, your surgeon may also manipulate the jaw to break up scar tissue and move the jaw into correct alignment. Pain-relieving or anti-inflammatory medications may be injected into the jaw at the same time. This procedure is performed at an ambulatory surgery center, meaning you will go home the same day. You may experience some bruising and swelling at the site, which should go away in several days.

TMJ Arthroscopy


During this procedure, your surgeon will insert a small camera, called a scope, through a small cut in your skin to view the inside of your jaw joint. This allows the surgeon to see whether the joint is damaged or loose, if disc problems are present, or if there is a cartilage concern. The surgeon can correct many problems during the procedure as well. TMJ arthroscopy is usually performed in an ambulatory surgery center, meaning you will go home the same day. Swelling may last up to seven days. It is normal to experience a change in your bite and to hear some clicking noises in your jaw following surgery.

Total Joint Replacement (Arthroplasty)


A total joint replacement may be performed if you are diagnosed with end-stage joint disease. The procedure replaces the jaw joint with a prosthetic device made from a combination of artificial materials. Duke surgeons only use custom-made prosthetics when performing these procedures. This means every person’s artificial jaw joint is unique to their facial structure. This procedure is performed in the hospital. Recovery can take six to 12 weeks.

This page was medically reviewed on 04/14/2021 by