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 TMD/Orofacial Pain

TMJ  Disorders or Temporomandibular Joint Disorders

What is TMD?

The joint that holds the lower jaw below the skull is known as the Temporomandibular Joint or TMJ.  This joint is located in front of your ear on both sides of your head.  When it does not work correctly or causes pain, doctors use the term TMD or Temporomandibular Joint Disorder.  Problems in the joints or in nearby muscles may cause TMD.   Your doctor can give you more details about your diagnosis and treatment options.

TMD Symptoms can include:

  • Jaw pain
  • Neck pain
  • Headache
  • Earache
  • Difficult jaw opening: catching, locking or shifting
  • Painful joint noises: clicking, popping or grating

TMD diagnosis:  Your doctor will perform a complete evaluation.  It may include:

  • A review of your medical, dental, and pain history
  • A brief social and psychological history
  • A physical examination of your head and neck, including muscles, nerves, jaw joints and mouth
  • Additional testing which may include x-rays, CT, MRI, laboratory tests, diagnostic injections, or other tests.

Specially trained dentists such as Dr. Rainwater, physicians, physical therapists, and psychologists are your best source for proper diagnosis and management of TMD and Orofacial Pain.

Causes of TMD

TMD usually has several symptoms and more than one cause.  Research has shown that several things may be acting together, including jaw injuries or joint disease to cause TMD:

Jaw Injury:  Getting hit in the jaw, or over-stretching from wide opening , long dental procedures, or inserting breathing tubes for surgery.

Abnormal Habits:  Clenching, grinding, fingernail biting, and chewing gum can lead to TMD in certain perople.  These habits can also make it harder to stop the pain

Occlusion:  Research has shown that the way your teeth bite together (occlusion) is rarely the cause of TMD.  In a small number of people, it may be part of why the pain is not going away

Psychological Factors:  Studies have shown that emotional stress, depression, and anxiety increase pain.

Prescription Medication:  Some prescription medicines can affect the brain and muscles.  This can lead to more pain.

Joint Diseases:  Several types of arthritis can happen in the TMJ just like any other joint in the body.  Some of these conditions may require teamwork from multiple doctors for your care.


Treatment of TMD

Because there are so many possible causes of TMD, there is no quick fix or cure.  Your TMD symptoms may be temporary and self-limited without serious long term effects.  Your doctor will work with you to help you manage the condition  Most researchers recommend that you and your doctor should first focus on conservative and reversible therapies as research has shown that self-management and canservative treatments are the most successful.

The goals of treatment are to decrease pain, to increase jaw function and to limit the impact of TMD on your daily life.  TMD is managed like other joint and muscle problems in the body.

Self-management of behaviors:

  • avoid grinding and clenching your teeth by keeping them slightly apart and the jaw relaxed
  • avoid chewing on items that are not food, such as pens, pencils, toothpicks or fingernails
  • avoid playing musical instruments that strain your jaw or put pressure on your jaw
  • limit your jaw opening during yawning or chewing, up to two fingers wide
  • rest your jaw muscles by avoiding heavy chewing on gum, bagels, ice, tough meat, or hard candy
  • use cold packs or moist hot compresses
  • Massage painful muscles
  • learn stress management and relaxation techniques
  • perform gentle jaw stretches or exercise as directed by your doctor or physical therapist
  • identify problems sleeping and work with your doctor on a plan to improve your sleep
  • keep a log of your specific pain and anything that you notice which makes your pain better or worse
  • keep a record of your treatment for TMD

Stress management:  Studies have shown that managing stress and anxiety helps relieve TMD symptoms.

Physical Therapy: Physical therapists are trained professionals that help patients rehabilitate from many types of injuries.  Your doctor will determine whether physical therapy can help your TMD symptoms

Medications:  Many medicines are available for discomfort.  Some are traditional pain relievers, while others work in different way to treat pain.  Your doctor will provide you with a specific treatment plan to fit your needs.

Orthotic:  Also known as a stabilization splint, nightguard, or biteguard.  The design will depend on your condition.  It should be used the way your doctor advises.  Most orthotics work to keep your teeth apart, to relieve pressure on your jaw joints and to help your jaw muscles relax.

Surgery:  In cases of severe, constant pain or loss of function, surgery may be needed.  Research has shown that for about 5 out of 100 TMD patients, conservative therapy is not enough.  These patients may benefit from surgery.


Dr. David Rainwater is a Diplomate of the American Board of Orofacial Pain, Fellow of the American Academy of Orofacial Pain and Fellow of the American Academy of Craniofacial Pain

 If you would like to schedule consultation,  please call the number below or email us @ !  We look forward to hearing from you soon!



David C. Rainwater DDS, MAGD, Pllc
12929 Gulf Freeway, Suite 204
Houston, TX 77034
ph: (281) 484-3675  fax: (281) 484-3679

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