A guide to managing TMD and teeth grinding

TMD and teeth grinding are usually not life threatening conditions. Symptoms can cause significant pain and discomfort, sometimes affecting quality of life and mood. 

In the majority of people, TMD and teeth grinding tend to come and go, and fluctuate in intensity. They often begin or worsen during times of stress and anxiety. With effective management the effect symptoms have on daily activities will be less impactful. 

TMD and teeth grinding can usually be managed with simple self-management techniques, lifestyle modifications and behavioural approaches, without the need for invasive procedures or surgery. A part of management may also include some dental interventions such as a mouthguard (also known as a splint) and over-the-counter pain medications. 

The aim of effective TMD management is to reduce pain and inflammation, and adjust lifestyle habits that prolong or worsen symptoms. Other methods such as surgery are rarely advised and are usually a last resort.

Self-management and self-care

TMD self-care and management involves adopting personalised strategies to alleviate symptoms and allow healing from Temporomandibular Disorders, focusing on reducing pain, inflammation, and muscle tension, while preventing further injury to the musculoskeletal system. 

It empowers you to maintain an active and fulfilling life, with an emphasis on lifestyle and behavioural adjustments that prioritise engagement, wellbeing, and long-term health, even amidst jaw pain. The following are strategies aimed at reducing pain and preventing further aggravation of TMD symptoms.

Self-management strategies are known to be highly effective in most TMD cases, and should be the first step in TMD management before considering other, more invasive treatments.

Applying heat and ice, and self-massage: Heat and ice therapies are effective in managing TMD with heat enhancing blood flow and muscle relaxation, and covered ice packs reducing inflammation and pain. Complementing these with self-massage can further improve circulation, alleviate muscle tension, and aid in overall TMD symptom relief.

Jaw exercises: Jaw exercises are designed to gently reduce muscle tension and restore jaw function, focusing on targeted movements that gradually increase mobility and alleviate discomfort in the jaw area.

Eating a softer diet: Adopting a soft diet, which includes foods that require minimal chewing, can be beneficial during periods of intense TMD symptoms.

Lifestyle and behavioural adjustments:

• Dietary modifications: Avoid chewing gum and opt for soft foods, avoiding hard, sticky, or large bites that strain the jaw.

• Posture awareness: Maintain good posture and avoid habits like resting your chin on your hand.

• Activity modification: Recognise and minimise activities that aggravate TMD, such as nail biting, sleeping on the stomach, and poor sleep habits.

• Stress Management: Employ relaxation techniques, yoga, meditation, or seek counselling, as stress can intensify TMD and teeth grinding.

• Sleep hygiene: Establish a regular sleep schedule and create a calming bedtime routine to improve sleep quality.

• Limiting stimulants: Reduce caffeine and alcohol intake, as they can exacerbate teeth grinding.

• Hydration: Stay hydrated to support muscle function, which can be beneficial for TMD and teeth grinding.

• Aligning with personal values: Consider broader lifestyle changes that align with your personal values and priorities for a more balanced life.

Learn more about TMD self-management and self-care

Splints and mouthguards

If you are grinding or clenching your teeth while you sleep, your dentist may recommend a custom-made mouthguard, also known as a splint. Splints help protect your teeth from wear during sleep and also protect your jaw joint from strain. However, splints do have their limitations. They do not stop grinding and clenching nor train the jaw muscles to relax.

Braces, Botox® and surgery 

Orthodontic treatments such as braces or clear aligners are rarely needed to treat TMD and teeth grinding. Misalignment of bite is rarely the cause of TMD symptoms unless you have had dental restorations such as a crown or bridge. 

Botulinum Toxin, also known as Botox®, is a neurotoxin used to modify muscle function and pain signalling, and has an uncertain role in Temporomandibular Disorders (TMD) management. Some studies indicate a positive effect, while others see no significant impact, making it unclear who might benefit from its use. In TMD treatment, Botox® is injected into jaw muscles often the masseter and temporalis, with no added advantage from higher doses. Although it may offer temporary relief, Botox® is not a cure for TMD or teeth grinding and clenching, typically lasting up to three months with variable benefits from repeat injections. This uncertainty is being addressed in a major trial by Newcastle University in the UK, focusing on comparing Botox® with standard TMD treatments. You can read more about this trial by visiting its website here.

Temporomandibular Joint (TMJ) surgery is rarely necessary for TMD and should only be considered after a detailed evaluation by a specialist dentist, possibly including a Cone Beam CT scan or MRI. It's typically reserved for severe cases with substantial decrease in jaw movement and intense pain, often resulting from internal joint issues like trauma or ankylosis. Surgical options include arthrocentesis, a minimally invasive procedure to clean the joint; arthroscopy, a keyhole surgery for debris removal; and TMJ replacement for severe arthritis, which requires a highly specialised surgeon. These procedures carry risks like infection or nerve damage, and recovery involves strict adherence to post-operative instructions, including exercises, diet changes, and physiotherapy. While TMJ surgery can be effective for chronic TMD, it's generally the last resort, with many finding relief through non-surgical management and continued preventive care.