TMJ Treatment in Houston: What Works

Seen in Midtown Houston, Saturday hours: Book an appointment  ·  (713) 322-7474  ·  New Patients in Houston

What Is Actually Going On

The temporomandibular joint sits just in front of each ear and connects your lower jaw to your skull. It hinges and it slides, which makes it more complex than most joints, and a small cartilage disc rides between the bones to keep the movement smooth.

TMD, temporomandibular disorder, is an umbrella term covering three quite different problems.

Muscle related pain is the most common by a wide margin. The muscles that close the jaw are overworked and tender, usually from clenching. The joint itself is fine.

Disc displacement is when the cartilage disc slips out of position. This produces clicking and popping, and if the disc blocks the movement, the jaw locks.

Joint disease, meaning arthritis in the joint itself, is the least common of the three.

They feel similar from the outside and need different treatment, which is the whole reason a proper diagnosis is worth having before anyone touches your teeth.

The Symptoms, and What They Point To

• A dull ache in front of the ear, in the cheek or in the temple, often worse in the morning. Morning pain points strongly at night clenching.

• Clicking or popping when you open. If it clicks but does not hurt and opens fully, that alone often needs no treatment.

• Locking, either unable to open wide or unable to close from an open position. Locking is the symptom that most warrants a prompt appointment.

• Headaches, particularly in the temples, which is where the temporalis muscle sits.

• Earache, fullness or ringing, with a normal ear exam from your doctor.

• Tiredness or aching in the jaw when chewing, so that a bagel or a steak becomes a chore.

• A bite that suddenly feels off.

• Neck and shoulder tension that travels with the jaw pain.

What should send you elsewhere first: jaw pain with chest pain, shortness of breath or pain down the left arm can be cardiac and needs emergency care, not a dentist. Sudden severe facial pain with weakness or numbness needs urgent medical assessment.

What Causes It

Often more than one thing at once, which is part of why it can be stubborn.

Clenching and grinding is the biggest contributor, and most people who do it at night have no idea. The signs are worn flat teeth, notches at the gumline, a scalloped edge on the tongue, and waking with a tight jaw.

Stress, because stress produces clenching. This is not a suggestion that the pain is imaginary. The muscle is genuinely overworked; the reason it is overworked happens to be behavioral.

Trauma, from a blow to the jaw, a whiplash injury, or a long dental appointment held wide open.

A bite that has changed, from a missing tooth never replaced, a crown that sits high, or teeth worn unevenly.

Joint arthritis, and some generalized joint hypermobility conditions.

Habits that keep the muscles loaded: chewing gum all day, biting nails, holding a phone against your shoulder, or resting your chin on your hand at a desk.

Start Conservative, Because It Usually Works

Most TMD improves with measures that are reversible and inexpensive. Give these several weeks before escalating.

• Soft diet for two to three weeks. Cut food up, avoid bagels, tough meat, raw carrots and anything requiring wide opening. Rest is treatment for an overworked muscle.

• Stop chewing gum entirely.

• Moist heat over the muscle for 15 minutes, two or three times a day, for muscle pain. Ice instead if the joint itself is acutely painful or swollen.

• Anti inflammatories at over the counter doses, if you can take them safely, for one to two weeks rather than indefinitely.

• Gentle jaw exercises. Slow controlled opening within a comfortable range, several times a day. Not forcing it wider.

• Do not open wide. Support your chin when you yawn.

• Notice daytime clenching. Teeth should be apart at rest, with only the lips touching. Most people are astonished at how often they catch themselves clenched once they start checking.

• Sleep on your back or side rather than face down with the jaw pressed into a pillow.

A good number of patients need nothing beyond this.

Night Guards and What Comes Next

A custom night guard is the most common next step. It is a hard acrylic appliance made from an impression of your teeth that separates the jaws slightly, so the muscles cannot generate full clenching force and the teeth stop wearing against each other.

It is reversible, which is the key point. It changes nothing permanently about your teeth or your bite.

Drugstore boil and bite guards are soft and thick, and a soft guard can make clenching worse in some patients by giving the muscles something satisfying to chew on all night. If you are going to wear something, have it made properly.

Beyond that: physical therapy for the jaw and neck is genuinely useful and underused. A short course of muscle relaxant at night may be prescribed. Trigger point injections help some patients with stubborn muscle pain. Joint injections and arthroscopy exist for specific joint problems diagnosed on imaging. Open joint surgery is reserved for a small minority with structural disease that has not responded to anything else.

Occasional Botox injections into the jaw muscles are used for severe clenching by some clinicians, and the evidence is mixed rather than settled. Worth discussing, not worth assuming.

What We Do Not Recommend Doing First

Be careful with anything irreversible offered early in the process.

Grinding down healthy teeth to adjust your bite, sometimes called occlusal equilibration, cannot be undone. Where a genuinely high crown is the trigger, adjusting that one restoration is reasonable. Reshaping a whole arch for TMD is not a conservative measure and the evidence supporting it as a first line treatment is weak.

Full mouth crowns or orthodontics presented as a TMD cure deserve a second opinion before you agree.

Any appliance meant to be worn 24 hours a day for months can allow your teeth to move and your bite to change permanently. Ask specifically whether an appliance is reversible.

And be skeptical of guaranteed cures. TMD is often chronic and managed rather than eliminated, and the honest framing is that most people get substantially better, not that everyone is permanently fixed.

Getting Assessed in Midtown Houston

An assessment takes about half an hour. We measure how far you can open, feel the joints as they move, palpate the chewing muscles for tenderness, check how your teeth meet, and look for wear patterns. Imaging is added when locking, trauma or suspected joint disease makes it useful, and a CBCT scan shows the bony joint in three dimensions.

That is what separates muscle pain, which responds to a guard and rest, from a displaced disc or joint disease, which do not.

TMJ cases here are managed by our oral and maxillofacial surgeons, the specialty trained to treat this joint, including Dr. Jonathan Rosenstein, who is board certified and a Diplomate of the American Board of Oral and Maxillofacial Surgery, Dr. Edmund Watkins and Dr. Evan Melamed. If your bite turns out to be part of the picture, our orthodontist Dr. Bernard Boback is in the same building.

We start conservative and escalate only if we need to.

A new patient exam is one of the least expensive appointments on our schedule, and we will give you today's exam fee when you call. We are at 106 W Gray St in Midtown, minutes from Montrose, River Oaks, Downtown, the Museum District and the Texas Medical Center, with Saturday appointments. Call (713) 322-7474 or book online.