Chronic temporo-mandibular joint (TMJ pain:
How to manage it ?
Understanding chronic jaw pain
Definition and epidemiology
Chronic temporomandibular joint (TMJ) pain is the second most common cause of chronic musculoskeletal pain after low-back pain, affecting 6-9% of adults worldwide. It manifest as pain in the jaw and associated structures, as well as symptoms such as headaches, ear pain, noises or crackles in the temporomandibular joint, and impaired mandibular function. Chronic pain is defined as pain that has been present for more than 3 months.
Current clinical recommendations for the management of chronic jaw pain are mainly based on expert consensus.
Causes of TMJ disorders
The main causes of chronic jaw pain are primarily musculoskeletal factors:
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Temporomandibular dysfunction (disc displacement, osteoarthritis)
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Myofascial syndrome (bruxism, clenching): muscle overuse creating painful trigger points.
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Direct or repeated trauma (prolonged dental surgery, cervical or facial impact).
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Systemic inflammatory conditions (polyarthritis, spondylitis) that can affect the TMJ.​
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These ongoing injuries lead to central sensitization: the nervous system lowers its nociceptive threshold and amplifies each stimulus.
In addition to this biological basis, there are psychological and social factors: stress, anxiety, depression, work overload, disturbed sleep, or lack of social support. These increase muscle tension, promote bruxism, and reinforce pain perception. This is why effective treatment must simultaneously reduce mechanical stress, control inflammation, and incorporate strategies for stress management and improving the patient's living environment.
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Symptoms of chronic TMJ disorder
There are many symptoms:
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Pain in front of the ear
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Pain in the jaw
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Pain in the masticatory muscles
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Headaches
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Noises in the joint (clicking, grinding)
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Limited mouth opening
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Tinnitus
Recommendations for the management of chronic jaw pain
Latest treatment recommendations published in the British medical journal (BMJ) in December 2023.​​
​Strong recommendations in favor:
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Cognitive behavioral therapy (CBT)
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Passive joint mobilization.
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Posture exercises.
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Exercises and stretching of TMJ muscles.
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Trigger point therapy.
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Routine care.
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Recommendations under certain conditions:
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Manipulation
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Non-steroidal anti-inflammatory drugs + CBT
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Acupuncture.
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Exercises + joint mobilization.
Osteopathy and manual therapy for chronic jaw pain
Scientifically proven efficiency
Osteopathy and manual therapy are approaches that have been scientifically proven to be effective in the management of chronic jaw pain, and have been shown to significantly reduce pain and improve patients' quality of life. Osteopathic techniques include specific, safe manual techniques to relax the muscles of the temporomandibular joint and the neck.
Mr Charbel Kortbawi DO, MSc, an osteopath specialized in pain management, treats acute and chronic TMJ pain in his practice in Paris 16.
