Persistent headaches and neck pain can have many possible causes. In some people, headaches occur alongside jaw pain, clenching, restricted movement or discomfort when chewing.
These symptoms may be associated with a temporomandibular disorder, commonly shortened to TMD or described as TMJ dysfunction.
Headaches or neck pain alone do not establish that you have TMD. A careful assessment is needed to consider whether the jaw joints or chewing muscles may be contributing and whether medical investigation is also appropriate.
What is TMD?
The temporomandibular joints connect the lower jaw to the skull. Together with the chewing muscles, ligaments and surrounding structures, they allow the jaw to move during speaking, eating and yawning.
TMD is an umbrella term for several conditions affecting:
- The jaw joints
- The chewing muscles
- Structures involved in jaw movement
- A combination of joint and muscular factors
TMD is generally considered multifactorial. Factors such as clenching, grinding, injury, joint disease, stress, sleep and persistent pain may contribute.
The way the teeth meet may be relevant in some circumstances, but an uneven bite does not, by itself, prove the cause of TMD, headaches or neck pain.
What symptoms may occur with TMD?
Symptoms associated with TMD may include:
- Jaw or facial pain
- Pain or tenderness around the temples
- Pain when chewing or yawning
- Restricted mouth opening
- Jaw locking
- Painful clicking, popping or grating
- Tired or tender chewing muscles
- Clenching or grinding
- Headaches occurring with jaw symptoms
- Discomfort extending towards the ear or neck
Some people also report tinnitus, dizziness or a blocked-ear sensation. These symptoms can arise from many dental and non-dental conditions and should not automatically be attributed to TMD.
Clicking without pain, locking or restricted movement is common and may not require treatment.
Can TMD contribute to headaches?
Pain arising from the jaw joints or chewing muscles may sometimes be experienced around the temples, face or side of the head.
However, headaches may also be associated with migraine, tension-type headache, infection, vision problems, medication effects and neurological or vascular conditions.
A dentist can assess whether your headaches occur with signs of TMD. Medical assessment may also be needed, particularly when headaches are new, severe, unexplained or changing.
Dental treatment cannot be guaranteed to improve headaches.
What about neck pain?
Some people with TMD also experience neck discomfort or stiffness. Jaw and neck symptoms may occur together, but this does not establish that the jaw is the cause of the neck pain.
Neck pain can also arise from muscular strain, injury, joint or spinal conditions and persistent pain disorders. Depending on your symptoms, assessment by a GP or physiotherapist may be appropriate.
Can clenching or grinding damage teeth?
Clenching and grinding may contribute to:
- Tooth wear
- Cracks or fractures
- Damage to existing restorations
- Tooth sensitivity
- Tender or tired chewing muscles
- Visible tooth wear does not always reveal when or why it occurred. Some wear can result from erosion, abrasion or a combination of factors.
- Notches near the gumline—sometimes called non-carious cervical lesions—can also have multiple contributing factors. They should not automatically be diagnosed as evidence of grinding or TMD.
How is TMD assessed?
A TMD assessment generally begins with a detailed history and clinical examination.
Your dentist may ask about:
- The location and pattern of your symptoms
- Jaw locking or restricted movement
- Clenching and grinding
- Headaches, neck discomfort or ear symptoms
- Previous jaw, head or neck injuries
- Sleep and stress
- Medical conditions and medications
- Previous investigations or treatment
- Factors that improve or aggravate your symptoms
The examination may include:
- Measuring jaw movement
- Assessing joint sounds
- Checking the chewing muscles for tenderness
- Examining the teeth and gums
- Reviewing tooth wear and restorations
- Assessing how the teeth meet
Imaging may be recommended when clinically indicated. Referral to a GP, physiotherapist, oral medicine practitioner, oral and maxillofacial surgeon, neurologist, pain specialist or hearing professional may also be appropriate.
Are EMG and jaw tracking used?
Surface electromyography, known as EMG, records electrical activity from selected muscles. Jaw-tracking equipment records aspects of jaw movement.
These tools may be used to provide supplementary information in selected circumstances. They do not independently:
- Diagnose TMD
- Prove that the bite is causing symptoms
- Identify a guaranteed ideal jaw position
- Predict whether treatment will be successful
Results need to be interpreted alongside the patient’s history, clinical examination and any other relevant investigations.
What about low-frequency electrical stimulation?
Low-frequency electrical nerve stimulation may be used by some practitioners as an adjunct to care.
Responses vary between patients. Electrical stimulation does not establish the cause of TMD or confirm a permanent physiological jaw position. It may not be appropriate for everyone, including some people with implanted electrical devices or particular medical conditions.
Suitability, limitations and possible risks should be discussed before it is used.
What treatments may be considered?
TMD management depends on the likely diagnosis, severity of symptoms and individual circumstances. Initial treatment will often favour conservative and reversible options.
These may include:
- Temporarily choosing softer foods
- Avoiding chewing gum and excessive jaw opening
- Reducing daytime clenching habits
- Applying heat or cold when advised
- Jaw exercises or physiotherapy
- Addressing relevant sleep and stress factors
- Appropriate pain relief following medical or pharmacy advice
- A removable oral appliance in selected cases
- Referral to another health practitioner
Many TMD symptoms fluctuate and may improve over time. No single treatment is appropriate for everyone.
Irreversible changes to the teeth or bite should not be presented as routine treatment for TMD, headaches or neck pain.
What is a dental splint or orthotic?
A dental splint or orthotic is a removable oral appliance.
Depending on its design, it may be intended to:
- Protect the teeth from some effects of grinding
- Alter loading of the jaw joints and muscles
- Assist with symptom management
- Provide information during a monitored treatment trial
An appliance does not guarantee that clenching or grinding will stop. It also cannot be guaranteed to eliminate pain or permanently reposition the jaw.
Possible limitations can include:
- Discomfort
- Changes in tooth contact
- Increased clenching
- Excessive saliva or dry mouth
- Damage or wear to the appliance
- The need for adjustment or replacement
The appliance should be reviewed during treatment. Patients should report any worsening of symptoms or changes in their bite.
Does TMD require surgery?
Most people assessed for TMD are initially managed with non-surgical approaches. Surgery may be considered for selected joint conditions following appropriate imaging, investigation and specialist assessment.
Jaw clicking, headaches or tooth wear alone do not establish a need for surgery.
When should you seek urgent medical attention?
Do not assume that every headache, episode of dizziness or neurological symptom is caused by TMD.
- Seek prompt medical assessment if you experience:
- A sudden or unusually severe headache
- Weakness, numbness or tingling
- Difficulty speaking
- Confusion or loss of consciousness
- New vision changes
- Sudden hearing loss
- Tinnitus pulsing with your heartbeat
- Persistent dizziness or difficulty balancing
- Fever or significant facial swelling
- Symptoms following a head injury
- A jaw that is stuck open or closed
- Inability to eat or drink
Call 000 if symptoms appear life-threatening.
When may a TMD assessment be appropriate?
Consider arranging an assessment if you experience persistent or recurring:
- Jaw or facial pain
- Pain when chewing
- Restricted mouth opening
- Jaw locking
- Painful jaw clicking
- Clenching or grinding
- Headaches occurring with jaw pain or muscle tenderness
The purpose of an assessment is to investigate whether a jaw-related condition may be contributing—not to assume that the jaw or bite is the cause.
Arrange a TMD assessment in Perth
If you have persistent jaw pain, restricted movement or headaches occurring with jaw symptoms, contact Smile Design Studio in Mosman Park, Perth, on (08) 9468 3322 or visit smiledesignstudio.com.au.
Following an assessment, Dr Vicky Ho can explain the findings, discuss whether further investigation or referral may be appropriate and outline management options relevant to your circumstances.
A complimentary initial consultation may be available for adults. It is a discussion only and does not include treatment, diagnostic testing or clinical services. It is limited to one consultation per person and subject to appointment availability.
Attending a consultation does not guarantee a diagnosis, and dental treatment may not be recommended in every case.
Important information
This article provides general information for adults and does not replace individual dental or medical advice. Headaches, neck pain, dizziness and jaw symptoms can have several possible causes. Treatment suitability, risks and outcomes vary between patients. No diagnosis, symptom improvement or treatment result can be guaranteed.
