Dr. Keith Roach

DEAR DR. ROACH: I have seen several doctors for my TMJ: my primary doctor and dentist, an ear nose and throat doctor, the dental hygienist and also “ask Google.”
I am a 73-year-old female and have had this problem on the left side of my face for at least a couple of years. It started with pain in my left ear that can last for 10 minutes or all day. Now, for months, when I eat almost anything, my left jaw makes a popping sound. Anybody sitting next to me can hear it. The only thing I do is press my check with my hand to make it stop and continue with a meal. The popping does not hurt, but the ear aching does.
My ENT said the jaw is a joint, like your knee or elbow, and it can pop and also have arthritis in it. He suggested I ask my dentist for help, because he’s the expert on this. I did, and he knew of nothing that would help me. My primary said the only thing she could suggest is to hold warm compresses on my cheek.
Please tell me what I can do for relief or even possibly some sort of physical therapy. — V.C.
ANSWER: Your ENT specialist is quite correct that the temporomandibular joint, like any joint, may develop problems. However, the movement of the lower jaw on the upper jaw is unlike any other joint, so the TMJ may develop unique problems.
TMJ problems affect up to 25% of people and are a major cause of lost work. They are more common in women. People who overuse their jaw (tooth grinding, gum chewing) are more likely to develop TMJ issues, but the factors influencing development of TMJ pain, and how it is experienced by the person, are complex.
Face pain, ear pain, headache and jaw popping all are symptoms consistent with TMJ disorders. Most people have symptoms that are worse in the morning.
A dental evaluation is appropriate because a dentist can correctly diagnose teeth grinding, also called bruxism. This can be treated. Also, unsuspected dental problems can cause a person to change chewing patterns, leading to symptoms. Similarly, your physician can look for other problems that predispose to developing TMJ pain (such as arthritis), or occasionally neurological conditions like trigeminal or glossopharyngeal neuralgia, that look like TMJ dysfunction.
Years ago, TMJ expert Dr. Carol Cunningham wrote this to me:
“I instruct patients to sleep on the edge of the pillow, and to make sure that the pillow ends even with their ear. They should have nothing touching (no pressure) on their face past the point of their ear. The facial muscles want to be neutral and relaxed during sleep. If pressure is exerted on the muscles by a pillow, hand or arm, then the muscle will try to get back to a neutral position. Most often this is done by clenching and grinding. Pressure can be exerted on the muscles and joint, and this results in pain. We see a lot of TMJ problems in people who are stomach sleepers, as this results in the jaw being torqued throughout the night from lateral pressure on the face. I also tell patients to be aware of what they are doing with their teeth during the day. The only time teeth should touch is when you eat (and very briefly during certain words). During all other times, lips may be together, but teeth should not touch.”
If this advice doesn’t give adequate help, find a local TMJ expert.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.


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