Assessing the jaw for a temporomandibular joint problem is quick and guides treatment. Start with getting a history including a timeline. Did the pain just start? Was there an event that preceded the jaw pain or loss of motion? Was there previous TMJ clicking that got worse?


Here are a list of questions that we ask our TMJ clients.


Have you ever had a head injury, whiplash injury or facial trauma, been hit in the face?

Have you ever had dental or jaw surgery?

Have you had or do you currently wear a mouth guard?

Have you ever been diagnosed with a TMJ problem?

Have you had any recent dental work?

Have you had past orthodontics?

Do you have any sounds when you open your mouth or chew?

Do you have any difficulty eating harder foods?

Do you have ear pain or fullness? Tinnitus?


Past trauma can suggest an injury that created a change in joint function and caused a progressive overload to the TMJ's. This is common with TMJ problems that have an insidious or unknown reason or cause for the beginning of pain or symptoms.

A recent crown can create a tooth interference increasing strain on the TMJ's.

Teeth removal can cause increasing muscle activity during biting or clenching also increasing TMJ strain with potential micro trauma and injury over time.

Ear pain and pressure can be related to TMD or TMJ injury but is also related to upper cervical or neck issues.


Interesting to note is that there is no increased or decreased risk of TMD with past or present orthodontic treatment. I am interested to know what tooth or skeletal changes have been made as this may match up to the clinical findings during the evaluation. Just because a TMJ problem occurs during dental or orthodontic treatment does not mean that the procedure caused the TMD.


These questions help us determine what imaging, specialists and treatment might be needed or what team communication needs to occur.



Information to Collect


Jaw opening and closing


  • Look for deflection or S-curves in jaw tracking.
  • Are there joint sounds? Describe the quality and where they occur.


TMJ synovial and ligament pain


  • Pain with palpation of the lateral upper and lower TMJ suggests inflammation.
  • Is there swelling of the joint? Check the skinfolds!


Bite orientation and teeth


  • Are there any missing teeth? The most common bite change that was related to TMD was an anterior open bite.


(Loss of molars on one side increases the strain on the TMJ's over time and can lead to accelerated degenerative changes on one or both TMJ's.)


Muscle palpation


  • We are looking for muscle trigger points, pain and pain referral.
  • Common referral patterns of the masseters and temporalis are to the teeth.


Associated conditions


Trigeminal Neuritis and nerve entrapment symptoms of the mandibular branch of the trigeminal nerve.

Tooth related problems that cause changes in TMJ function and facial pain.

Pain referral patterns of temporalis and masseters.

Dental work and TMD


So you think your patient has TMD?

What do you do?


Home Program for TMD


This is a program that can be started for any type of acute or painful TMJ problem.


Resting tongue position


Just say "no". The "N" sound we make when our tongue goes to the roof of our mouth behind the upper front teeth is the resting position of the tongue. When our tongue is in this position it seals our mouth and allows us to breathe through our nose. It also drops your jaw, separating your teeth, and relaxing your clenching muscles.

This is probably the most important home program activity you can do!


Jaw traction and masseter massage


Traction to the jaw including a stretch to the masseters and temporalis muscles can be done by using your finger tips to hold onto the sides of your jaw, dropping your arms downward, pulling your mouth open. Hold for 5 to 6 seconds.

(Best to do this when no one is looking.)


Firm pressure to your masseter on the inside of your mouth with outside pressure deep into your cheek can be painful but steady pressure, pulling downward, can help relax this muscle.


TMJ synovial pain? Soft diet


Liquid or softer diet. Salad, steak, apples and sub sandwiches are going to be tough with a swollen and painful TMJ.

Stop chewing gum or tough candy.

If you need to chew gum then chew on the painful side. This will reduce pressure to the joint on the same side but increases the load on the opposite joint.



The Goal of Any TMJ Treatment


No matter what philosophy or profession the goal of any TMJ treatment is the same. Pain free efficient function of the jaw. If your jaw has normal mobility, does not hurt, and you can chew anything you want, your treatment has been successful!

Each profession may take different paths to get to this goal.



Sometimes it is appropriate to order imaging.

Here are some reasons to order a test.


  • There is joint crepitus or grinding with pain.
  • You have a locked TMJ that is not improving with treatment.
  • Screening for other conditions that can cause pain such as a sinus infection.
  • Sleep Questionnaire is positive and you are checking the airway.
  • You want to check for joint or bony damage, including degenerative changes and changes to the cortex of the bone.