Jaw disorders

Last updated: November 13, 2023

Summarytoggle arrow icon

The most common disorders affecting the jaw are temporomandibular joint (TMJ) disorders and jaw dislocation. TMJ disorders include conditions that cause myalgias, arthralgia, headaches, and biomechanical dysfunction in and around the TMJ. They commonly affect young adults and are likely multifactorial in origin. The diagnosis is clinical and based on characteristic features, which include pain, headache, limitations in jaw functioning, and clicking or grinding of the TMJ. Most patients are treated conservatively, e.g., with oral analgesics, behavior modification, heat therapy, and/or splints, and those with refractory symptoms are referred to a specialist. TMJ dislocation can occur unilaterally or bilaterally as a result of extreme mouth opening or direct trauma. Patients present with an inability to close their mouths, impaired speech, and visible facial deformities. The standard treatment is closed reduction. Complications include mandibular fractures, neurovascular injuries, dental injuries, and repeat dislocations. Irreducible TMJ dislocations and mandibular fracture-dislocations usually require specialized treatment (e.g., surgery).

Temporomandibular joint disorderstoggle arrow icon

Background [1][2]

Etiology [1][4]

The etiology of TMJ disorders (TMDs) is likely multifactorial and involves:

Clinical features [1][2]

  • Pain
    • Typically preauricular
    • Constant, dull, unilateral, with intermittent sharp pain
    • Can spread to the ear, temporal regions, periorbital regions, and/or the mandible
  • Aggravating factors
    • Worsened by jaw motion (e.g., chewing)
    • Tenderness on palpation of the TMJ
  • Other symptoms
    • Ear discomfort
    • Headache (most often temporal)
    • Clicking, cracking, or grinding of the TMJ
    • Mild trismus, e.g.:
      • Limited jaw opening (occasionally painful)
      • Intermittent locking of the jaw
    • Patients may report bruxism. [1][5][6]

Consider a more serious cause of trismus (e.g., head and neck cancer, deep neck infection, tetanus, acute dystonic reaction) if trismus is sustained, progressive, severe, occurs without jaw clicking, or accompanied by atypical symptoms, e.g., lymphadenopathy or oral lesions. [10][11]

Diagnosis [2]

  • TMJ disorders are clinical diagnoses.
  • Diagnostic criteria for temporomandibular disorders (DC/TMD) are used clinically and for research. [12]
    • Multiple TMD subtypes exist with unique individual criteria.
    • Generally, a TMD is diagnosed if characteristic clinical features (e.g., pain, locking, clicking, headache):
      • Can be localized to the TMJ and nearby anatomic regions
      • Are reproducible with jaw function and/or provocation tests
      • Have been present for at least 30 days
      • Cannot be explained by another disorder
  • Imaging (e.g., CT, MRI) is typically used to rule out other diagnoses (e.g., fracture, infection) and if symptoms persist despite conservative treatment.

Management [1][2][13]

  • Begin a trial of conservative management for all patients.
  • If there is no improvement in 2–4 weeks or a severe acute exacerbation, consider imaging, outpatient specialist consultation, and treatment escalation as needed. [2]
    • Consult oromaxillofacial surgery (OMFS) if there is a history of TMJ trauma or fracture, refractory severe pain, or persistent pain of unclear etiology for longer than 3–6 months. [2]
    • Consult dentistry for underlying dental disorders.

Conservative management

Opioids are generally not recommended to treat TMDs. Opioids should only be used for a short period of time in patients with severe pain refractory to nonopioid medication. [2]

Invasive management

Temporomandibular joint dislocationtoggle arrow icon

Etiology [14][15]

  • Significant and/or prolonged mouth opening (e.g., yawning, dental procedures, acute dystonic reaction)
  • Direct trauma
  • Anatomic predisposition
  • Weakness or injury to the TMJ ligaments

Previous TMJ dislocation is a risk factor for recurrent TMJ dislocations. [14]

Pathophysiology [14][15]

  • Anterior TMJ dislocation (most common): The mandibular condyle becomes trapped anterior to the mandibular fossa (can occur unilaterally or bilaterally).
    • With wide mouth opening, the articular surface of the mandibular condyle rotates and glides anteriorly.
    • If the condyle slides past the articular eminence of the mandibular fossa, spasm of the muscles of mastication pulls it superiorly, locking it in place.
  • Dislocations in other directions (e.g., posterior, lateral) are rare.

Clinical features [14]

  • Inability to close the mouth
  • Impaired speech
  • Pain
  • Palpable and/or visible depression in the preauricular space
  • Unilateral dislocation: deviation of the jaw to the contralateral side

Bilateral symmetrical dislocations are more common than unilateral dislocations. [14]

Diagnosis [14]

TMJ dislocation is typically a clinical diagnosis.

  • Atraumatic: Routine imaging is unnecessary.
  • Traumatic: Obtain imaging to rule out a fracture, e.g., CT face (see “Diagnostics” in “Mandibular fractures”).

Management [14][15]

Complications [15]

Closed reductiontoggle arrow icon

Indication [14][15]

Closed reduction is indicated for clinically apparent anterior TMJ dislocation.

Contraindication [14][15]

Concurrent mandibular fracture is the only absolute contraindication to attempting a closed reduction in an emergency setting.

Consult OMFS if there is a mandibular fracture-dislocation.

Equipment [14][15]

Landmarks and positioning [14][15]


  • Sit the patient upright with support for the back and head.
  • Face the patient or stand behind them, with the elbows at the level of the patient's mandible or higher.


  • Intraoral
    • Place the thumbs on the mandibular ridge posterior to the molars.
    • Alternatively, place protected thumbs on the occlusal surfaces of the patient's teeth.
    • Wrap the other fingers along the base of the mandible on either side.
  • Extraoral
    • Place the thumbs on the skin overlying the displaced mandibular condyle.
    • Wrap the other fingers along the base of the mandible on either side.

Procedure [15]

  1. Administer procedural sedation and analgesia (PSA).
  2. Consider inserting a bite block for provider protection.
  3. With the hands in position, apply steady caudal pressure to the mandible.
  4. Guide each mandibular condyle inferiorly and posteriorly into the mandibular fossa.
  5. Evaluate mandibular range of motion after the reduction.

If using the intraoral approach, be careful not to injure the thumbs, as the teeth may snap together at the time of reduction. [15]

For bilateral TMJ dislocations, it is typically easier to reduce one mandibular condyle at a time rather than both simultaneously. [15]

Pitfalls and troubleshooting [15]

Complications of jaw reduction

Referencestoggle arrow icon

  1. List T, Jensen RH. Temporomandibular disorders: Old ideas and new concepts. Cephalalgia. 2017; 37 (7): p.692-704.doi: 10.1177/0333102416686302 . | Open in Read by QxMD
  2. Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician. 2015; 91 (6): p.378-86.
  3. Valesan LF, Da-Cas CD, Réus JC, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clin Oral Investig. 2021; 25 (2): p.441-453.doi: 10.1007/s00784-020-03710-w . | Open in Read by QxMD
  4. Chisnoiu AM, Picos AM, Popa S, et al. Factors involved in the etiology of temporomandibular disorders - a literature review. Medicine and Pharmacy Reports. 2015; 88 (4): p.473-478.doi: 10.15386/cjmed-485 . | Open in Read by QxMD
  5. Ohlmann B, Waldecker M, Leckel M, et al. Correlations between Sleep Bruxism and Temporomandibular Disorders. J Clin Med. 2020; 9 (2): p.611.doi: 10.3390/jcm9020611 . | Open in Read by QxMD
  6. Manfredini D, Lobbezoo F. Sleep bruxism and temporomandibular disorders: A scoping review of the literature. J Dent. 2021; 111: p.103711.doi: 10.1016/j.jdent.2021.103711 . | Open in Read by QxMD
  7. Rommel N, Rohleder NH, Koerdt S, et al. Sympathomimetic effects of chronic methamphetamine abuse on oral health: a cross-sectional study. BMC Oral Health. 2016; 16 (1).doi: 10.1186/s12903-016-0218-8 . | Open in Read by QxMD
  8. Teoh L, Moses G, McCullough M. Oral manifestations of illicit drug use. Aust Dent J. 2019; 64 (3): p.213-222.doi: 10.1111/adj.12709 . | Open in Read by QxMD
  9. van Kempen EEJ, de Visscher JGAM, Brand HS. Are periodontitis, dental caries and xerostomia more frequently present in recreational ecstasy users?. Br Dent J. 2022; 232 (6): p.389-395.doi: 10.1038/s41415-022-4040-1 . | Open in Read by QxMD
  10. Dhanrajani PJ, Jonaidel O. Trismus: Aetiology, Differential Diagnosis and Treatment. Dent Update. 2002; 29 (2): p.88-94.doi: 10.12968/denu.2002.29.2.88 . | Open in Read by QxMD
  11. Beddis HP, Davies SJ, Budenberg A, Horner K, Pemberton MN. Temporomandibular disorders, trismus and malignancy: development of a checklist to improve patient safety. Br Dent J. 2014; 217 (7): p.351-355.doi: 10.1038/sj.bdj.2014.862 . | Open in Read by QxMD
  12. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications. J Oral Facial Pain Headache. 2014; 28 (1): p.6-27.doi: 10.11607/jop.1151 . | Open in Read by QxMD
  13. Murphy MK, MacBarb RF, Wong ME, Athanasiou KA. Temporomandibular disorders: a review of etiology, clinical management, and tissue engineering strategies. Int J Oral Maxillofac Implants. 2013; 28 (6): p.e393-414.doi: 10.11607/jomi.te20 . | Open in Read by QxMD
  14. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  15. Roberts JR. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. Elsevier ; 2018

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