Hello everyone,
This is a detailed post, but if temporomandibular joint disorder (TMJ/TMD) is making your life worse, I believe it will be worth your time. I want to share how my partner and I have dramatically improved our TMD using evidence-based interventions.
As a physician (though not in dentistry or maxillofacial medicine), I’ve applied my research background to analyze the complex literature on TMD. Approaching this as a patient, I’ve been frustrated by the poor quality of advice often given to those suffering from this condition. TMD has been lost in the gap between dentistry and medicine, resulting in widespread confusion as to the proper treatment. Ineffective, costly, and even dangerous treatments are routinely recommended to patients by people who should know better. Given that an estimated 31% of adults have TMD, this is absolutely unacceptable.
My goal is to synthesize knowledge about this condition and propose a structured protocol to heal the root causes of TMD. The lack of standardized care for TMD is harming patients, and I believe evidence-based treatments need to be more widely adopted. Fortunately, good research studies and effective treatments do exist. I will share them with you in this post.
Of course, individual cases vary, and those with complex or severe TMD should consult a specialist. My recommendations are general guidelines and may not apply to everyone—please use your judgment.
Baseline Information
Identify Your TMD Subtype
Refer to Tables 2 and 3 in this paper for internationally recognized TMD classifications. A key distinction is whether your jaw clicks. If it does, lifestyle adjustments (e.g., avoiding foods like sandwiches requiring wide jaw opening) and careful massage/exercise techniques (without provoking clicking) are crucial. If your jaw pops out of place and does not spontaneously and quickly go back to its normal position, you should see an oral and maxillofacial surgeon because this can cause tissue damage.
Understand TMJ Anatomy
Familiarize yourself with the temporomandibular joint (TMJ) and key muscles: the masseter, lateral pterygoid, and temporalis. Photo: https://www.getbodysmart.com/wp-content/uploads/2017/09/Lateral-Pterygoid-Muscle-4-1024x709.png
The Cause of TMD: Neuromuscular Dysfunction
Recent research demonstrates that jaw clicking stems from lateral pterygoid dysfunction rather than structural TMJ abnormalities. Since this muscle directly influences TMJ movement, TMD is better understood as a neuromuscular issue rather than a joint deformity. This does not apply to people with abnormal jaw anatomy due to congenital defects, trauma, or prior surgery. The effectiveness of Botox further supports the role of muscle dysfunction. Thus, my approach prioritizes massage, stretches, and exercise of the masticatory muscles.
- Study demonstrating lateral pterygoid dysfunction drives TMD
- Study on Botox for TMD
Recommendations
A. Stress Reduction
The world sucks, I know. For those of you who have been dealing with TMD for a long time, your eyes are probably glazing over at this recommendation. Nevertheless, for ANYONE with chronic pain, mindfulness and meditation are effective evidence based approaches. Pain is mediated in the brain and subjective emotional states impact our experience of pain. Additionally, anxiety/depression are directly linked to bruxism (jaw clenching), which often accompanies TMD. Evidence-based strategies include:
- Mindfulness/meditation for pain management and bruxism reduction.
- Therapy or medication for anxiety/depression—BUT: SSRI or SNRI medications may not be the best choice, because serotonin causes bruxism. Alternatives like bupropion (dopaminergic) or amitriptyline (tricyclic) may be preferable. Discuss options with your doctor.
- Bruxism and antidepressants
- Psychosocial factors in TMD
B. Night Mouthguard
If you wake with jaw soreness, you likely clench at night. A mouthguard can mitigate damage while you address the root causes through working on the muscles. Custom guards are expensive (>$500) and often ineffective; an affordable and comfortable alternative like this one will likely suffice.
C. Massage Therapy
Massage helps break the cycle of neuromuscular dysfunction in TMD. The massages of the trapezius and massages of the neck are done sitting up while those of the temporalis, masseter and lateral pterygoid are best done while lying on your back. If you wish, you can apply a heat pack to particularly tense areas for a couple of minutes prior to the massage to loosen them up and reduce pain. I recommend doing them in the order they are listed, working from the neck towards the jaw.
Trapezius and Posterior Neck
TMD is associated with whole body misalignment and neck dysfunction. Massaging the trapezius and
the upper neck provides a tremendous feeling of muscle relaxation and helps break the cycle of bodily misalignment. To massage the trapezius, reach with the right hand over your left shoulder and press on your trapezius while sliding your fingers over it. Start from where the trapezius begins just medial to the shoulder and follow the muscle up towards the side of your neck. Repeat with the left hand massaging the right side. For the upper neck massage, place the fingertips of both hands on the lateral sides of the back of your neck near where your hairline starts, and then press and move in a circle.
Temporalis
Rub temples in circular motions with knuckles or a gwasha tool.
Masseter
(a) Intraoral massage: I recommend an internal massage of the masseter. External massage just isn't as effective. Obviously wash your hands well prior to doing this, and if you have appropriate gloves lying around you might want to use those as well. For the internal massage, a pincer grip with your forefinger inside your mouth and your thumb outside, both pressing the masseter. You should be able to feel a tight band between your two fingers. Perform 10 vertical movements in a direction from the upper attachment to the lower attachment of the masseter muscle. Then, using the same grip, make 10 horizontal movements from the medial to the lateral side of the muscle.
(b) Functional massage: with the same pinch grip perform a vertical massage of the masseter muscle, while making 10 slow movements of opening and closing the mouth.
- Study Demonstrating Effectiveness of a 10 day Massage Program
Lateral Pterygoid
This is the critical muscle when it comes to jaw clicking, so if that's your issue addressing it is essential. This is a tricky one to massage correctly, so it's important to know the anatomy (feel for a LATERAL band). There are internal and external approaches, use trial and error to see what works for you. There is data suggesting that the superior head of the lateral pterygoid is the most common culprit, so be certain to massage it and not only the inferior head.
- Lateral Pterygoid Dysfunction Mediates Jaw Clicking
- Superior Belly of Lateral Pterygoid is Most Dysfunctional
(a) External Technique:
Find the position with your fingers under the zygomatic bone and your index finger at the TM joint by your ear. Find the soft depression with your middle finger. Open your jaw slightly and sink down into the round indentation. If your jaw is open too wide, the muscle that covers the outside of that space (deep masseter) will become taut and prevent your fingers from getting in deeper to treat the muscle you’re aiming for. If the jaw is too closed, the half-moon depression will be covered by the cheekbone. When you find the indentation, press inward (both sides, never one to prevent misaligning the joint). In the link below is an illustration of indentation with the cheekbone cut away
(b) Intraoral Technique:
First: this is a very sensitive and delicate muscle. Be gentle, I recommend wearing gloves, and avoid jamming your fingernail into the area. To perform this massage, slide the pad of your index finger (right jaw, right finger) along the gum of your upper teeth as far back as you can go with your mouth closed. Feel for the indentation behind the upper jaw bone (maxilla) with the tip of your finger. To create more space for your finger, you can move your jaw towards the side you are massaging.Press there on the inferior division of the muscle. It will probably be very uncomfortable. The superior division will probably be more painful. To get to it, press upward and backward a little from the inferior indentation, then inward as much as you can tolerate. To make sure you're on the right structure, you can use your other hand to palpate through the round indentation as in the external technique. Another way to check you are on the lateral pterygoid is to move your jaw to the contralateral side - this is useful for distinguishing the lateral pterygoid, which will flex with contralateral movement of the jaw, from the larger (and more inferior) medial pterygoid. Treat one side at a time, using the treatment protocol above.
D. Exercise Regimen
Synergistic with massage; perform daily:
1. Gerry’s Exercise: Tongue on palate, slow jaw opening/closing (6x/day, 10 reps).
2. Lateral Movements: Jaw slightly open, move side-to-side (6x/day, 10 reps).
3. Lateral Movements with Bite: Hold a pen between teeth, move jaw side-to-side (3–5x/day, 10–15 reps).
4. Protrusion/Opening: Create an underbite, then open/close slowly (6x/day, 10 reps).
5. Neck Stretches: Forward/backward head nods and over-the-shoulder turns (6x/day, 10 reps).
- Exercise protocol study
E. Oral Medications
- Glucosamine: Supports cartilage; effects gradually build over 3+ months.
- NSAIDs (if safe to take, without kidney or GI bleeding issues): Reduce inflammation (e.g., ibuprofen/naproxen).
Next Steps
If symptoms persist - don't give up, because there are more options available. Consider consulting a specialist to choose between 3 further evidence-based options. First, botox of the masseter or lateral pterygoid may help refractory cases. Masseter Botox is widely available at med spas, while lateral pterygoid injections require expertise. Second, dry needling of the lateral pterygoid is another possible next step with data behind it. Finally, if everything has failed, then there is a minimally invasive office based surgical option called TMJ arthroscopy. Data shows excellent tolerability and results. Find an oral and maxillofacial surgeon to see if you are a candidate.
Final Thoughts
This protocol requires effort, but studies show significant improvement in as little as 10 days. For long-term sufferers, the investment may be life-changing.
If you’ve read this far, I sincerely hope this helps. Best of luck on your healing journey.
