What is causing my jaw pain?

Most jaw pain comes from one of three overlapping sources: temporomandibular disorder (TMD), bruxism (clenching and grinding), and the stress that drives both. But jaw pain can also come from a tooth, an ear, a sinus, or occasionally something more serious — which is why the first step is a diagnosis rather than a device.

One thing to rule out immediately: jaw pain with chest pain, breathlessness, nausea, or pain spreading to the arm or shoulder can be a symptom of a heart attack, particularly in women. That is a 000 call, not a dental appointment.

TMD and Teeth Grinding is the treatment page for most of what follows; Causes of TMJ jaw pain covers the joint itself in more detail.

Temporomandibular disorder

The temporomandibular joint (TMJ) connects your lower jaw to your skull; you can feel it just in front of each ear. Problems affecting that joint, or the muscles that move it, are grouped as temporomandibular disorder (TMD) — involving either dysfunction of the muscles or a problem within the joint itself.

A point of terminology, since the terms get used interchangeably: TMJ is the joint; TMD is the disorder.

Symptoms include:

• Pain or tenderness around the jaw joint
• Difficulty chewing
• Clicking or popping on opening or closing
• Locking of the jaw
• Headaches

Worth adding, because they send people to the wrong practitioner: TMD frequently produces earache with no ear infection, ringing in the ear, and pain that mimics toothache in the upper back teeth. The joint sits directly in front of the ear canal, and referred pain from the chewing muscles lands there readily. The RACGP confirms the pattern, reporting that "Otological symptoms, including otalgia, tinnitus, aural fullness, vertigo and subjective hearing impairment, are also frequently reported in patients with TMD", and that these are "more common in patients with myofascial disturbance than in those with intra-articular disc disorder". If you are not sure whether it is the joint or a tooth, What could be causing my toothache? and Tooth Pain and Ache set out how they are told apart.

Also worth knowing for reassurance: clicking on its own, without pain or restriction, is common and often needs no treatment.

Bruxism

Bruxism — teeth grinding and clenching — is another common cause. The habit is often subconscious and occurs during sleep, straining the muscles and joints of the jaw and producing pain and discomfort. Over time it also causes tooth damage: wear, cracks, chipped fillings, and eventually tooth loss.

A useful diagnostic clue: pain that is worst on waking points to something happening overnight. Pain that builds through the day points more to daytime clenching, which is a different habit with a different management.

The international consensus on what bruxism actually is was updated in 2025, and it is worth knowing because it changes the language. Reporting in the Journal of Oral Rehabilitation, the consensus group concluded that "Bruxism is a motor behaviour rather than a disorder", and that it "can be a risk factor, protective factor or neutral factor" depending on the outcome you are looking at. The aim, in its words, is to assess bruxism "to determine its presence in conjunction with its possible consequences, rather than to diagnose it as a disorder". Its two definitions are worth separating as well: sleep bruxism and awake bruxism are described as "different behaviours", not one habit with two settings.

The awake form is associated with stress, anxiety and concentration. It tends to be sustained clenching rather than rhythmic grinding — the consensus defines clenching as "the act of sustained (static) tooth contact" and grinding as "dynamic tooth contacts" which "may or may not be accompanied by sounds". Because you are conscious, the awake form responds better to behavioural approaches: you can learn to notice and interrupt it. See How can I stop grinding my teeth when I sleep? and How is bruxism managed?.

One connection that is often asserted more confidently than the evidence allows: the idea that sleep bruxism is the body's response to a compromised airway. It is a genuine hypothesis — the 2025 consensus notes that bruxism "may also act as a protective factor, the most often suggested example is in people with obstructive sleep apnea, where the activity may contribute to maintaining the patency of the upper airway, thus preventing collapse". Healthdirect similarly says that people who grind in their sleep "may be more likely to have other sleep disorders, such as sleep apnoea".

But a causal link has not been demonstrated. A 2024 meta-analysis in Sleep Medicine Reviews found that "The odds of SB presence in OSA did not differ from the control group (OR: 1.23, 95% CI: 0.47–3.20)", with no gradient across mild, moderate or severe obstructive sleep apnoea. So grinding is not a test for sleep apnoea and should not be treated as one. What remains true, and is worth acting on for its own reasons: if you snore, wake unrefreshed, or are told you stop breathing in your sleep, say so — those are symptoms that warrant assessment regardless of whether you grind. See Snoring and Sleep Apnoea.

How common bruxism is, and what a night guard is actually shown to do

One piece of independent evidence is worth quoting carefully, because it says something narrower — and more useful — than “splints help jaw pain”.

A long-term cohort study of primary root canal treatment published in PMC followed 312 patients. Of those patients, 119 (38.1%) were diagnosed with bruxism, and 69 (22.1%) used a night guard — a reminder that clenching and grinding are common findings in an ordinary dental population, not a niche complaint.

In that study's analysis of what predicted whether a treated tooth survived or was eventually extracted, use of a night guard was a protective factor (odds ratio 0.34; 95% CI 0.13–0.86), and the authors named lack of occlusal protection — alongside deep periodontal pockets and pre-operative apical radiolucency — among the most significant factors associated with tooth extraction.

Read that for what it is. Those figures describe root-canal-treated teeth in one long-term cohort; they are not a general-population finding, and they say nothing about whether a splint relieves jaw pain. What they support is the narrower claim this page already makes: an occlusal splint is a device for protecting teeth from load, and in people who grind, that protection appears to matter for how long heavily restored teeth last. Whether it eases your symptoms is a separate question, addressed in the questions at the end of this page. How is bruxism managed? and Can TMD be fixed? go into the options.

Stress and anxiety

Stress and anxiety are linked to both TMD and bruxism, and they make both worse. Stress causes clenching and grinding, which puts additional strain on the jaw muscles and joints — and the resulting pain disturbs sleep, which raises stress further.

This is not a reason to dismiss jaw pain as “just stress”. It is a reason to treat the physical and the behavioural sides together, since addressing one without the other tends not to hold. The National Academies made the same point from the other direction in 2020, observing that people with TMD "often feel stigmatized and invalidated in their experiences by their family, friends, and, often, the health care community", and concluding that "only the biopsychosocial approach has both strong evidence and strong theory relating clinical findings to symptoms".

The other causes worth excluding

Before settling on TMD, these should be ruled out:

• A dental cause — a cracked tooth, an abscess, or a failing restoration
• Wisdom teeth — particularly a partly erupted lower one
• Sinus disease, which produces upper jaw pain
• Ear infection
• Salivary gland problems, including a blocked duct
• Neuralgia or other neurological causes of facial pain
• Arthritis affecting the joint
• Injury to the jaw — see What should I do in a dental emergency?

On that last one, the Australian Dental Association's policy on oral injuries is worth knowing, because people routinely wait out a knock to the jaw. It holds that oral damage is often irreversible, frequently complex, difficult, and costly to repair, and that anyone who has suffered an oral injury should be promptly assessed by a dentist and be treated and reviewed as recommended — with dentists working to the International Association of Dental Traumatology guidelines. If your jaw pain started with an impact, that is a different pathway from the rest of this page and a faster one.

A good assessment is largely a process of exclusion, which is why it involves a history, a clinical examination and often radiographs rather than an immediate appliance. Where the jaw joint or the facial skeleton itself is the problem, an oral and maxillofacial surgeon is the relevant specialist; where the bite relationship between the jaws is the underlying cause, that is orthodontics and sometimes jaw surgery.

When to seek attention sooner

• The jaw locks and will not open or close fully
• Pain is severe, or is disturbing sleep
• You cannot eat normally
• Symptoms follow trauma
• There is swelling, fever, or a change in how your teeth meet
• Numbness in the face or lip

The RACGP's own red-flag list for jaw and facial pain is broader and worth knowing: "Persistent and worsening pain; trismus; cranial nerve abnormalities; neurologic dysfunction; concurrent infection; systemic illness; weight loss; asymmetrical neck or facial swelling; unilateral hearing loss; vestibular dysfunction; new onset or unilateral tinnitus." Its reason for publishing that list is blunt: "the assumption that TMD is the cause of a patient's symptoms can result in a more sinister pathology being missed."

Swelling with fever, or difficulty swallowing, is an emergency rather than an appointment — see What is considered a dental emergency? and Emergency Dentistry.

What treatment involves

Consult a healthcare professional — a dentist is the usual starting point — for a proper diagnosis and a plan tailored to your situation. Depending on the cause, interventions may include:

• Lifestyle changes and stress management techniques
• An occlusal splint (night guard) to protect the teeth and reduce muscle load
• Physiotherapy
• Medication for pain relief
• Referral for a sleep study, where a compromised airway is suspected

Things that help in the meantime, and are worth starting before your appointment: a soft diet, heat packs on the muscles, avoiding chewing gum and hard foods, supporting your chin when you yawn, and consciously keeping lips together, teeth apart during the day. Teeth should not be in contact at rest.

One caution: irreversible treatments — permanently adjusting the bite, or surgery — should not be a first step for jaw pain. Conservative management first, and a specific diagnosis before anything permanent. That is the guideline position as well as ours: the BMJ's 2023 clinical practice guideline on chronic TMD pain issued "strong recommendations AGAINST irreversible oral splints, discectomy, and NSAIDS with opioids".

A note on the evidence behind this page

This page was written at a point when we had very little independent literature on temporomandibular disorder to work from, and it said so. That is no longer the case, and the page has been updated accordingly: the questions below draw on the RACGP's 2018 Australian clinical article, the National Academies' 2020 consensus report, the BMJ's 2023 GRADE-based clinical practice guideline, the DC/TMD diagnostic criteria, and the 2025 international consensus on bruxism definitions.

What has not changed is the caution. Jaw pain attracts a great deal of confident advice, much of it about the bite, and the strongest sources are unusually direct about how little of it is supported. Where those sources disagree with each other — and on prevalence and on the airway question they do — this page says so rather than picking the tidier answer.

Common questions

How will anyone work out which of these it is?

By history and examination, mostly, and by a deliberate process of exclusion. The RACGP's position is that "TMD is a clinical diagnosis and a thorough history of the presentation and physical examination should be conducted".

Three specifics from that examination are worth knowing in advance, because you can check the first one yourself with a ruler:

• Opening. "Normal jaw opening values are 35–45 mm; a value less than 25 mm suggests dysfunction with no translation occurring within the joint."
• Where the pain is provoked. "tenderness elicited on palpation of the TMJ, joint clicking and crepitus are signs of intra-articular derangement, whereas pain on jaw movement, headache and referred pain are suggestive of a muscular problem." Muscle and joint problems are treated differently, so the distinction is not academic.
• What else it could be. The RACGP publishes a formal differential list for orofacial pain that includes caries and tooth abscess; acute otitis media, otitis externa, mastoiditis and Eustachian tube dysfunction; tension-type headache, migraine and cluster headache; trigeminal, postherpetic and glossopharyngeal neuralgia; temporal arteritis, rheumatoid arthritis, lupus and parotitis; mandibular and temporal bone fracture; and sinusitis. Its warning is explicit: "many orofacial and otological conditions can mimic TMD".

One piece of vocabulary that will help you at the appointment: the National Academies concluded that "‘TMD' should not be used as a diagnostic term", because it names a family of more than 30 disorders. Ask which specific one, and what was examined to reach it.

I grind my teeth. Should I be tested for sleep apnoea?

Not on the strength of the grinding alone — and this is a place where a lot of confident advice has run ahead of the evidence.

The careful version: healthdirect says people who grind in their sleep "may be more likely to have other sleep disorders, such as sleep apnoea", and that a dentist finding sleep bruxism "may refer you to be checked by a doctor for sleep apnoea". That describes a referral pathway, not a causal link.

The measurement: a 2024 meta-analysis in Sleep Medicine Reviews found that "The odds of SB presence in OSA did not differ from the control group (OR: 1.23, 95% CI: 0.47–3.20)" — a confidence interval that comfortably includes no effect — and found no gradient across mild, moderate and severe apnoea. Grinding is therefore not a screening test for sleep apnoea.

What should prompt assessment is the apnoea symptoms themselves: loud snoring, witnessed pauses in breathing, waking unrefreshed, daytime sleepiness. Those warrant investigation whether or not you grind. And if you have both, treat them as two findings rather than one — in particular, do not accept the argument that a single appliance treats both because they share a cause. That cause has not been established. Snoring and sleep apnoea

Will a night guard stop the pain?

It may, for some people, but the evidence for pain relief is much weaker than the evidence for tooth protection — and those are two different claims that get merged.

On tooth protection, the cohort figures quoted above are the honest support: in root-canal-treated teeth, night guard use was a protective factor for tooth survival.

On pain, the picture is different. The RACGP states that "The use of occlusional and non-occlusional splints is controversial and evidence to support their use is inconclusive". The BMJ's 2023 guideline panel went further for chronic TMD pain, placing reversible occlusal splints among its "conditional recommendations AGAINST" — and irreversible oral splints among its "strong recommendations AGAINST".

What the same panel put in its strong recommendations in favour is worth reading beside that: cognitive behavioural therapy with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching, and "usual care (such as home exercises, stretching, reassurance, and education)".

So a splint is a reasonable option to discuss, particularly if tooth wear is part of the picture, and it is reversible. It is not the automatic first answer to jaw pain, and a plan that consists only of a splint is missing the interventions with the strongest evidence behind them. How can a night guard be used to treat TMD?

How long should I give the simple measures before pushing for more?

Six to eight weeks, on the published Australian guidance — and the reason for waiting that long is genuinely encouraging rather than a brush-off.

The RACGP reports that "Up to 40% of symptomatic patients have spontaneous resolution of their symptoms without any treatment", and that "50–90% of patients have relief with conservative therapy". In cases without the red-flag symptoms listed above, it considers it "reasonable to trial conservative management for six to eight weeks prior to referral".

What "conservative management" means in that sentence is specific: "patient education and reassurance, jaw rest, a soft diet, warm compress over the region of pain and passive stretching exercises", plus "Behaviour modifications, including improving sleep hygiene, stress reduction and elimination of parafunctional habits such as teeth clenching and grinding".

Two cautions from the same source. "Stretching and jaw exercises may improve range of movement but may not necessarily improve pain" — so judge them on the right outcome. And do not immobilise the jaw: "TMJ immobilsation has no benefit and may actually worsen symptoms due to muscle contractures and fatigue." Physiotherapy "has been shown to be effective", particularly for range of motion, and referral "should be considered in refractory cases".

If six to eight weeks of that changes nothing, that is the point to ask for the next step rather than to keep going.

Is there a medicine that helps?

That is a question for your doctor or dentist, who knows your history — this page does not give directions on taking anything. What can usefully be reported is what the published guidance says is not supported, because that is where people most often end up.

The RACGP lists, as having "little to no benefit in the management of TMD": tramadol, topical preparations such as diclofenac, selective serotonin reuptake inhibitors, serotonin–noradrenaline reuptake inhibitors and monoamine oxidase inhibitors. On one class it is categorical: "Opioids are not recommended for the management of chronic TMD pain because of the risk of the patient developing drug dependency."

The BMJ's 2023 panel added several more to the against column for chronic TMD pain — among them gabapentin, botulinum toxin injection, hyaluronic acid injection, trigger point injection, corticosteroid injection, benzodiazepines and β blockers — all as conditional recommendations against, and "NSAIDS with opioids" as a strong recommendation against.

Botulinum toxin deserves a specific mention because it is widely marketed for this. The RACGP's 2018 article described it as efficacious; the BMJ's 2023 guideline, which is later and GRADE-based, recommends against it. Where two reputable sources disagree, the more recent and more rigorously graded one is the safer guide, and you are entitled to ask which one a proposal is relying on.

Where to go next

• The treatment page — TMD and Teeth Grinding
• More on the joint itself — Causes of TMJ jaw pain and Can TMD be fixed?
• If you grind at night — How can I stop grinding my teeth when I sleep?
• If you snore or wake unrefreshed — Snoring and Sleep Apnoea
• If it might be a tooth after all — Tooth Pain and Ache
• If grinding has already worn or chipped teeth — Chipped and Cracked Teeth

Practical details

The cohort figures quoted above are from a peer-reviewed long-term study of primary root canal treatment published in PMC; the oral injury position is the Australian Dental Association's own published policy. Clinical statements attributed to the RACGP are from its Australian Journal of General Practice article on temporomandibular dysfunction (2018); the guideline recommendations are from the BMJ's 2023 clinical practice guideline on chronic pain associated with temporomandibular disorders; the bruxism definitions are from the 2025 international consensus report in the Journal of Oral Rehabilitation. Each remains the primary source.

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Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. Full details on Contact Us.

Published 29 April 2024, by Sophie Oostermeyer. General information only; it does not replace advice from your treating practitioner, and it is not a diagnostic tool. Any medicine mentioned here is a matter for your treating practitioner to decide. In a medical emergency call 000.

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