A streamlined stack of supplements designed to meet your most critical needs - Adapt Naturals is now live. Learn more

Jaw Pain: 3 Little Known Causes of TMJ

by Kelsey Kinney, RD

Last updated on

For years doctors and dentists believed that malocclusion (teeth that don’t line up correctly) cause pain in the TMJ. However, newer research shows that while structural abnormalities may be part of the picture, this disorder is also associated with biological, behavioral and cognitive factors.

The cause of your TMJ (temporomandibular joint) pain may not be what you think. Wavebreakmedia Ltd/Wavebreak Media/Thinkstock

Temporomandibular joint disorders (TMD) cause pain in the temporomandibular joint (TMJ), and those with TMD usually have difficulty opening their mouths widely and may experience clicking or popping of the joint. TMD is also associated with neck and tooth pain, as well as dizziness and tinnitus.

In this article, I’ll describe some of the current theories regarding TMD and what you should do to improve your symptoms if you suffer from this painful condition.

HPA Axis Dysregulation

Anyone with TMD can attest that stress tends to make their symptoms worse. When you’re stressed your muscles tense, and in the case of TMD, this clenching can cause pain. But stress also causes physiological changes in the body that can lead to symptoms.

Those with TMD have been shown to have altered cortisol rhythms indicative of HPA axis dysregulation (i.e. “adrenal fatigue”). They have high levels of cortisol in the morning, and also exhibit an enhanced release of cortisol when stressed. (1, 2) Pain itself is a stressor, so it’s important to note that there have also been studies looking at TMD patients who had resolved their pain that also show elevated levels of cortisol, indicating that it is not just the pain causing higher levels of this stress hormone. (3)

While the normal response to acute stress is an increase in pain tolerance, researchers have shown in rat TMD models that chronic stress causing HPA axis dysregulation can actually decrease pain tolerance. (4)

Can adrenal fatigue cause TMJ pain?

Sadly, stress not only increases pain in those with TMD; it actually changes the structure of the temporomandibular joint. (5) It is vital to keep your stress under control if you want healthy temporomandibular joint structure and function.

If you suffer from TMD, it’s a good idea to check up on your adrenal health – if you suffer from HPA axis dysregulation it’s likely that improving your adrenal status will improve your symptoms. One of the best ways to improve your HPA axis activity is to implement mind-body activities like yoga, deep breathing, meditation, etc. These are simple things to incorporate and can often be done in the comfort of your own home. Here are some of my favorite resources if you’re new to mind-body activities:

Inflammation in TMD

When you are subject to chronic stress, your body becomes resistant to the effects of cortisol. When this happens, inflammation is allowed to run rampant as the normal processes that keep it in check don’t function as they should. (6)

Inflammation and oxidative stress are associated with TMD, and it is thought that these inflammatory processes that takes place within the TMJ may be a cause of the pain patients experience. (7)

To decrease your inflammation, it is first crucial to get your HPA axis functioning normally, as HPA dysregulation increases inflammation.

It is also important to eat a healthy diet high in antioxidants – a Paleo diet is a perfect place to start, but make sure to get lots of fruits and vegetables of different colors to increase your antioxidant intake.

There have been limited studies on supplements that can help alleviate TMD. However, one study showed that N-acetyl-cysteine (NAC) helped to alleviate oxidative stress on TMJ cells. (8) This has yet to be studied in animals or humans, but it’s likely that supplemental NAC may reduce the oxidative stress associated with TMD and help to relieve symptoms.

Sleep deprivation has also been shown to increase pain in those with TMD, which is thought to be because sleep deprivation increases inflammatory markers as well as estrogen (that part will make more sense in the next section). (9) To reduce inflammation in the body, it’s vital to get enough sleep. Make sure to listen (or read) Chris’ podcast with Dan Pardi on sleep to learn how to get restful sleep.

Mind-body activities are also great for not only improving HPA aHxis function but also lowering inflammation. Both yoga and meditation have been shown to lower inflammatory markers. (10) Yet another reason to practice!

Like what you’re reading? Get my free newsletter, recipes, eBooks, product recommendations, and more!

Hormone Balance

The prevalence of TMD is 1.5 times higher in women than in men. This, coupled with the fact that other pain disorders like fibromyalgia are also much more common in women, made researchers believe that hormones may play a part in these diseases.

Both male and female TMD patients show high levels of estrogen, and estrogen seems to have a damaging effect on the TMJ while testosterone seems to inhibit damage. (11, 12) Research also shows that women who have genetic polymorphisms in a specfic estrogen receptor are more likely to have TMD than controls. (13) In addition to this, women who are exposed to estrogen via hormone replacement after menopause or through oral contraceptive use are more likely to suffer from TMD than those who haven’t been exposed to exogenous estrogen. (14)

Because estrogen seems to have such a significant impact on damage and pain in TMD, it’s crucial for both men and women suffering from TMD to make sure their hormones are balanced. Hormone balance is a topic unto itself and is best done with the help of a practitioner, but Chris gives a great primer on the topic in this podcast.

To help balance your hormones yourself, you’ll want to make sure:

  • You’re at a healthy weight
  • You avoid estrogen-like compounds in your environment as much as possible (BPA, birth control, soy, fat from non-pastured animals, etc)
  • Your HPA axis is functioning properly and you keep stress to a minimum
  • Your gut is healthy and you eat adequate fiber

TMD is a multifactorial disease that can be complicated and difficult to treat. However, with newer research we have a better understanding of the many factors that lead to the development of this condition. Given this newer research, it’s likely that treating HPA axis dysregulation, controlling inflammation, and balancing hormones will bring relief to those that suffer from TMD.

ADAPT Naturals logo

Better supplementation. Fewer supplements.

Close the nutrient gap to feel and perform your best. 

A daily stack of supplements designed to meet your most critical needs.

Chris Kresser in kitchen


Join the conversation

  1. I developed pain in my upper right jaw about 6 months ago at the age of 62, and after xrays and an MRI discovered that my jaw was deteriorating (osteoarthritis). I’ve been taking lots of joint supplements and seeing a specialist (cranial massage and lidocaine injections). Doing better, but with this diagnosis, isn’t my jaw permanently damaged? Would any of these suggestions help with my diagnosis?

    • Are you on meds like nexium or none preserving meds? Look at the side effects if you are.

  2. While I know alcohol in general, and beer in particular are not Paleo, I do think they should be mentioned when discussing phytoestrogens. I know people who are Paleo except for their beer. Hops are a much more powerful phytoestrogen than soy, and modern beers are much hoppier than traditional beers. If you have TMJ, try cutting beer down or out as well as following the other suggestions mentioned in the article.

  3. I am very surprised this article doesn’t mention mineral loss as a cause of TMJ. I love chiropractic care – but adjustments for me would not last long when I was eating high oxalate foods. What works for me with TMJ and most pain is magnesium…and also a low oxalate diet. I really believe that high oxalate foods play a large role in many health issues including TMJ as well as crowded teeth. Too many high oxalate foods (spinach, rhubarb, beets, sweet potatoes, nuts, chocolate, chia seeds, quinoa, buckwheat, teff, etc.) rob your body of needed minerals. When I first went gluten-free I ate a lot of high foods and ended up needing to get braces (and I’m in my 50’s). The same thing happened to a friend of mine. Join the free group [email protected] to learn more and get access to a free foodlisting spreadsheet. High phytate foods would also be an issue.

  4. As a hypnotherapist, I have been treating clients with TMD, Bruxism and related conditions and symptoms (anxiety, anger, lost confidence, etc) with a great deal of success. It`s not new that every condition has psychological and emotional factors in addition to the physical ones and hypnosis, and self-hypnosis which is taught to the client, have been well documented as viable solutions. As doctors and dentists become better informed, they are also referring clients to hypnotherapists in increasing numbers, As you may not have been aware of the effectiveness of hypnosis, I look forward to seeing you include it as a reference in your future articles on this and other topics.

  5. My research, articles and podcasts show totally different. TMJ pain is a GABA neurotransmitter issue. Support GABA with Passion Flower and read more on GABA deficiency.
    And it is a narrow palate that crowds the teeth and jaw. I write on both of these extensively, chronicaling my own recovery.

  6. My TMJ was bad. 3 times I had to go to the emergency room because my jaw locked open. Then when I was stressed it would also lock closed. It clicked and I was always afraid it would lock open especially at the dentist. Then I found out I was gluten sensitive. After I went on a gluten free diet the inflammation went away and the TMJ went away. I have been problem free since then.

    • That’s great. How long were you on the gluten free diet before you noticed the improvement? Or were totally pain free?

  7. I’ve had a clicking jaw with tight muscles under the chin, and distended right neck for over a year. No pain though. A few months ago I had a parathyroidectomy. My hormone and electrolyte levels have changed since and I’ve started to get pain on both sides of my neck.

  8. all the above information and comments have been very helpful to understanding many of my long-standing problems dating back to my early childhood (I am neary 74 yrs. now). I had braces on my teeth for 3 years starting when I was 9, because of my malaclusion, and then when the braces were removed and teeth very straight, after I was 15 the teeth moved back out of alignment and I had braces on again for 2 years. Have had lots of trouble with sinus all my life, weak immune system due to being a non-secretor (blood group), and after I got lyme disease very bad in 2002, still have it, my teeth have moved a lot out of alignment, still moving. Had periodontal gum disease very bad and lost a lot of bone and gums. I am grateful for all the info you give on this site. Thank you.

    • TMJ is one of the numerous Functional Somatic Syndromes found in a sleep disorder called UARS .- upper airways resistance syndrome

      Your prosthodontic history suggests that your could have the airflow limitation of UARS which can also constantly stimulate the HPA ( adrenals ) via stimulation of the limbic system via olfactory bulb in the nose

      Get a sleep trudy done but make sure that the sleep clinic you choose is able to manually measure the RERAS ( respiratory effort related arousals ) to diagnose UARS ( upper airways resistance syndrome ) . If they only measure the apneas and hypopneas – AHI index , they may miss the UARS diagnosis .

      For more information on this syndrome there is a great book Sleep Interrupted by an ENT dr Steven Park. He interviews many experts on this subject including Dr Christian Guilleminault who first identified this syndrome in 1993 . Check it out on his website http://www.drstevenpark.com or search for this on the Podcast app .

      The following is from a flyer on UARS that I prepared and hand out to my patients who I suspect of this syndrome : A lot of my information was supplied from a paper written on UARS by Dr Clyde Keevy.

      Hope this helps
      Dr Maureen Allem

      UARS is classified under Obstructive Sleep apnea OSA and is a Sleep Breathing Disorder SBD that is associated with numerous FSS Functional Somatic syndromes and Anxiety disorders .

      Symptoms of UARS can overlap with OSA . UARS patients are more likely to complain of daytime fatigue rather than sleepiness.

      UARS is a form of sleep disordered breathing associated with fragmentation of sleep and is associated with inspiratory flow limitation whilst breathing during sleep . This inspiratory airflow limitation does not drop the oxygen saturation as per OSA .

      Chronic insomnias are more common with UARS . These patients find it difficult to fall asleep (Sleep onset) and then find it difficult to stay asleep ( sleep maintainance ) These patients have nocturnal awakenings and find it difficult to return to sleep .
      Studies report that Chronic insomnia is more prevalent with UARS than OSA

      50% of UARS have cold hands and feet especially in childhood
      30 % have light headedness when standing up or bending over abruptly due to parasympathetic over activity
      UARS patients have more sleep disturbance than OSA patients
      UARS patients have more sleep fragmentation that causes daytime sleepiness/ fatigue

      What initiates the UARS ? Any Physical or emotional trauma can sensitize the limbic system which modulates emotions .The limbic system then activates the HPA axis .
      The physical trauma can be a Motor vehicle accident , physical abuse, assault , home invasion , hijackings, rape , attempted rape etc . The initial trauma can also be emotional abuse . These traumas activate the HPA axis and sensitize the olfactory bulb and then the the limbic system thereby altering the brain response to external or internal stimuli .
      This activation can also lead to the Functional Somatic Syndromes FSS

      Patients with UARS have usually consulted numerous doctors who are not able to diagnose the condition as they are unaware of this newly documented condition . These doctors have not manage to improve their patients symptoms of anxiety , depression, insomnia, ADHD and these FSS disorders .

      Antidepressants are usually prescribed to alleviate symptoms but the underlying cause goes undiagnosed until a sleep study is ordered by a doctor who is aware of this new sleep disordered breathing called UARS . The sleep study is usually a last resort .
      Once diagnosed, UARS is better treated with a mandibular advancement device which opens the airway and up improves these FSS symptoms . USARs patients usually do not tolerate CPAP

      The sleep study must measure RERAS ( respiratory effort related arousals ) manually . Automated computer analysis of polysonograms PMG do not measure RERAs and are unable to diagnose the sleep disordered breathing of UARS .
      PSG have to be manually analyzed to diagnose this condition

      What are the Main FSS symptoms ?
      Body pain/ Fibromylagia , headaches , insomnias and irritable bowels IBS

      What are the main anxiety disorders that UARS is associated with ?
      Anxiety, depression, Bipolar , ADHD and Insomnia

      Other FSS syndromes that doctors must be aware of that are associated with UARS are:
      Chronic fatigue syndrome
      Restless leg syndrome
      Gastrointestinal Hyper mobility / Hypomobility
      Joint hyper mobility syndrome
      Mitral valve prolapse syndrome
      TMJ syndrome
      Sick house syndrome / multiple chemical sensitivity syndrome
      Gulf war illness
      Tension headaches / migraines
      Problems of concentration and memory
      Hyper somnolence / sleepiness
      Daytime fatigue

      Improvement of sleep disordered breathing with a mandibular advancement device improves symptoms . However one must Identify and manage the the initial trauma that activated the limbic system and HPA axis . There will be little success if the patient continues to suffer emotional/ physical stress

  9. I have had TMJ all my adult life. Recently I had orthodontia, which corrected my bite. This has not eliminated TMJ, but it has greatly improved it. Now that my teeth close down in a more normal position, the tension in my jaw muscles is reduced. Emotional stress Is certainly a factor, but fixing the bite problem was something I could control, and I’m glad I took action.

    • Absolutely, Carol! This article is definitely not to say that malocclusion doesn’t play a part – more so that there are usually other factors in the mix, too.

    • That is the same routine I have had done. Bad TMJ (wanted to pull my hair out) due to the pain. I am getting better through the “invisilign” system and mood stabilizer pills. I really have to concentrate on staying “stress free” or the clenching and grinding starts all over again..

  10. I too am a dentist but over the past 5 years have veered away from the older way of thought that you refer to, the occlusion/stress etiology model. TMD and facial pain are extremely complicated and hence are difficult to treat (let alone diagnose). However, I’d like to add one more thing to the this complex equation. People with airways prone to obstruction while asleep tend to suffer from bruxism, TMD and facial pain pain. Why is this you may ask? Grinding your teeth at night has the ability to reopen the airway ending an apneic event. If one has severe OSA for example, they would be grinding/clenching their teeth 75 times per hour. This of course is hard on the jaw joint itself and the muscles of grinding/mastication, and even on the muscles of facial expression.

    However, defining TMD and its causes is a real “chicken or egg” conundrum? Is it the grinding or is it the hormonal (cortisol) levels elevated by lack of deep sleep (no activation of growth hormone) that causes TMD directly? In my experience it’s surely multifactorial. However, clearly bruxism and its sleep interruption based etiology needs to be included in this discussion. If I see a patient with signs of bruxism, I typically think thyroid and sleep interruption, not occlusion and stress. My, how things have changed in the TMJ/TMD/Facial Pain world!

    Thanks Chris for the ever stimulating discussion of we healthcare practitioners often get set in our ways and need to keep an open mind when treating our patients.

    • Have you heard of Dr. Farrand Robson, and Oral Systemic Balance? If not, I would highly recommend researching his work 🙂

    • For me it’s caused by sleep apnea, elevated cortisol, insomnia, occlusion, (a lifetime of traumatic) stress, and adrenal fatigue. A specialist told me he suspects I don’t make much hgh. It all fits.

    • Thanks for chiming in here – always great to hear a dentist’s perspective as well.

      And as I mentioned to a commenter above, this is definitely not to say that there aren’t some physical causes/contributors like malocclusion and bruxism, but it’s multifactorial for sure.

    • There appears to be a sleep disordered breathing syndrome called UARS – upper airways resistance syndrome which is well described . See my previous post in this thread

      For more info and for interviews with experts on this subject … See this website http://www.drstevenpark.com
      Or search for dr Park’s interviews with experts on the Podcast app ( sleep apnea and UARS )

      Hope this helps

  11. hmm, no thoughts about breastfeeding? they taught us about all the teeth, palette, and jaw deformities that are caused by not breastfeeding (or not breastfeeding long enough) at a recent La Leche League International conference (it was taught by an M.D. / Ph.D. who is a leading expert in the field). i was sure that i was going to see something about breastfeeding in the list. is this not one of the things connected to facial deformities caused by not breastfeeding, or is this information just not as widely known? i think it’s a totally relevant topic to the primal community, that our babies are evolutionarily adapted to suck only on a breast, not a bottle or pacifier, and so of course their faces develop properly when they breastfeed and problems arise otherwise. i’m SO surprised this didn’t come up in this article.

    • Hi Max,

      This definitely plays a part – as I mention in the article, teeth lining up improperly is certainly an issue (which breastfeeding, among other things, can help prevent) but there are other factors at play that don’t often get talked about, so this article is focused on those.

      • The constant HPA axis stimulation may be called by a sleep disordered breathing syndrome called UARS – upper airways resistance syndrome . See my post in this thread

        Malocclusion , teeth crowding , large tongues, bottle feeding etc can cause airflow limitation whichever can lead to UARS

    • Maybe to some degree but probably genetics for the alignment. My now 15 yo was breast fed til he was 4 years old. We ve had to expand his upper palate, remove two teeth to surgically pull down and expose uppers stuck, had braces, and when done growing will have to have upper jaw and lower jaw operated on, after putting the braces back on. Oh and no room for wisdom teeth that will also be removed. Lack of breast feeding was not the cause in this scenario although I appreciate the comments. And it wasn’t a hobby for him.

  12. For many years I had TMJ pain. I wore splints, have had my teeth straightened, surgeries to repair disc. They said it would come back again. I read everything on it and discovered in old medical texts that chronic sinusitis was a major cause. I proceeded to treat the latent sinusitis with surgery, antibiotics, nasal spray etc. This kind of sinusitis is caused by slow growing staph (not acute infection) that effects the muscles around the jaw causing contractions. Sometimes CS is treatable but mostly just managed. Bromelain is helpful. Get a sinus xray.

      • Anyone who has had acute sinusitis should consider it as a possible cause of their TMJ. These bacteria do not go away, but live within us suppressed by our immune system. I want a complete resolution of this latent infection and I’m trying to do that by a paleo or ketogenic diet with lots of probiotics.

    • Interesting…I also had misaligned teeth in my teens and at school one day found I could not open my mouth to eat lunch! I got splints as well as my braces and then a retainer…it wasn’t so bad that I needed surgery but they said I would probably always have it. It’s manageable now but I still wear my splint every night (ugh), and a couple years ago I opted for a sinus surgery to clear up my constant congestion problems. They reduced the right turbinate and removed some bone spurs. Now I’m pregnant so I get to deal with congestion again but it’s certainly better than it would have been. Not sure if I fall into the chronic sinusitis category though since my CT scan said they were “perfectly clear.”

  13. For any fellow TMJ sufferers out there, I highly recommend this book; “The TMJ Healing Plan” by Cynthia Peterson, PT. Cynthia gives a thorough look at all the possible causes of jaw issues and ways to fix them yourself. Her encouraging, supportive tone was exactly what I needed when I was suffering and my dentist was “clueless”.

  14. My TMD kept getting worse and worse. I tried anything – like you’ve listed above. Finally out of desperation I got braces 6 months ago as a 33 year old adult. And within a short period of time my pain and aching was diminished or gone completely (depending on the orthodontist status for that time). Everyone is different but that’s what worked for me!

  15. For me, night grinding and sore masseter muscles following day all started when I started nursing school and when I’m in ketosis. Hmmm.

  16. All the above postings are blaming numerous factors for TMJ pain. The real issue here is DIAGNOSIS( or lack of). This can only be accurately accomplished by analysis of facebow articulated teeth models, postural and intraoral photos, CT and MRI of the Temporomandibular joints. Once a diagnosis is made, the structural components are assessed and the factors that exacerbate the problem can be discussed. With a stable “foundation” harmony should exist among all the body’s physiological factors.
    …..and BTW…..all clenching and grinding is not bad, as it helps the TM joint to adapt to a change in its structure. Any dentist who just places a splint is practicing blindly and could in fact create more harm.

    RTWylie DDS

    • I agree Robert. I don’t think many people understand the true functional cause(s) of TMD. It’s not their fault! There is way too much mis-information about this condition and I would guess that the author, although well-meaning, does not have direct experience working with TMD patients and likely no understanding of occlusion. But honestly where would she learn it? Certainly not in nutrition school! I just wish there was more education on this topic.

    • Thank you Dr. Wiley for this response. I’ve been saying this for so long! As a patient who was totally blown off by her providers and told that I essentially had anxious women disorder, I had to advocate for myself…….I had to go a long ways from where I was living but I found a doctor who required a TMJ MRI, cone beam CT scan, intraoral pictures, and models and it was shown that both of my discs were permanently displaced, my condyles were flattening and I’m bone on bone. I continue to advocate for dentists and doctors to have all of those measures be the standard of care for TMJ-because just as you have said, otherwise they are treating blindly and could cause more damage. I’m so grateful I listened to my gut before jumping into a treatment option.

      As for this article-I liked it, I’ve seen how my hormone levels and other factors like diet play a large role in my pain but I also have had the validation of the fact that I have a true joint issue.

  17. I gave myself a case of TMJ with a new pillow. I’m a side sleeper, and a bought a fat pillow to prop my head up more. It felt comfortable, but it was rather stiff and pushed my jaw sideways (a problem only on one side, oddly enough). So I added the skinny, soft, goose-down pillow I had been using on top of the new pillow. The fat pillow tends to shift up, leaving just the goose down under my jaw. Cured my problem.

    • Yes, you may caused some muscle dystonia or hypertonic muscles, but the real issue is could be cervicogenic implications.
      These often go together with TMD and are often overlooked.

  18. Have any ideas about Trigeminal Neuralgia? What appeared to start as TMJ, became Trigeminal neuralgia. Pain management with gabapentin, which involves numerous sideeffects. Ideas?

    • (Sandi, I’ve been told Trigeminal Neuralgia can be successfully treated naturally through chiropractic & acupunture treatments.)

    • Hi Sandi,
      I’ve worked previously with an Osteopathic practitioner and a Craniosacral therapist whom had great success with relieving Trigeminal Neuralgia as well as TMJ. Misalignment or restrictions in the C-spine can affect the nerves and muscles in the neck, head and face.
      All the best, Teresa