Finding relief and managing TMD

Key takeaways:

• Self-management is the first-line treatment for all TMD — not optional or secondary, but the evidence-based foundation on which all other treatments are built.

• There are six internationally recognised components of self-management: education, jaw exercises, self-massage, thermal therapy, a temporary soft diet, and behavioural habit awareness.

• Stress management and lifestyle adjustments — including sleep hygiene, hydration, reduced stimulants, and meaningful daily activities — support the nervous system and reduce flare-ups.

• A formal diagnosis helps guide appropriate care, particularly for persistent or complex cases; imaging may be used in rare instances like joint trauma or severe locking.

• Medications and splints can help when used appropriately, but painkillers should be limited to short-term use to avoid medication overuse headache (MOH).

• Botulinum toxin injections may help some people, but the evidence is still evolving.

• Specialist support may be needed in more complex cases and can include physiotherapists, psychologists, or oral surgeons — but all interventions work best when layered over strong self-management.

Understanding the care pathway — from foundational self-management to specialist support

Temporomandibular Disorders (TMD) are a group of conditions that affect the jaw joint, surrounding muscles, and that can, in a small number of cases, influence the way pain is processed by the brain and nervous system. TMD can cause a range of symptoms including: facial pain , and or headache in the temples worsened by jaw movement or function; changes in movement and or joint noises.

The most important thing to know is this: TMD can be effectively managed — and most people improve without needing invasive treatment. But successful management starts with understanding the pathway and knowing where to begin.

Self-management: The foundation of TMD care

Self-management is the clinically recommended starting point for all forms of TMD — not a fallback, but the first step in best-practice care. It is strongly supported by international guidelines and expert consensus, not only because it is safe and effective, but because it provides the foundation upon which all other treatments build. Without it, more advanced interventions are less likely to give as much benefit as when they are provided with it.

In 2016, a global panel of experts defined six core elements that make up effective self-management for TMD. These include education, jaw exercises, self-massage, thermal therapy, temporary dietary adjustments, and awareness of aggravating habits. Each component plays a role in improving symptoms through rest and rehabilitation, building resilience, and helping you live more comfortably — even when symptoms persist.

In JawSpace, you’ll find these six principles embedded into your daily support. Whether it’s guided exercises, relaxation tools, reminders to reduce clenching, or check-ins that help you track your progress, every element is grounded in this internationally recognised standard of care.

Based on international guidelines, TMD self-management includes six core components:

1. Education — Understanding what TMD is (and what it isn’t) reduces fear and empowers you to take control. JawSpace helps explain your symptoms in plain language and clears up common misconceptions.

2. Jaw exercises — Gentle, self-guided movements can ease stiffness, improve jaw function, and reduce pain. These can be followed within the app at your own pace.

3. Self-massage — Massaging tight jaw or temple muscles after applying warmth can help reduce tension and discomfort.

4. Thermal therapy — Applying heat or cold to the jaw joints and muscles helps manage flare-ups and soothe discomfort.

5. Temporary softer diet — Eating soft foods for 2–4 weeks — like soups, smoothies, or mashed meals — gives your jaw muscles a break while other treatments take effect. Once symptoms begin to settle, you can gradually return to your regular diet over another few weeks. The goal isn’t to reduce nutrition, but to make meals easier to chew without adding extra load to your jaw.  The Temporomandibular Joint Association, the international patient advocacy organisation, has an excellent free guide to diet and TMD available at this link.

6. Behavioural habit awareness — One of the key aspects of self-management for TMD is understanding the nature of this group of conditions and addressing the behaviours that could be causing or exacerbating its symptoms. This might involve identifying habits, such as nail biting  or chewing gum, which could worsen your symptoms. Learning to notice and reduce clenching, teeth grinding, poor posture, and other behaviours that put strain on your jaw.
   

Together, these strategies aim to not only reduce pain and tension but also support your ability to live well alongside symptoms — even if they don’t disappear immediately. It's about shifting the focus away from fighting pain, and toward living a fuller, less restricted life. For many people, this is enough to significantly improve symptoms. But if more help is needed, these foundations remain essential for the success of any further intervention.

Moreover, managing stress and tension is equally important, as these can exacerbate TMD symptoms. Breathing exercises, progressive muscle relaxation, or mindfulness techniques can support overall wellbeing and help reduce pain intensity. Just as important is building a life around things that bring you joy, meaning, and fulfilment. Planning and prioritising rewarding activities — even in small ways — can buffer against the physical effects of stress and help you feel more in control of your condition.

Lifestyle changes play an important role in managing TMD. Stress, poor sleep, and certain everyday habits can increase muscle tension and make symptoms worse. Building a calming bedtime routine, limiting caffeine and alcohol, and staying well-hydrated all help support muscle recovery and reduce the risk of clenching or grinding. In some cases, broader lifestyle adjustments — like bringing your daily activities more in line with your values or seeking support through therapy — can also make a meaningful difference.

These changes don’t replace self-management, but they work alongside it, creating a supportive foundation for recovery. When combined with education, physical care, and professional guidance, these shifts can significantly reduce symptoms and support long-term oral and overall health.

Getting a diagnosis

If you haven’t yet seen a healthcare professional, getting a proper diagnosis is a critical next step. A dentist or specialist will assess whether your TMD is primarily muscle-related, joint-related, or a combination of both. In a small number of cases, they may need to refer you for imaging such as (Cone Beam) CT or Magnetic Resonance Imaging (MRI) to assess the structures within the joint — particularly if jaw locking, or trauma are involved.

Receiving a diagnosis also helps rule out other possible causes of your symptoms and ensures that the next steps are appropriate, safe, and tailored to your situation.

When self-management isn't enough

If you’ve been engaging in self-management for six to eight weeks without significant improvement — or if your symptoms are worsening — it may be time to build on that foundation with additional support.

One of the most accessible additions is medication. Short-term use of over-the-counter simple painkillers such as ibuprofen or paracetamol (acetaminophen) can help reduce inflammation and relieve pain during flare-ups. However, these should only be used for a maximum of 5 to 10 consecutive days, and ideally under the guidance of a pharmacist, GP, or dentist.

It’s important to be aware of the risks of medication overuse headache (MOH) — a condition that can develop when simple painkillers are used on 15 or more days in a month. Although the exact mechanism isn’t fully understood, it’s thought that overuse of simple painkillers alters the brain’s pain regulation pathways, leading to headaches — which then prompts another dose when the painkiller has worn off, continuing a cycle. MOH is most commonly associated with ibuprofen and paracetamol and is often temporary, but resolving it may require stopping the medication altogether, which can worsen symptoms in the short term. The Migraine Trust has some excellent advice on medication overuse headache here.

If medications aren’t providing adequate relief or aren’t suitable for you, your care team may recommend a dental splint (mouthguard) to protect against grinding or reduce strain on the jaw joint. In some cases, botulinum toxin (e.g. Botox®) injections are considered, particularly for people with persistent muscle-related pain. Botulinum toxin injections may help by decreasing muscle size, but more importantly recent research suggests  they mainly influence pain pathways in the brain and nervous system helping directly turn their volume down.  Current research suggests mixed results for botulinum toxin injections, and the benefits appear to vary widely between individuals. The world’s largest ever trial in botulinum toxin and medications is being run by the Co-Director of JawSpace (Professor Justin Durham) and is due to complete in 2027. If you’d like to read more or be part of it if you are in the UK see here.

Specialist support: Who else might help

For more persistent or complex cases, your care team may expand to include additional specialists both inside and outside of dentistry. A physiotherapist can help address posture, joint mobility, and muscle release through targeted techniques. A clinical psychologist or therapist may provide support for managing the emotional impact of chronic pain, especially if stress, anxiety, or disrupted sleep are contributing to your symptoms. In very specific cases such as severe disc displacement, a referral to an oral and maxillofacial surgeon may be considered. These surgical interventions are rare and only occasionally indicated in very specific circumstances..

Final thoughts

Relief from TMD starts with the right knowledge and the right tools. And the first, most essential tool is you — empowered with self-management strategies that are grounded in clinical evidence and tailored to your daily life.

Not every case requires further treatment. But when it does, your early self-management efforts create the conditions and foundation for other therapies to succeed.

At JawSpace, we’re here to help you make sense of what’s happening in your jaw, to support you with small, daily steps that move you forward, and to remind you: you’re not alone, and you’re not stuck.

Healing may not be linear, but with the right support, it is absolutely possible.

References:

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