Jaw Pain, TMJ Dysfunction & Why We Sometimes Treat Inside the Mouth

By Anthony Dileo Osteopath I Kallista Osteopathy

Jaw pain is one of those problems that people often put up with for far too long.

Some people notice clicking, locking, clenching, grinding, headaches, ear pressure, dizziness, or pain when chewing. Others simply feel like their jaw is “tight”, “crooked”, or not opening properly.

In clinic, I treat a lot of jaws — on average around five jaw presentations per day which will be the reason why someone visits or it will be part of the clinical picture. So yes, you’ll often find me gloving up and putting my fingers inside mouths. Don’t worry — it is not as invasive as the dentist. It is usually gentle, targeted, and only done with clear consent.

The reason osteopaths may be able to help jaw pain is actually quite simple: jaw muscles are muscles. Like your neck, back, shoulder or hip muscles, they can become tight, irritated, overworked, guarded or poorly coordinated. When that happens, they can affect how the jaw joint moves and how comfortable chewing, talking, yawning and opening the mouth feels.

1. What is TMJ syndrome?

TMJ stands for temporomandibular joint — the jaw joint. You have one on each side, just in front of the ears.

Strictly speaking, TMJ is the joint itself. TMD, or temporomandibular disorder, refers to the broader group of problems that can affect the jaw joint, jaw muscles, facial structures and associated nerves.

Symptoms can include:

• Jaw pain

• Clicking, popping or grinding

• Pain with chewing

• Limited mouth opening

• Jaw locking

• Facial pain

• Headaches

• Neck pain

• Ear pressure or earache-like symptoms

• Dizziness or a sense of imbalance

• Tooth sensitivity that is not always dental in origin

• Clenching or grinding

A key point: clicking alone is not always a problem. Many people have clicking jaws without pain or limitation. In those cases, it may not need treatment. I become more interested when the clicking is painful, progressive, associated with locking, or when the person cannot open, chew or function normally.

2. How can an osteopath help jaw pain?

An osteopath looks at jaw pain as a mechanical, muscular, joint and nervous system problem — not just a “jaw joint” problem in isolation.

A typical osteopathic approach may include:

• Assessing how far the jaw opens

• Looking for deviation or asymmetry during opening

• Palpating the jaw muscles

• Checking the neck, upper back, shoulders and posture

• Assessing clenching habits, sleep, stress and work position

• Treating tight or painful jaw muscles

• Treating the neck and upper back where relevant

• Prescribing jaw exercises

• Helping reduce overload from habits such as clenching, nail biting or gum chewing

• Referring to a dentist, GP, ENT or specialist when needed

This is where osteopathy can be very useful. We are not replacing dentists. We are not changing bites or making dental appliances. But we can assess and treat the musculoskeletal system around the jaw, which is often a major part of the problem.

In my opinion, the jaw is often under-treated as a muscle and movement problem and often missed when managing headaches. People will happily get treatment for a tight calf, shoulder or hip flexor — yet the jaw muscles, which work constantly every day, are often ignored.

3. Why would an osteopath treat inside the mouth?

Some of the most important jaw muscles are easier to access from inside the mouth.

The masseter, temporalis and pterygoid muscles are heavily involved in chewing, clenching and jaw control. In particular, the pterygoid muscles can be difficult to treat properly from the outside.

This is where intraoral treatment may help.

That means I put on gloves and gently treat the muscles from inside the cheek or along the inner jaw. It is not dental work. There is no drilling, scraping or poking around the teeth. It is usually more like treating a tight muscle, just in a different location.

It should always be:

• Explained clearly first

• Done with consent

• Gentle enough to tolerate

• Stopped immediately if the patient is uncomfortable

• Part of a broader treatment plan, not the whole plan

I often tell patients: “It sounds stranger than it feels.”

For many people, once they experience it, they understand why it can be useful. The jaw can feel looser, opening may feel easier, and the person may suddenly realise how much tension they were holding through the face.

4. Why do jaw muscles become tight?

Jaw muscles can become tight for the same reason other muscles become tight: they are overloaded, irritated, guarded or repeatedly used in a way they cannot recover from.

Common contributors include:

• Clenching during the day

• Grinding at night

• Stress and concentration habits

• Chewing gum

• Nail biting

• Jaw bracing while exercising

• Dental procedures requiring prolonged mouth opening

• Neck pain or poor neck mechanics

• Trauma to the jaw, face or head

• Sleep issues

• Anxiety or nervous system arousal

• Posture and prolonged desk work

• Habitually chewing on one side

Many people do not realise they clench. They are not walking around thinking, “I am clenching my jaw.” They are concentrating, driving, working, scrolling, exercising or sleeping — and the jaw is quietly working in the background.

One of the first useful things is simply helping someone become aware of what their jaw does during the day.

A relaxed jaw posture is usually: Lips together, teeth apart, tongue resting gently on the roof of the mouth.

For many jaw pain patients, “teeth apart” is a revelation.

5. Can TMJ problems cause headaches?

Yes — jaw problems and headaches are commonly associated.

The jaw, face, head and upper neck share important nerve pathways, particularly through the trigeminal system. The trigeminal nerve is one of the major nerves involved in facial sensation, jaw function and many headache presentations.

This does not mean every headache is caused by the jaw. It does mean the jaw should be considered, especially when headaches are associated with:

• Jaw tightness

• Clenching or grinding

• Pain chewing

• Morning headaches

• Temple pain

• Facial pain

• Neck pain

• Ear pressure

• Headaches that worsen with talking, chewing or stress

• Tenderness in the masseter or temporalis muscles

One of the most memorable cases I have treated involved a patient who had headaches for around 10 years. She had seen multiple practitioners and had largely accepted that headaches were just part of her life.

On assessment, her jaw muscles were extremely tender and her jaw movement was restricted. We treated her jaw, including intraoral muscle work, and gave her exercises and habit changes to reduce clenching.

Her headaches improved dramatically.

She joked that I was a miracle worker. I am clearly not. There were no miracles. I applied osteopathic training, anatomy, clinical reasoning and evidence-informed care to a problem that had been missed: her jaw was a major contributor to her headaches.

That is why I always assess the jaw in certain headache patients. Sometimes it is not the whole answer, but sometimes it is a very important missing piece.

6. Can TMJ problems be linked with dizziness?

They can be linked, but this needs careful wording.

Dizziness can come from many causes, including inner ear disorders, vestibular migraine, blood pressure issues, medication effects, neurological conditions, anxiety, neck-related dizziness and other medical causes.

So I would never say, “Your dizziness is definitely from your jaw” without proper assessment.

However, jaw disorders are often reported alongside ear and balance-type symptoms, including:

• Dizziness

• Ear fullness

• Earache-like pain

• Tinnitus

• A sense of pressure around the ear

• Symptoms that fluctuate with jaw tension or neck pain

The jaw joint sits very close to the ear, and the jaw, neck and vestibular systems are anatomically and neurologically interconnected. Some patients with TMJ issues describe a vague off-balance sensation rather than true spinning vertigo.

My clinical opinion is this: if someone has dizziness plus jaw pain, jaw tightness, ear pressure, headaches and neck tension, the jaw is worth assessing. But dizziness should be screened properly. If there are red flags, sudden hearing loss, severe vertigo, neurological symptoms, fainting, new severe headache or unexplained symptoms, medical review is important.

Osteopathic treatment may help when the dizziness appears to be part of a broader jaw-neck-headache pattern, but it is not a replacement for appropriate medical or vestibular assessment.

7. What does a jaw assessment involve?

A jaw assessment is usually very straightforward.

I may look at:

• How far you can open your mouth

• Whether your jaw moves straight or deviates to one side

• Whether opening or closing causes pain

• Whether there is clicking, popping or locking

• Which muscles are tender

• Whether the pain refers into the temple, ear, teeth or face

• How your neck moves

• Whether neck movement reproduces symptoms

• Your headache pattern

• Clenching, grinding and stress habits

• Dental history

• Trauma history

• Sleep and pillow position

• Workstation and posture

• Whether you need dental or medical referral

A useful part of the examination is palpation. When I press on a jaw muscle and it recreates the person’s familiar headache, ear pressure or facial pain, that gives us important clinical information.

It does not prove everything, but it helps build a clearer picture.

8. What treatment might an osteopath use?

Treatment depends on the person. There is no single “TMJ treatment”.

It may include:

• Soft tissue treatment to the masseter and temporalis muscles (Jaw Muscles)

• Intraoral treatment to deeper jaw muscles

• Gentle jaw joint mobilisation

• Neck treatment

• Upper back and rib treatment

• Dry needling if appropriate and consented

• Breathing and relaxation strategies

• Jaw coordination exercises

• Controlled opening exercises

• Isometric jaw strengthening

• Postural and ergonomic advice

• Clenching awareness strategies

• Advice around chewing load and habits

The goal is not simply to “loosen the jaw”. The goal is to improve how the jaw functions.

A tight jaw often needs a combination of:

1. Hands-on treatment to reduce pain and muscle guarding

2. Exercises to improve control and confidence

3. Habit changes to reduce repeated irritation

4. A plan to stop the symptoms returning

This is no different from treating a shoulder or a lower back. You calm the system down, restore movement, build capacity, and reduce the behaviours that keep stirring it up.

 

9. What can I do at home for TMJ pain?

The right advice depends on the diagnosis, but common starting points include:

Keep the jaw moving gently

Avoid forcing the mouth open or stretching aggressively. Gentle, comfortable movement is usually better.

Reduce chewing load temporarily

For a flare-up, consider avoiding very chewy foods, big burgers, hard crusts, chewing gum and prolonged chewing.

Use heat

Heat over the jaw muscles can help reduce muscle guarding for some people.

Notice clenching

Set reminders during the day: lips together, teeth apart, tongue relaxed.

Avoid testing the jaw repeatedly

Many people keep opening, clicking or checking the jaw to see if it still hurts. This can keep irritating it.

Manage stress load

This does not mean “it is all stress”. It means the jaw is one of the places the body commonly expresses stress, concentration and tension.

Do prescribed exercises

Jaw exercises should be specific. Some people need mobility. Others need control. Others need strengthening. The wrong exercise at the wrong time can irritate symptoms.

10. When should jaw pain be referred to a dentist, GP or specialist?

Osteopathic care can be very helpful for many jaw pain presentations, but not every jaw problem is purely musculoskeletal.

Referral may be needed if there is:

• Tooth pain or suspected dental infection

• New facial swelling

• Fever or feeling unwell

• Trauma or suspected fracture

• Sudden change in bite

• Progressive locking

• Severe unexplained pain

• Neurological symptoms

• Sudden hearing loss

• True spinning vertigo

• Unexplained weight loss

• History of cancer

• Constant night pain

• Symptoms that are not improving as expected

Dentists are important when there may be tooth pathology, bite appliances, bruxism-related tooth wear or dental contributors. GPs and ENTs are important when symptoms suggest ear, neurological, inflammatory or systemic causes.

The best results often come from sensible collaboration.

My role as an osteopath is to assess whether the jaw, neck, muscles and movement system are contributing — and if they are, to treat that contribution properly.

Jaw pain can be frustrating, but it is often very treatable. For some people, especially those with headaches, facial pain, ear pressure or long-term clenching, assessing the jaw can be the missing piece.

No miracles required. Just anatomy, clinical reasoning, evidence-based care, and a willingness to look inside the mouth when needed.

References & Further Reading

1. National Institute of Dental and Craniofacial Research. TMD (Temporomandibular Disorders). National Institutes of Health. Accessed 31 May 2026. Available from: https://www.nidcr.nih.gov/health-info/tmd

2. Lomas J, Gurgenci T, Jackson C, Campbell D. Temporomandibular dysfunction. Australian Journal of General Practice. 2018;47(4). doi:10.31128/AFP-10-17-4375

3. National Academies of Sciences, Engineering, and Medicine. Temporomandibular Disorders: Priorities for Research and Care. Washington, DC: The National Academies Press; 2020. doi:10.17226/25652

4. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. Journal of Oral & Facial Pain and Headache. 2014;28(1):6–27. doi:10.11607/jop.1151

5. International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia. 2020;40(2):129–221. doi:10.1177/0333102419893823

6. Schiffman E, Ohrbach R, List T, Anderson G, Jensen R, John MT, et al. Diagnostic criteria for headache attributed to temporomandibular disorders. Cephalalgia. 2012;32(9):683–692. doi:10.1177/0333102412446312

7. Busse JW, Casassus R, Carrasco-Labra A, Durham J, Mock D, Zakrzewska JM, et al. Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline. BMJ. 2023;383. doi:10.1136/bmj-2023-076227

8. Yao L, Sadeghirad B, Li M, Li J, Wang Q, Crandon HN, et al. Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials. BMJ. 2023;383. doi:10.1136/bmj-2023-076226

9. Shimada A, Ogawa T, Sammour SR, Narihara T, Kinomura S, Koide R, Noma N, Sasaki K. Effectiveness of exercise therapy on pain relief and jaw mobility in patients with pain-related temporomandibular disorders: a systematic review. Frontiers in Oral Health. 2023;4:1170966. doi:10.3389/froh.2023.1170966

10. Bizzarri P, Manfredini D, Koutris M, Bartolini M, Buzzatti L, Bagnoli C, Scafoglieri A. Temporomandibular disorders in migraine and tension-type headache patients: a systematic review with meta-analysis. Journal of Oral & Facial Pain and Headache. 2024;38(2):11–24. doi:10.22514/jofph.2024.011

11. Porto De Toledo I, Stefani FM, Porporatti AL, Mezzomo LA, Peres MA, Flores-Mir C, De Luca Canto G. Prevalence of otologic signs and symptoms in adult patients with temporomandibular disorders: a systematic review and meta-analysis. Clinical Oral Investigations. 2017;21:597–605. doi:10.1007/s00784-016-1926-9

12. Binduhayyim RIH, Vaddamanu SK, Kanji MA, Vyas R, Di Blasio M, Cervino G, Marrapodi MM, Minervini G. Prevalence of dizziness in patients with temporomandibular disorders: a systematic review and meta-analysis. Journal of Oral & Facial Pain and Headache. 2026. doi:10.22514/jofph.2026.044