Bruxism and Temporomandibular Disorder

Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN

TMD or Temporomandibular Disorder is often described as an internal derangement (joint misalignment), which is a problem with the articular disc inthe jaw moving into an abnormal position. This can lead to mechanical interference and restriction of mandibular activity. Internal derangement typically causes continuous pain that will be exacerbated by jaw movement. Clicking and locking will result in restricted mandibular opening or deviation of mandibular movements during opening and closing. While there are nomenclature systems that divide TMD into classification systems including disc derangements, hypermobility disorders (subluxations), and hypomobility conditions (adhesions and ankyloses), some doctors believe ultimately what initially causes all of these conditions is joint instability of the TMJ.

A December 2025 study in the Journal of oral & facial pain and headache (1) noted that there is a higher proportion of patients with Temporomandibular Disorder who experience concurrent symptoms such as headache, migraine, tension-type headache, or neck pain. They also not when all these symptoms occur, it presents challenges for accurate clinical diagnosis and effective treatment. The connection between Temporomandibular Disorder and neck and shoulder pain may be found in posture, central nervous system dysregulation (heightened sense of pain), and inflammation processes.

Understanding the TMJ temporomandibular joint itself. What are we seeing in this image?

In this simplified view of the TMJ, we can get an understanding of the mechanisms behind TMJ disc displacement. When this person would close their mouth, they would get the characteristic clicking sound and accompanying “pop” or feeling of displacement. See that the disc in this image has ligaments behind it. The ligaments are there to provide structural stability between the jaw bone at the skull. The ligaments are holding the jaw to the skull. In front of the disc towards the face are the powerful jaw muscles. Attaching these power muscles to the jaw are the muscle tendons. Notice how the muscle turns white as they approach the bone. The tendons are the muscles attached to the bones and they are white. They hold the muscles to the jaw. If the ligaments or tendons are weak, damaged, stretched out, or lax, the jaw is floating, and the disc can be displaced.

The temporomandibular joint connects the mandible (lower jaw) to the part of the skull known as the temporal bone. The joint allows the lower jaw to move in all directions so that the teeth can bite off and chew food efficiently. The temporomandibular joint syndrome occurs when the joints, muscles, and ligaments involved do not work together properly, resulting in pain. Temporomandibular joint syndrome and TMD or TemporoMandibular Disorders have been demonstrated to be caused by ligament weakness in many patients, often as a result of clenching the jaw or grinding the teeth, sleeping position, or a forward-positioned mandible (lower jaw).

Bruxism

There has been a great deal of emphasis on occlusal devices in the treatment of TMJ because of the tremendous forces that occur with bruxism. Bruxism is defined as the clenching or grinding of the teeth during nonfunctional movements of the mandible. When it occurs during sleep, it is termed nocturnal bruxism. Most individuals engage in nocturnal bruxism activity at some point in their lives. The etiology of nocturnal bruxism by most traditionally-minded practitioners is that it is a sleep disorder related to the patient’s waking emotional state that is centrally mediated and precipitated by emotional stress. It occurs in greater frequency during periods of emotional or physical stress, as well as the anticipation of stress.

Many people we have evaluated for bruxism have clicking and grinding in their TMJ. While bruxism can cause TMJ, TMJ instability can cause bruxism. Most bruxism completely stops once the TMJ instability is resolved. It is imperative that it stop because nocturnal bruxism can generate incredible forces resulting in significant loads to the TMJ complex.

The problem of fluid buildup, a jaw joint trying to stabilize by swelling is a chronic and long-term problem of the degenerative joint disease

In a 2017 study, doctors publishing in The Journal of Headache and Pain (2) made these observations on cytokine levels in the masseter muscle (inflammation of the jaw muscle), and the response to tooth-clenching. The response the researchers were looking for was if tooth clenching caused inflammation and accompanying pain, fatigue, and psychological distress in patients with temporomandibular disorders (TMD) and myalgia (pain).

What they found was when the patients clenched their teeth, already elevated levels of inflammatory markers increased in the jaw muscle, BUT, there was no correlation between this increased inflammation and the jaw muscle pain and fatigue the patients were experiencing.

What does this mean?

According to the researchers, “This implies that subclinical muscle inflammation may be involved in TMD myalgia pathophysiology (The process of TMD), but that there is no direct cause-relation between inflammation and pain.”

What does this mean?

Subclinical means something not detected or understood. There is a chronic inflammatory response because something is not healing. In our experience that is the entire TMJ is in degenerative disease. This is a problem of the whole jaw joint disease and treatments must address the entire jaw joint, not a TMJ disc.

Instead of treating the inflammation, find the cause of the inflammation and treat that.

Researchers from the Netherlands writing in December 2023 (3) acknowledge this type of treatment thinking. They suggest: “Clinicians who treat TMD pain and masticatory muscle pain disorder (TM myalgia) usually try to discover the specific cause(s) of their patient’s pain and dysfunction in order to manage that condition. Pain frequently creates a confusing overlay of biomechanical and psychological signs and symptoms that obscure the original cause(s) of the problem. Until now, it was considered important as the first phase of treatment to focus on relieving the patient’s pain in patients suffering from TMD. It may be interesting to consider the role of inflammation on pain and therefore, to identify and determine the relationship of inflammatory markers with TM myalgia may provide a first step towards an effective treatment for these patients suffering from TMD.” In other words, is inflammation present and causing pain? Instead of treating the inflammation, find the cause of the inflammation and treat that.

Bruxism and chronic inflammation: There is a connection between inflammation and bruxism. It is just hard to prove.

Let’s return to our discussion of bruxism. Doctors are realizing that there is a connection between inflammation and bruxism. It is just hard to prove. In July 2023, doctors at Wroclaw Medical University in Poland, writing in the journal Brain Sciences (4) evaluated the relationship between inflammatory status and sleep bruxism. The researchers examined data from five studies and could only suggest that sleep bruxism could be associated with inflammation but there are no papers conclusively showing that the inflammatory status in bruxers is comparable to non-bruxers. What does this mean? There is a connection between inflammation and bruxism. It is just hard to prove.

Where there is inflammation, there is corticosteroids. Can steroid injections make TMJ pain worse?

Any medical treatment can make a condition worse. Many people have very successful outcomes with steroids. Much of the research demonstrated in this article shows short-term relief in many cases. However, the adverse effects of corticosteroids are well-known and cause concern among patients and the medical community.

Steroids / Anti-inflammatories – research questions effectiveness and worthiness in helping TMJ patients.

In a January 2019 paper in the Journal of Oral Rehabilitation, (5) researchers from leading medical universities in Sweden looked at steroid injection, specifically Methylprednisolone as a means to help alleviate TMJ patient symptoms.

In this study, the researchers looked at inflammation as a symptom problem in the TMJ. Clearly, they hypothesized, an anti-inflammatory would help with the inflammatory pain the patient was suffering from. What they found was the exact opposite, the steroid injection made the pain worse.

In this study, 54 patients were randomly assigned to single-dose injection with methylprednisolone (27 patients) or saline (27 patients).
At the 4-week follow-up after injection, the researchers found little difference in pain relief in the steroid group and the saline group.
What they did find was that in addition to the Methylprednisolone providing no additional benefit for reducing pain, the steroid injection caused more harm. “Treatment-related adverse events were doubled in the methylprednisolone group.”

Our published research

The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology? Lockerman LZ, Hauser R. The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology? Cranio. 2023 Sep;41(5):403-406. [Google Scholar]

Dextrose Prolotherapy and Pain of Chronic TMJ Dysfunction Hauser R., Hauser H, Blakemore KA. Dextrose Prolotherapy and Pain of Chronic TMJ Dysfunction. (2007) [Google Scholar]

References
1 Du SS, Hu YY, Niu YM. Associations between temporomandibular disorders/bruxism and head and neck pains: a bidirectional Mendelian randomization study. Journal of Oral & Facial Pain and Headache. 2025 Dec 12;39(4):122. [Google Scholar]
2 Jounger SL, Christidis N, Svensson P, List T, Ernberg M. Increased levels of intramuscular cytokines in patients with jaw muscle pain. The journal of headache and pain. 2017 Dec 1;18(1):30. [Google Scholar]
3 Farré-Guasch E, Aliberas JT, Spada NF, de Vries R, Schulten EA, Lobbezoo F. The role of inflammatory markers in Temporomandibular Myalgia: A systematic review. Japanese Dental Science Review. 2023 Dec 1;59:281-8. [Google Scholar]
4 Fulek M, Wieckiewicz M, Szymanska-Chabowska A, Michalek-Zrabkowska M, Fulek K, Lachowicz G, Poreba R, Mazur G, Martynowicz H. Systematic Review on the Link between Sleep Bruxism and Systemic Chronic Inflammation. Brain Sciences. 2023 Jul 21;13(7):1104. [Google Scholar]
5 Isacsson G, Schumann M, Nohlert E, Mejersjö C, Tegelberg Å. Pain relief following a single‐dose intra‐articular injection of methylprednisolone in the temporomandibular joint arthralgia–a multi‐centre randomised controlled trial. Journal of oral rehabilitation. 2018 Sep 21. [Google Scholar]