Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN
Temporomandibular Joint (TMJ) dysfunction and Irritable Bowel Syndrome (IBS) are two conditions that we see frequently in patients. These two problems are typcially not isolated to each other but exist within a myriad of symptoms. Some symptoms considered mysterious and of unknown origin. For many years, doctors thought that the two disorders, which appeared simultaneously in patients, were not related by cause. However, in recent years, researchers have connected TMJ problems and IBS as functional pain syndromes, but still without an identifiable structural origin. In our research listed below, we find that a missing cause can be cervical spine instability.
In November 2020, doctors in Spain writing in the International Journal of Environmental Research and Public Health (1) sought to identify if the presence of irritable bowel syndrome was included as an eligibility criterion of participants included in clinical trials investigating the effects of physical therapy in individuals with temporomandibular pain disorders (TMDs). In other words, was irritable bowel syndrome recognized as a comorbidity or condition in addition to TMJ that the patient suffered from?
The reason for asking this question was that a link had been noted in previous research, and researchers were beginning to understand that treating both conditions may be easier if a common cause was found.
Common components for the two disorders have been noted.
In 2014, doctors at the University of Maryland wrote: “The majority of patients with temporomandibular disorder report symptoms consistent with irritable bowel syndrome. Stress and female prevalence are common to both conditions.” (2)
In 2017 doctors writing in the World Journal of Gastroenterology (3) investigated the prevalence and the risk of temporomandibular disorders (TMDs) in patients with irritable bowel syndrome (IBS) (including each subtype: constipation, diarrhea, and mixed) compared to the general population. Bowel syndrome patients had a more than three times greater risk of TMD compared to healthy controls. The risk of having TMD was similar in different IBS subtypes. IBS patients who also fulfilled the criteria for TMD seem to share along with chronic facial and abdominal pain a significant co-occurrence with psychiatric disorders and female preponderance.
So again, in female patients it was more common and in this research, psychiatric disorders were seen as a common component.
Central Sensitization Syndrome
In December 2024 in the Journal of Clinical Medicine (4) confirmed the rates of simultaneous occurrence in TMD and IBS patients are relatively high. But they found pain disorders was a more common component. Disorders that co-occur with both are similar (including fibromyalgia, whiplash-associated disorders, migraine, chronic fatigue syndrome, chronic pelvic pain, depressive syndromes, and anxiety disorders). Seemingly confirming the hypothesis about existing Central Sensitization Syndrome (over sensitized to pain stimulus), a group of interrelated diseases with a common etiology related to Central Sensitization. Research suggests that treating co-morbid conditions like temporomandibular disorders (TMDs) and irritable bowel syndrome (IBS) together can be more effective than treating each disorder separately due to their common pathophysiological mechanisms. Combining therapeutic approaches with psychological support can benefit synergistically.
Summary
A June 2025 study in the Journal of oral & facial pain and headache (5) examined the findings of previous studies reporting a higher prevalence of TMD in individuals affected by irritable bowel syndrome (IBS), noting the two conditions are commonly linked to stress-induced psychosomatic factors. The data from five studies, involving 3138 patients, were included. The researchers found TMD prevalence was significantly higher in IBS patients compared to pooled controls, suggesting a shared pathophysiological mechanism likely linked to stress response systems. These findings underscore the need for a multidisciplinary approach to patient management and emphasize the importance of further research to explore the causal links and underlying mechanisms between IBS and TMD.
More reading
Cervical spine instability and digestive disorders: Indigestion and irritable bowel syndrome
Ernest Syndrome | Is this the answer to unresolved TMJ, facial, ear and throat pain?
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 Rodrigues-de-Souza DP, Paz-Vega J, Fernández-de-Las-Peñas C, Cleland JA, Alburquerque-Sendín F. Is Irritable Bowel Syndrome Considered in Clinical Trials on Physical Therapy Applied to Patients with Temporo-Mandibular Disorders? A Scoping Review. International Journal of Environmental Research and Public Health. 2020 Jan;17(22):8533. [Google Scholar]
2 Traub RJ, Cao DY, Karpowicz J, Pandya S, Ji Y, Dorsey SG, Dessem D. A clinically relevant animal model of temporomandibular disorder and irritable bowel syndrome comorbidity. The Journal of Pain. 2014 Sep 1;15(9):956-66. [Google Scholar]
3 Gallotta S, Bruno V, Catapano S, Mobilio N, Ciacci C, Iovino P. High risk of temporomandibular disorder in irritable bowel syndrome: Is there a correlation with greater illness severity?. World Journal of Gastroenterology. 2017 Jan 1;23(1):103. [Google Scholar]
4 Saczuk K, Roszuk S, Wirkijowska M, Fabisiak A, Eyüboğlu TF, Özcan M, Lukomska-Szymanska M. Association Between Temporomandibular Disorders and Irritable Bowel Syndrome: A Scoping Review. Journal of Clinical Medicine. 2024 Dec 2;13(23):7326. [Google Scholar]
5 Cricri M, Luglio G, Tropeano F, Miele A, De Palma GD, Marrapodi MM, Russo D, Cicciù M, Minervini G. Prevalence of temporomandibular disorder in irritable bowel syndrome (IBS) patients: a systematic review. [Google Scholar]