Neck pain upon opening the mouth can be a sign of temporomandibular disorder (TMD) or, in layman’s terms, a dysfunction of the jawbone and surrounding structures. TMD describes a group of disorders, some of which are pretty common, affecting some 6-12% of adults. Women, and younger adults are more likely to experience TMDs but they can affect anyone throughout life.
Symptoms of TMJ / TMD
Symptoms of TMD, or temporomandibular joint disorder (TMJ) can include pain, reduced mobility of the jaw, reduced ability to chew (as TMD can affect masticatory muscles), and clicking, popping, or cracking noises upon moving the jaw joint. The dysfunction involved in TMD can cause referred pain in the neck, face, and head, as well as symptoms of paraesthesia. In some cases the condition may affect overall health and wellbeing by adversely influencing diet and nutrient intake and social interaction.
Understanding the Jaw Joint
In many cases TMD’s origins are not well understood, with no single cause usually identifiable. A developmental anomaly of the jaw joint could be to blame, muscular dysfunction may be implicated, or nerve involvement could be affecting both mobility and joint pain. There are also discs in the jaw joint that can become degraded over time, especially through excessive use, and these may affect joint function and cause jaw pain and neck pain upon opening the mouth.
In myofascial pain and dysfunction, the most common type of TMD, the pain may be part of an overall chronic pain condition with increased sensitivity to pain. There may also be psychological factors invovled, muscle overactivity (such as bruxism or teeth grinding or jaw clenching) and orofacial dystonias. Some people have dental issues that affect the jawbone, but TMJ is no longer considered a dental issue but a multifaceted condition.
Causes of TMJ / TMD
Just as neck pain can be caused by osteoarthritis, so can jaw pain. Rheumatoid arthritis may also lead to jaw pain as can gout, intra-articular disc problems, and even gout, pseudogout or spondyloarthropathy. Where someone has incurred trauma to the jaw, such as from a fall or fight, there may be swelling that causes pain upon opening the mouth, or long-term issues from scar tissue formation or a fracture jawbone.
Hypermobility conditions, including Ehlers-Danlos syndrome may be a factor in jaw pain and neck pain when chewing, talking or opening the mouth. Infection, tumours, and congenital disorders are also possible causes of symptoms such as facial pain, jaw dysfunction and noise in the jaw joint. Typically, the pain associated with TMD will present as pain in front of the ear and into the ear, temple and cheek as well as along the mandible.
Diagnosing Temporomandibular Joint Disorder
Patients may experience ear pain, tinnitus and even dizziness, as well as headaches and neck pain. Where the jaw feels tight this is usually caused by a muscular issue. Where the jaw appears to catch or stick this can be a sign of a structural jaw joint issue. Where there is just a clicking noise in the jaw unaccompanied by pain or other symptoms this is usually not significant. Sometimes a person may have difficulty opening their mouth or closing their mouth, the former being more common.
Anyone suspected of TMJ or TMD as the cause of pain when opening the mouth will undergo a physical assessment for structural and functional issues with the jaw joint and may also have assessments carried out on the health of their salivary glands, teeth, ears, cranial nerves, and levels of systemic inflammation and white blood cell count, to check for infection.
Other Causes of Neck and Jaw Pain
Other causes of neck pain upon opening the mouth can include dental problems, cardiac pain, trigeminal neuralgia, Herpes zoster, and migraine or headaches. If a patient also has swelling in the neck this may indicate a thyroid issue or problem with lymph nodes in the neck. Where patients have undergone neck surgery there is the possibility that accidental nerve damage occurred or that scar tissue is impairing nerve health and triggering jaw and neck pain.
Patients may not need any invasive tests if it is a clear case of TMD, but others may undergo the blood tests mentioned above in addition to CT scan, x-ray, MRI or ultrasound, diagnostic nerve block, and arthroscopy.
Treating Neck and Jaw Pain
Usual treatment for pain when opening the mouth is pain management and possible physical therapy and rest if there has been recent jaw trauma. Addressing any relevant psychological issues is important, and some patients may benefit from intra-articular steroid injection, botox injections, surgery (to remove dislodged bone fragments or reshape the jaw), or arthroscopy, or even from acupuncture or massage. Non-steroidal anti-inflammatory drugs can be helpful as can muscle relaxants when used appropriately. Tricyclic antidepressants may also help as can selective norepinephrine reuptake inhibitors like duloxetine.
During recovery, or for chronic conditions it is usually recommended to choose soft foods and avoid wide mouth opening or excessive movement of the jaw (yawning, singing, chewing etc.). It may be necessary to have a dental guard fitted to minimize bruxism at night. Biofeedback can also help retrain posture and joint movement, and relaxation techniques may help some of those with jaw and neck pain upon opening the mouth.