TMJ & Jaw Pain Treatment in Milford, MA
Gentle, Conservative Relief — Without Surgery When Possible
Jaw pain, headaches, clicking, popping, or tension in your face are not normal — and you do not have to live with them.
At Drs. Goodman & Ko’s Advanced Dentistry in Milford, MA, we help patients of all ages find lasting relief from TMJ disorder (also called TMD). Our philosophy is simple: we focus on why the problem started, not just how to reduce pain temporarily.
The jaw is one of the most complex systems in the body. It is connected to your teeth, muscles, joints, posture, airway, and even how you breathe and sleep. When one part of this system is out of balance, symptoms can appear far away — such as headaches, neck pain, ear pressure, or facial tension.
Our goal is to calm inflammation, restore balance, and help the jaw move freely again.
What Is TMJ? (Explained Simply)
TMJ stands for temporomandibular joint. You have two of these joints — one on each side of your face, located just in front of your ears.
These joints act like hinges and sliders at the same time. They allow your lower jaw to move up and down, side to side, and forward.
You use your TMJ every time you talk, chew, swallow, yawn, breathe, or even smile.
When the joint, the muscles around it, or the way the teeth come together stop working in harmony, it can lead to TMJ disorder, also called TMD. This is when pain, clicking, locking, or stiffness can begin.
TMJ Discussion - Made with Clipchamp
Hi everybody. Dr. Co here. I would like to take the next few moments to talk about TMJ. TMJ is actually quite complex if you really dive into it. It is a joint. It is a joint that’s freely moving. It’s a joint that consists of ball in the socket in between the cushion’s cartilage disc that’s attached to muscles. A typical joint would look like this. You will have a ball that’s nicely rounded, but with equal space that’s all the way around it could distance behind it, above it. And in front of it, I’m going to show you a CT scan of a patient who does not have that. Okay? And then I’m going to show you a CT scan of a 6-year-old boy that has a nice anatomy.
So this is one of my adult patients who is in hers emis, that is suffering from T injury issue. So can you see that what we talked about is we want the spaces to be equal distance behind it, above it, and also in front of it. So we do have a little space in the front. As you can see here. We do have a little space, much, much less space on top and also some space behind it. So this doesn’t look quite like what we see here, even though this doesn’t really give you a great presentation of it. But in essence, the CT scans does not show where the cartilage is, but that cartilage basically is presented as space. So when there is distance that’s equal all the way around it, it is a healthy joint. So going back to this CT scan where we start to see that there’s compression of space of that disc space, we know that there’s definitely some destruction of the cartilage. There’s probably a malposition of the cartilage. And then there’s a good chance that that compression is pressing against the nerve tissue at the back. So in this particular patient, she is suffering from pain whenever she opens one full prolonged period of time, or when she opens really wide try to eat. I’m going to show you another patient, a 6-year-old boy that has basically a healthy joint.
This is, so this is a CT scan of a 6-year-old boy that has a healthy joint. The teeth are nicely aligned together. You can see as a contrast. So you can see as a contrast, the space, the space that’s all the way around the joint. There’s distance in the front, right above it and behind it. This is a sign of healthy joint. This is what we want, this is what we want to see. So typically when patients who have a breakdown of the joint, there’s a few reasons behind it and the reason behind it is actually quite complex. So for 6-year-old, there’s obviously less wear and tear, but also developmentally they’re not at the stage where everything is fixed together. So oftentimes, believe it or not, the joint issue came from the position of the front teeth. So if the front teeth is underdeveloped, if the front jaw, if the front of the jaw is underdeveloped, the lower jaw does not have the ability to develop forward. And a lot of times that causes distalization. Basically the joint gets pushed back and over the years it causes inflammation, which is what’s degrading the joint space and also causing inflammation and pain.
Alright? So really the key is the spacing. Okay? So notice the nice space around the TMJ and then as a contrast of the 70-year-old who is suffering from pain, the joint space is completely different. Okay? So that’s really the key of TMJ and we can talk about what’s causing this to happen a lot of times and developmentally, what’s inducing this and how do we prevent it from happening to other dots.
TMJ IG - Made with Clipchamp
This is one of my adult patients who is in hers emis, that is suffering from T injury issue. Can you see that? What we talked about is we want the spaces to be equal distance behind it, above it, and also in front of it. So typically when patients who have a breakdown of the joint, there’s a few reasons behind it. And the reason behind it is actually quite complex, right? So for 6-year-old, there’s obviously less wear and tear, but also developmentally they’re not at the stage where everything is fixed together. So oftentimes, believe it or not, the joint issue came from the position of the front teeth. So if the front teeth is underdeveloped, if the front jaw, if the front of the jaw is underdeveloped, the lower jaw does not have the ability to develop forward. And a lot of times that causes or distalization, basically the joint gets pushed back and over the years it causes inflammation, which is what’s degrading the joint space, and also causes inflammation and pain.
How TMJ Problems Develop Over Time
TMJ problems rarely happen all at once. Most develop slowly, over months or years.
Imagine your jaw joint like a door hinge. If the door is slightly crooked, the hinge still works — but it wears down faster. Over time, it starts to squeak, stick, or hurt.
Common associations of TMJ problems include:
- Teeth grinding or clenching, especially during sleep
- A narrow upper jaw that does not give the lower jaw enough room
- A bite that does not line up evenly
- Jaw muscles working too hard to compensate
- Stress that causes chronic muscle tightening
- Past orthodontic treatment that moved teeth but not jaw position
- Airway or breathing issues that push the jaw backward
When the jaw is pushed too far back, too far to one side, or held under constant pressure, the joint becomes irritated and inflamed.
Why TMJ Causes Headaches, Ear Pain, and Neck Pain
Many patients are surprised to learn that TMJ problems can cause headaches, ear pain, or neck and shoulder tension.
This happens because:
- Jaw muscles attach to the skull and neck
- The TMJ sits very close to the ear canal
- Nerves in the jaw also supply the head and face
- Tight jaw muscles pull on surrounding structures
When the jaw system is under stress, pain can spread beyond the jaw itself. This is why many TMJ patients are often referred by physicians, ENTs, or neurologists.
Common Symptoms of TMJ Disorder
TMJ symptoms can look different from person to person. Common signs include:
- Jaw pain or tightness
- Clicking, popping, or grinding sounds
- Headaches or migraines
- Ear pressure, fullness, or ringing
- Facial pain or fatigue
- Neck and shoulder tension
- Difficulty opening wide
- Jaw locking or catching
- Pain when chewing or yawning
- Waking up with sore jaw muscles
Symptoms may come and go at first, then slowly become more frequent if the underlying cause is not addressed.
Our Treatment Philosophy
We believe the jaw should be centered, relaxed, and free to move.
That means:
- We do not jump straight to surgery
- We do not rely on one-size-fits-all solutions
- We do not only treat symptoms
Instead, we ask:
- Why is this joint under pressure?
- What is pushing it out of balance?
- How can we create long-term stability and comfort?
Most TMJ cases improve significantly when muscle tension is reduced, and the jaw is guided into a healthier position.
Step 1: Relieve Muscle Tension and Pain (Botox for TMJ and Facial Muscles)
Overworked jaw muscles are a major driver of TMJ pain.
Botox helps by:
- Relaxing tight jaw muscles
- Reducing headaches and facial pain
- Decreasing clenching and grinding
- Allowing inflamed joints to calm down
Botox does not permanently change the jaw. Instead, it creates a window of relief so healing can begin. For many patients, this is the first step toward recovery.
Step 2: Center the Jaw Joint (Nightguards and Bite Splints)
Once the muscles are calmer, the next step is guiding the jaw into a healthier position.
Custom nightguards and bite splints:
- Protect teeth from damage
- Reduce joint compression
- Help center the jaw in the socket
- Improve comfort during sleep
- Decrease inflammation over time
These appliances are carefully designed and adjusted. Store-bought guards do not provide the same benefits.
Step 3: Create Long-Term Stability (Invisalign, VIVOS, MARPE)
For many patients, true long-term relief comes from correcting space and alignment problems.
We may recommend:
- Invisalign or orthodontics to balance the bite
- VIVOS therapy to support jaw and airway development
- MARPE expansion to widen the upper jaw
- Expansion to free a trapped lower jaw
When the jaw has enough room and the bite is balanced, muscles relax naturally, and joints are no longer under constant stress.
Do Most TMJ Patients Need Surgery?
In most cases, no.
Many patients experience significant improvement with conservative care that focuses on muscle relaxation, joint positioning, and bite balance.
Surgery is considered only after careful evaluation and when non-surgical options are ineffective.
Start Your TMJ Relief Journey
If jaw pain, headaches, clicking, or facial tension are affecting your quality of life, help is available.
Call (508) 850-0686 or request an appointment online.
Our team will take the time to understand your symptoms, explain what is happening, and guide you toward the most appropriate treatment path.
>> Speaker 1: I’d like to take the next few moments to go over with you how we treat TMJ issues in our office. So this child came to me when she was 10 and noticed that how much overlap there is between the upper and lower teeth, you can barely see her lower teeth. How we treat TMJ issues basically is to actually influence the position of the lower jaw by making the upper jaw bigger and more forward. And that’s what we did for her. Notice that how much more you can see her lower teeth and the only way we can do this really is by making her arches wider and so allow her front teeth to come forward more. So she came to me first because she couldn’t open to eat and I’m happy to report that she’s doing so much better, happy child and basically ready to receive braces without any symptoms. Now this second patient is a college student, came to me with similar issues with her joint is clicking and not comfortable at all. So what we did for her is similar. We made spaces bigger, made the upper teeth cover over the bottom teeth without taking any teeth out or without stripping any enamel. So several rounds of expansions plus Invisalign, making the arches wider, free up the lower jaw. That’s how we actually treat our TMJ patients.
>> Speaker 1: So I hope this is helpful for you and if you have any questions, please do reach out to our office. Thanks so much.
I’d like to take the next few moments to go over with you how we treat TMJ issues in our office. So this child came to me when she was 10 and noticed that how much overlap there is between the upper and lower teeth, you can barely see her lower teeth. How we treat TMJ issues basically is to actually influence the position of the lower job by making the upper job bigger and more forward. And that’s what we did for her. Notice that how much more we can see her lower teeth and the only way we can do this really is by making her arches wider and so allow her front teeth to come forward more. So she came to me first because she couldn’t open to eat and I’m happy report that she’s doing so much better I happy child and basically ready to receive braces without any symptoms.
Now this second patient is a college student, came to me with similar issues with her joint is clicking and not comfortable at all. So what we did for her is similar. We made spaces bigger, made the upper teeth cover over the bottom teeth without taking any teeth out or without stripping any enamel. So several rounds of expansions plus Invisalign, making the arches wider, free up the lower jaw. That’s how we actually treat our TMJ patients. So I hope this is helpful for you and if you have any questions, please do reach out to our office. Thanks so much.
Anatomy
Painful R joint: Noticed the increased space in front of the joint indicating joint pushing back. Disc (not visible in CT scan) is forward and has partial separation from the ball joint.
Asymptomatic L joint: also retruded, but the space distribution appears to be more normal
Temporomandibular Joint
Muscles
Muscles govern the movement of the jaw. People who clenches, grinds, or have habits with excessive use of lower jaw can experience symptoms similar to overworked, tired muscles. Symptom includes headaches, facial pain, pain behind eyes, incoordination of muscles, tenderness to touch are common with TMD.
Teeth/Bite
TMJ/TMD FAQ
What is TMJ/TMD?
TMJ (temporomandibular joint) is the joint that connects your jawbone to your skull, located just in front of your ears. TMD (temporomandibular disorders) is a term used to describe various conditions that affect this joint and the surrounding muscles. TMD can cause pain, difficulty chewing, and jaw clicking or locking, affecting your ability to speak, eat, or sleep comfortably.
What are the symptoms of TMJ/TMD?
Symptoms of TMJ/TMD can vary, but common signs include jaw pain or tenderness, pain around the ears, headaches, clicking or popping sounds when moving the jaw, difficulty opening or closing the mouth, and discomfort while chewing or yawning. In some cases, individuals may also experience headaches, myofacial pain, pain of the neck or shoulders, as the tension from TMJ/TMD can extend to those areas.
What causes TMJ/TMD?
TMJ/TMD can result from several factors, including jaw injury, teeth grinding (bruxism), misaligned teeth or bite, poor posture, stress, or inflammation in the joint. It can also be linked to habits such as chewing gum frequently or clenching your jaw. For some, TMJ/TMD may develop without an obvious cause, though genetics or previous jaw-related injuries can increase the risk.
How is TMJ/TMD diagnosed?
A dentist or doctor will typically perform a thorough examination, including evaluating your jaw’s range of motion, checking for tenderness or swelling, and asking about your symptoms. Imaging tests like X-rays or MRIs may also examine the joint and assess any underlying issues. A dentist may also check for signs of teeth grinding or misalignment, which can contribute to TMD.
What treatments are available for TMJ/TMD?
The severity of TMJ/TMD determines how it should be treated. For mild cases, conservative measures such as applying warm or cold compresses, taking over-the-counter pain relievers, and practicing relaxation techniques may be sufficient. A dentist may recommend oral appliances such as a nightguard to prevent teeth grinding, physical therapy, or even dental work to correct bite misalignments for more severe cases. We also had great success using botox to decrease muscle activity and that really help with most symptoms. In rare cases, surgery may be considered if other treatments are ineffective.
Can stress contribute to TMJ/TMD?
Yes, stress is a common contributing factor to TMJ/TMD. Stress can lead to habits like teeth clenching or jaw tightening, which puts excessive pressure on the temporomandibular joint and surrounding muscles. Managing stress through relaxation techniques, exercise, and stress reduction practices can help alleviate some symptoms associated with TMJ/TMD.
How can a dentist help with TMJ/TMD?
Dentists play a crucial role in diagnosing and treating TMJ/TMD. If you are experiencing symptoms, your dentist can evaluate your bite, jaw alignment, and any signs of teeth grinding. Based on their findings, they may recommend treatments such as custom nightguards, physical therapy, or adjustments to your bite. We also make positive permanent long term changes with clear aligner therapy, which improves the overall bite and occlusion which will also help the TMJ.
What makes your office an expert in treating TMJ/TMD?
Collectively, the doctors have decades of experience treating TMJ/TMD. We are also extremely well versed in understanding the anatomy, developmental deficiencies that’s causing your TMJ/TMD. We believe in treating the root cause and often when we target the root cause, the symptoms do resolve. We’ve achieved decades of success treating TMJ/TMD with botox, splint therapy, or making permanent changes to the bite with Invisalign or orthodontics.