Jaw pain, clicking or popping, morning headaches, a jaw that locks or feels tight. These all get called TMJ, but they don’t all come from the same place. Some of it is the muscles that close your jaw. Some of it is the joint itself. Plenty of people have both.
Those need different treatment, and treating the wrong one is the most common reason people come to us after already trying something that didn’t work. So the first thing we do is figure out which problem you actually have, before we treat any of it.
What happens at your first visit
This is a real workup, not a quick look and a night guard.
- A conversation about your symptoms, when they started, what makes them worse, and what you’ve already tried.
- A hands-on exam of your jaw joints and the muscles around them. We press on the muscles to find which ones are really sore, and we load the joints, putting pressure through them on purpose to see whether that brings on your pain. A joint that handles pressure comfortably tells us something very different from one that doesn’t.
- Your teeth. Wear, cracks and failing fillings are often the clearest record of what your jaw muscles have been doing. Wear patterns tell a story.
- How you breathe and sleep. A nose that doesn’t move air changes where your jaw and tongue sit, and grinding at night is tied to disturbed sleep.
- 3D CBCT imaging when the exam raises a question about the joint itself. It shows the bone directly, instead of us guessing from your bite.
- An MRI, once in a while. CBCT shows bone. When the question is about the disc or other soft tissue, an MRI is what answers it, and we only order one when the answer would change the plan.
Something showing up on a scan doesn’t automatically explain your pain. Wear-and-tear changes in the joint are common on CBCT, even in people whose joints handle pressure fine and who have no joint pain at all. The exam decides what’s causing your symptoms. The scan adds information.
If you’re looking for a TMJ specialist
We want to be clear about what we are.
Dr. Sandquist has done extensive postgraduate education in the jaw and the bite, and it’s been a big part of his work for nearly three decades. He isn’t an orofacial pain specialist, and he won’t call himself one.
What he does bring is the ability to work through the problem with you: often all the way to a resolution here, and when that isn’t possible, to a clear answer about where your treatment needs to happen instead.
Either way, you leave with a diagnosis. That’s the piece most people are missing when they come in, and it’s what decides whether any treatment was ever going to work.
How we treat it: a ladder, and most people don’t climb far
Once there’s a diagnosis, we start with the simplest thing that could fix it, and only go further if we need to. Everything on the first steps can be undone.
1. Hands-on treatment
For some patients, buccal massage and physical therapy are the whole answer, especially when the pain is coming from the muscles and not the joint. No appliance, nothing to wear, nothing permanent. There’s randomized trial evidence behind it for muscle-related jaw pain, and it works best alongside the retraining in the next step, not on its own.
2. Changing what’s overloading your jaw
Sore muscles are usually overworked muscles, and something is overworking them.
- Clenching while you’re awake and grinding while you’re asleep are two different problems with different causes, and many people have one without the other. Which one you have changes the answer.
- How you breathe, swallow and rest your tongue. Myofunctional therapy retrains the pattern instead of just treating what it causes.
3. Orthotic therapy, our most common approach
A custom orthotic does two jobs, in order. First it lets the overloaded muscles settle. Then, once they have, it shows us where your jaw joints actually want to rest. A jaw held stiffly by sore muscles won’t show you that, which is why the order matters.
Expect to come in weekly to every other week for about three months. The adjustments aren’t aftercare. They’re the treatment, because the appliance has to keep changing as your muscles settle and your jaw shows where it wants to sit. If an appliance is sold as TMD treatment with no follow-up schedule, it’s really a night guard, whatever it’s called.
What happens next depends on how you respond, and every outcome is useful:
- You feel better and can slowly stop wearing it. That’s the end of the story, and a lot of people finish here.
- You feel better, but the symptoms come back whenever it’s out. That usually means your bite isn’t where your joints want it, and the next question is whether to permanently move your bite toward the position the orthotic has been holding.
- You don’t improve with a well-made orthotic. That tells us managing the load won’t solve it, and a different conversation, sometimes a referral, is the right next step.
4. Botox, occasionally
We offer it and rarely use it. Botox turns a muscle down for a few months, which can bring real relief, but it does nothing about what’s overloading the muscle. We mostly treat it as a test. If turning the muscle down resolves your symptoms, the muscle was the source, and we still need to find out why it’s overloaded. Where it fits, and why we rarely start with it.
5. Permanent changes, only when the evidence points there
Orthodontics, restorative work, or a referral for surgery, when the orthotic has shown that your bite has to move to keep you comfortable. By then, you’re making permanent a jaw position that’s already been shown to work for you, not acting on a theory.
What the research says
The published evidence on splints for TMD is weak. The 2024 Cochrane review of bite treatments pooled 57 trials and 2,846 participants. It judged only one of them to be at low risk of bias, and rated every comparison it looked at as very low certainty. It couldn’t show that a stabilization splint reliably does better than a placebo or physical therapy.
Singh BP et al. Occlusal interventions for managing temporomandibular disorders. Cochrane Database of Systematic Reviews. 2024;9:CD012850.
So we don’t use orthotics because they beat everything else. We use them because they can be undone, they don’t remove any tooth structure, and they tell us something whichever way they go. When the research can’t tell you which treatment is best, it makes sense to start with the ones you can undo. Our full reasoning is here.
What we don’t start with
We don’t start by grinding down teeth, and we don’t start with crowns or orthodontics aimed at a bite problem nobody has confirmed is the cause. Those can’t be undone. Anything permanent should come at the end of the process, not the beginning.
We’re also careful with appliances worn for years without follow-up. An appliance changes how your teeth meet, and your bite can shift under one without you noticing. What we watch for, and why.
When it’s not us
Some jaw pain isn’t dental. Nerve pain, certain headache disorders and inflammatory joint disease can all show up as a sore jaw, and they belong with other doctors. Surgical cases go to a surgeon. Saying so early, instead of after a course of treatment that was never going to help, is part of doing this right.
One patient lived with twenty years of bite problems before we resolved it →
Dealing with jaw pain now?
Call 702-734-0776 or tell us what’s going on. If it turns out to be something we shouldn’t be treating, we’ll tell you early.
Individual outcomes described on this page reflect our own clinical experience, not trial results. Evidence for occlusal splints in TMD is rated very low certainty. This is general information, not a substitute for an exam.