Women's Health
Jaw Pain (TMJ/TMD)
TMD is roughly twice as common in women. The jaw is where stress, hormones, and neck tension all converge at once. Here's what's actually going on and what helps.
Book Your First VisitTMJ dysfunction affects women at roughly twice the rate of men (Bueno et al., 2018). The reasons are biological: the TMJ contains oestrogen receptors, meaning hormonal fluctuations are thought to influence joint laxity and inflammation. Add in the neck-jaw neurological connection and the clenching patterns that high-demand work and stress produce, and you have a condition with multiple contributing threads. Most TMD has a meaningful cervical component. Many people need both a chiropractor and a dentist working on it.
Why TMD is a women's health issue
Psychosocial stress is one of the strongest predictors of TMD onset and progression (Fillingim et al., 2013), and it tends to express itself in the jaw through clenching and bracing. Women in high-demand roles who carry physical tension through the upper body are at particular risk of a self-reinforcing pattern where upper cervical tension and jaw clenching drive each other.
Temporomandibular disorders are approximately twice as common in women as in men (Bueno et al., 2018), a finding consistent across population studies. A 2018 systematic review and meta-analysis of 28 studies found an odds ratio of 2.24 for women compared to men. The gender disparity is not explained by hormones alone, but hormones are a real part of the picture. Oestrogen receptors in the TMJ mean that the joint appears to be sensitive to hormonal fluctuations (Zielinski & Pajak-Zielinska, 2024). During the luteal phase of the menstrual cycle, around perimenopause, or following hormonal changes, joint laxity may increase and the disc may become more susceptible to displacement and irritation. This is why many women notice their jaw symptoms worsen at predictable times in their cycle, and why existing TMD often intensifies during perimenopause.
Why the jaw and neck are connected
The connection between the jaw and cervical spine is neurological. The trigeminal cervical nucleus, spanning the brainstem and upper cervical spinal cord, processes sensory input from both the face and jaw (via the trigeminal nerve) and the upper cervical spine (via C1-C3) (Bartsch & Goadsby, 2003). This convergence is why upper cervical joint restriction may contribute to facial pain and jaw symptoms, and why TMD patients so frequently also report neck pain, base-of-skull headaches, and ear symptoms (Šedý et al., 2022). The reverse is also true: jaw dysfunction can maintain upper cervical tension.
This overlap is why TMD often doesn't fully resolve when treated from only one direction.
Common presentations
- Myofascial TMD: primary muscle tension in the masseter and temporalis without significant joint pathology. The most common presentation in women with high work stress. Often related to clenching patterns that are unconscious and chronic. Morning jaw soreness, afternoon facial aching, and headaches at the temples are typical.
- Disc displacement with reduction: clicking or popping during jaw opening, where the disc snaps back into place. The click can be painless or painful depending on associated inflammation. More common in women, partly due to increased joint laxity from oestrogen fluctuation.
- Cervicogenic TMD: jaw symptoms driven primarily by upper cervical dysfunction, with little primary joint pathology. Assessment and treatment of the cervical spine is where this practice has the most direct role. If you've had chronic neck stiffness you've never treated, it may be contributing more to your jaw symptoms than you'd expect. This also applies if you've already seen a dentist and have partial relief but still have ongoing headaches or jaw tension: the cervical component may not have been addressed yet.
- Bruxism-related symptoms: morning jaw soreness, teeth sensitivity, headaches on waking. The jaw muscles are overloaded by nighttime clenching and grinding. Bruxism is often a response to stress and nervous system arousal rather than a primary cause of TMD.
What helps
Chiropractic focuses on the cervical and craniocervical (skull-to-neck) contribution. In practice, treatment typically involves hands-on mobilisation of the upper cervical joints and soft tissue work at the base of the skull and jaw muscles. No intraoral work. A first session is largely assessment-focused, with hands-on treatment beginning once the clinical picture is clear. For women where the cervical component is primary, 7,8 this can produce meaningful improvement in jaw symptoms even without direct jaw treatment. In my clinical experience, many patients with a primarily cervical presentation notice meaningful change within 4 to 6 sessions, though this varies by chronicity and how much bruxism and hormonal factors are also active. If stress and clenching are primary drivers, that conversation is part of the plan too.
Dental causes (occlusion issues, disc displacement needing a splint) need a dentist. Bruxism responds better when cervical contributors and stress are also addressed alongside dental management. Many TMD presentations benefit from both chiropractic and dental care working together.
When to see a dentist alongside chiropractic
If you have significant disc displacement that locks open or closed, bite changes, teeth sensitivity, or you've been told you grind your teeth significantly at night, a dentist should be involved. A night guard alone won't address the cervical contribution; upper cervical treatment alone won't address dental causes of bruxism. If your night guard helped but hasn't fully resolved headaches or clicking, that pattern often suggests both cervical and dental contributors are active. For women in perimenopause, when both cervical contributors and dental causes are active, addressing both gives each intervention a better chance to hold.
Jaw pain with a cervical component is something I can assess and treat directly. If a dentist or orofacial physiotherapist is also needed, I'll tell you that clearly and can refer. If you'd like to talk through your situation before booking, book a time to chat.
When to seek care promptly
For most gradual-onset jaw tension, clicking, and discomfort, a chiropractic or dental assessment is a reasonable first step. See a doctor or dentist first if you have:
- Jaw locking open or closed (cannot fully open or close)
- Severe jaw pain with swelling (possible infection or fracture)
- Jaw pain after trauma to the face or jaw
- Significant difficulty chewing or speaking
- Ear pain with jaw symptoms (rule out middle ear infection)
These warrant dental or medical assessment before conservative manual therapy. Persistent but non-acute jaw clicking and discomfort is appropriate for conservative assessment.
Common questions
The answer depends on what's causing it. Dental causes (tooth grinding, occlusion issues, disc displacement that needs a splint) need a dentist. Muscular TMD and cervicogenic jaw pain often respond well to manual therapy and upper cervical treatment, with or without a dental splint. Many TMD patients benefit from both working together. I'll assess the cervical and craniocervical picture, identify how much of the presentation appears cervicogenic, and refer to a dentist clearly if the presentation calls for it.
I assess and treat the cervical and craniocervical region, which can influence jaw symptoms via the trigeminal cervical nucleus. 5,6 Upper cervical manipulation and mobilization can reduce jaw pain and improve mouth opening in patients where cervical dysfunction is a significant contributor. I don't treat inside the mouth. If direct jaw joint work is needed, an orofacial physiotherapist or dentist specialising in TMD would be appropriate, and I'm happy to refer.
The jaw joint sits immediately in front of the ear canal, and the auriculotemporal nerve (a branch of the trigeminal nerve) runs through both regions. TMD can cause referred pain into the ear (sometimes felt as earache, fullness, or tinnitus) without any ear pathology. This is also why upper cervical dysfunction, which affects the same neural territory, can produce similar ear symptoms. If you've had your ears checked and they're clear, the jaw and cervical spine are the next structures to assess.
Yes, consistently. Psychosocial stress is one of the strongest predictors of TMD onset and progression (Fillingim et al., 2013). Under stress, most people clench or brace their jaw unconsciously, often without realising it. This loads the masseter and temporalis muscles chronically and compresses the joint. The pattern tends to be worse in people with high-demand work environments, poor sleep, or anxiety. Managing the cervical contribution and addressing clenching habits (sometimes alongside stress management) is part of how I approach this. A night guard from your dentist is often useful alongside manual therapy.
There's a biological reason for this. The TMJ contains oestrogen receptors, and as oestrogen declines during perimenopause, joint laxity may increase and the disc may become more prone to displacement and clicking. This is one proposed reason why existing TMD symptoms often worsen in the perimenopausal years, and why symptoms may have shifted recently. Research into how directly hormonal fluctuations translate into clinical symptoms is ongoing, and results so far are mixed (Zielinski & Pajak-Zielinska, 2024), but the association between perimenopause and worsening jaw symptoms is clinically consistent enough to factor into how the rehabilitation is paced. The treatment approach is the same regardless of hormonal stage, and the cervical component can be assessed and treated regardless of hormonal stage.
Related reading
References
- Bueno CH, et al. Gender differences in temporomandibular disorders in adult populational studies: A systematic review and meta-analysis. J Oral Rehabil. 2018;45(9):720–729. PubMed 29851110
- Zielinski G, Pajak-Zielinska B. Association between estrogen levels and temporomandibular disorders: an updated systematic review. Int J Mol Sci. 2024;25(18):9867. PMC11432328
- Fillingim RB, et al. Psychosocial factors associated with development of temporomandibular disorders: OPPERA prospective cohort study. J Pain. 2013;14(12 Suppl):T75–90. PMC3855656
- Bartsch T, Goadsby PJ. Increased responses in trigeminocervical nociceptive neurons to cervical input after stimulation of the dura mater. Brain. 2003;126(Pt 8):1801–1813. PubMed 12821523
- Calixtre LB, et al. Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials. J Oral Rehabil. 2015;42(11):847–861. PubMed 26059857
- La Touche R, et al. Manual therapy and therapeutic exercise in patients with temporomandibular disorders. Pain Medicine. 2020;21(10):2373–2384. PubMed 32181811
- Bednarczyk M, et al. Cervical spine rehabilitation in patients with myogenic temporomandibular disorders. J Oral Rehabil. 2024;51(6):1091–1107. PubMed 38454576
- Liberato FMD, et al. Manual therapy applied to the cervical joint reduces pain and improves jaw function in individuals with temporomandibular disorders: a systematic review on manual therapy for orofacial disorders. J Oral Facial Pain Headache. 2023. PMC10627199
- Šedý J, Pajak-Zielinska B, Olate LE, Vlna M, Žižka R. Neural basis of etiopathogenesis and treatment of cervicogenic orofacial pain. Medicina (Kaunas). 2022;58(10):1324. PMC9611820
Disclaimer
This page is for general information only and does not constitute medical advice. Every person's situation is different. Nothing here should be used as a substitute for assessment and advice from a qualified health professional who can evaluate your specific circumstances.
If you are experiencing severe or rapidly worsening symptoms, loss of bladder or bowel control, progressive weakness, or any symptom that concerns you, seek medical care promptly rather than reading websites.
This page was written with AI assistance and reviewed by Erik Anderson for accuracy. If you find an error, please contact us and we will endeavour to correct it.
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