TMJ Support
Understanding jaw involvement in pediatric rheumatic disease
Temporomandibular joint (TMJ) involvement can occur in children and youth living with rheumatic disease. Because symptoms may be subtle or develop gradually, TMJ can sometimes go unnoticed.
Understanding how TMJ presents — and how it is assessed and managed — is important for supporting overall function, comfort, and long-term joint health.
What is TMJ Exactly?
The temporomandibular joint (TMJ) connects the jaw to the skull, just in front of each ear. It plays an essential role in everyday activities such as speaking, chewing, and yawning.
When this joint becomes inflamed—a condition sometimes referred to as TMJ involvement—it can affect how the jaw moves and feels.
How TMJ Presents Itself
Signs and symptoms of TMJ
TMJ involvement may not always be obvious.
Symptoms can include:
- Jaw pain or tenderness
- Clicking or popping sounds when opening or closing the mouth
- Difficulty or discomfort when chewing
- Limited range of motion or the jaw feeling “stuck”
- Changes in how the teeth align when biting
TMJ involvement can be part of certain rheumatic conditions and may come and go over time. Early awareness and support can help manage symptoms and maintain comfortable movement.
Why This Matters
Because the TMJ plays a role in growth and development, untreated inflammation can affect jaw development over time.
Monitoring and early management help reduce the risk of long-term complications.
“TMJ involvement can be easy to miss, but early identification is important in preventing long-term changes in jaw development.”
— Pediatric Rheumatology Care Team
Assessment and Monitoring
Healthcare teams may assess TMJ involvement in a few different ways, depending on symptoms and age:
Physical examination
Checking jaw movement, alignment, and any signs of pain, stiffness, or clicking.
Imaging (such as MRI)
In some cases, imaging may be used to look more closely at inflammation or changes within the joint that aren’t visible during a physical exam.
Ongoing monitoring of jaw movement and development
Tracking how the jaw grows and functions over time is especially important for children and youth, as early changes can affect development.
Regular assessment helps support early detection and allows care teams to adjust treatment as needed—helping maintain comfort, function, and healthy jaw development.
Management and Support
Managing TMJ involvement focuses on reducing inflammation, maintaining comfortable movement, and supporting healthy jaw development over time. Care is tailored to each child based on their symptoms and needs.
Management approaches may include:
Medical treatment to control inflammation
Medications prescribed by a rheumatologist can help reduce inflammation and manage symptoms affecting the joint.
Physiotherapy or guided jaw exercises
Targeted exercises may help improve mobility, reduce stiffness, and support proper jaw function.
Dental or orthodontic support when needed
In some cases, dental specialists may be involved to monitor alignment and support healthy jaw development as a child grows.
Regular monitoring over time
Ongoing check-ins allow healthcare teams to track changes, adjust care, and respond early if new symptoms arise.
Care is often coordinated between rheumatology and dental specialists, helping ensure a well-rounded approach that supports both joint health and development.
Daily Support
Supporting comfort day to day.
Simple, everyday strategies can help reduce discomfort and support jaw function—especially during flare-ups:
Choosing softer foods during flare-ups
Foods like yogurt, smoothies, soups, or mashed options can reduce strain on the jaw when chewing is uncomfortable.
Avoiding excessive strain on the jaw
Limiting habits like chewing gum, biting hard foods, or opening the mouth very wide (e.g. big yawns) can help prevent added stress on the joint.
Following recommended exercises
Gentle, guided exercises from a healthcare provider can support mobility and help maintain proper jaw movement over time.
Monitoring changes in symptoms
Noticing patterns—such as increased pain, clicking, or reduced movement—can help families and care teams respond early and adjust support as needed.
Small adjustments like these can make a meaningful difference in day-to-day comfort and help support long-term joint health.
TMJ Videos
Understanding jaw involvement and supporting healthy movement.
These videos explain how juvenile arthritis can affect the jaw, what symptoms families can watch for, why assessment may be needed, and how guided jaw exercises may support movement and comfort
TMJ & JIA | Class Rheum Hub | Tips & Tricks | Cassie + Friends
Range of motion for the jaw exercise #1
Range of motion for the jaw exercise #2
Isomeric strengthening with resistance- FIRST EXERCISE
Isometric strengthening exercise- SECOND EXCERISE
Strength with movement jaw exercise #1
Strength exercise for jaw #2
Neck Mobility
TMJ Massage exercise
Deep flex for neck exercise
TMJ FAQs
If the patient seems to respond great to naproxen/NSAID and cortisone, what would be the reasoning for starting methotrexate or another second-line agent? Would part of it be in hopes of coming off the NSAID?
In our treatment of JIA, we often initially start with NSAID (e.g. naproxen) and may use corticosteroid joint injections for a few large joints. If this allows patients to achieve remission, then typically a disease modifying anti-rheumatic drug (DMARD) such as methotrexate is not required. However, if there is any residual disease activity after NSAID and injections (for example, in small finger or toe joints, or jaw [TMJ]) then a DMARD would be indicated. Also, if the joint injections don’t have a lasting effect, a DMARD may be beneficial. An advantage of using a DMARD is that it can also help to prevent additional joints from becoming affected by arthritis, and prevent joint damage in the long term.
If my oligo child now also has TMJ involvement, is that still considered Oligo? And how aggressive should this joint be treated?
Involvement of the TMJ joint is very common in JIA and is most often without symptoms like pain or stiffness. Most commonly, a pediatric rheumatologist notices changes in the movement of the TMJ or growth of the jaw bones which prompts an evaluation for TMJ disease with an MRI. TMJ involvement does occur in oligoarthritis but would be more commonly seen in polyarthritis patients. How to best diagnose, treat and monitor TMJ arthritis is an active area of research in pediatric rheumatology. At this time, our approach is to treat the TMJ if it is significantly inflamed with medications including DMARDs (e.g. methotrexate) +/- biologics to attempt to decrease the risk of long-term complications. This could include facial bone growth abnormalities, need for orthodontics, oral surgery, chronic TMJ pain and sleep apnea. We also often seek advice from our dental colleagues regarding the need for a splint or other specific dental care.
Are there any sports children with JIA should avoid?
Children who have had arthritis affecting their neck should be screened for instability in that area before participation in any contact sports. Children should be reminded to wear protective eye equipment as per the general population. For children who have had uveitis, there might be an increased risk of eye injury in some sports. Children with a history of arthritis in the jaw (TMJ) are advised to wear properly fitted mouth guards for certain sports (e.g. contact) when these precautions are already recommended for the general population.
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TMJ Summary
Understanding TMJ involvement and monitoring changes over time can help support long-term comfort, function, and development.