General Dentistry · Last reviewed May 2026
TMJ Pain: Conservative First
Surgical Last.
Picasso Dental treats TMJ and jaw pain in Vietnam with a conservative-first approach: jaw clicking, locking and pain assessed for, stabilisation splints. Most TMJ pain responds to conservative care: a splint, behavioural advice and jaw physical therapy. Picasso has no registered TMJ specialist or oral medicine physician on staff, so surgical or imaging-led cases are referred transparently to a maxillofacial specialist.
What is TMJ / TMD?
Temporomandibular joint disorder (TMD), commonly called TMJ, is an umbrella term for pain and dysfunction in the jaw joint and the muscles that move it. Symptoms include clicking, popping, limited mouth opening, locking, jaw pain, ear pain and headaches. The cause is usually multifactorial: bruxism, joint disc displacement, stress, posture, occlusion or trauma all contribute. Most cases are managed without surgery.
Common Symptoms
Any combination of these warrants assessment, especially when symptoms persist beyond a few weeks or interfere with eating, speaking or sleeping.
Clicking or Popping
Audible or palpable click when opening, closing or chewing. Painless clicks are common and may not need treatment, painful clicks do.
Jaw Pain on Function
Pain when chewing tough food, yawning widely or speaking for long periods. Often localised to in front of the ear or along the jaw line.
Limited Mouth Opening
Less than approximately 40mm at rest (about three fingers stacked vertically). Restricted opening is one of the clearest functional indicators.
Locking
Cannot fully open (closed lock), or cannot close from an open position (open lock). Locking is a red flag and warrants prompt assessment.
Referred Pain
Pain radiating to the ear, temple or neck. The trigeminal nerve and adjacent muscle groups make referred pain common in TMJ.
Headaches
Especially temporal headaches from overactive temporalis muscle, often worse on waking when sleep bruxism is involved.
Tinnitus
Ringing or fullness in the ear is sometimes associated with TMJ. ENT review is appropriate when ear symptoms dominate the picture.
Why Picasso for TMJ
We are general dentists, not oral medicine specialists. What we do well is conservative diagnosis and first-line care, with transparent referral when sub-specialty input is needed.
Comprehensive Joint and Muscle Exam
Palpation of the joint and the masseter, temporalis and lateral pterygoid muscles. We map where it hurts before we plan what to do.
Occlusal Analysis
We assess your bite for premature contacts, recent restorative changes and parafunctional wear patterns that could be loading the joint.
Range of Motion Measurement
Maximum opening, lateral excursion and protrusion, measured in millimetres. Objective numbers we can track at follow-up.
Splint Therapy When Appropriate
Custom Michigan-style stabilisation splint, fabricated from your iTero scan. We adjust it across follow-up visits as your bite and muscles settle.
Behavioural and Posture Advice
Jaw rest, soft diet during flares, parafunctional habit awareness, sleep hygiene, stress management. Cheap and often surprisingly effective.
Transparent Referral
If your case needs joint injection, arthrocentesis, BOTOX, MRI-led specialist work or surgery, we say so and coordinate the referral.
What's Causing It?
TMJ is rarely a single-cause problem. Most patients have two or three of these contributing at once, which is why a single intervention rarely solves everything.
Bruxism (Grinding)
The most common single contributor. Sleep grinding loads the muscles and joint for hours each night. See our bruxism page for detail.
Disc Displacement
The fibrous cushion between the jaw bone and skull has slipped forward. Causes clicking on opening, sometimes locking. Often manageable conservatively.
Joint Inflammation
Osteoarthritis, rheumatoid arthritis or other inflammatory joint disease can affect the TMJ. Rheumatology input may be appropriate.
Trauma
A direct blow to the jaw, whiplash from a motor vehicle accident, or a wide forced opening (long dental procedure, intubation) can trigger TMJ symptoms.
Habitual Posture and Stress
Forward head posture, prolonged screen use, gum chewing, nail biting and clenching during stress all load the joint and muscles.
Recent Dental Work
A new crown or filling that sits high on the bite, or extensive restorative work that altered your occlusion, can trigger TMJ symptoms within days to weeks.
TMJ Pricing
Diagnostic and conservative care pricing. Specialist referral fees vary by specialist; we coordinate but do not control them.
| Service | Price |
|---|---|
| Diagnostic exam | |
| Panoramic X-ray (OPG) | |
| CBCT 3D imaging (if structural concern) | 600,000 |
| Stabilisation splint (Michigan style) | 1,500,000 – 3,000,000 |
| Adjustment visits during splint therapy | 200,000 each |
| Follow-up visits | |
| Specialist referral (maxillofacial) | We coordinate, fees vary |
If grinding is the dominant cause, see teeth grinding and bruxism for nightguard pricing.
Treatment Ladder
We always start at the bottom rung. Most patients never need to climb past splint therapy.
1. Education and Behavioural Advice
Jaw rest, soft diet during flares, awareness of clenching and parafunctional habits, sleep hygiene, stress management. The cheapest intervention and often the most effective.
2. Physical Therapy or Jaw Exercises
Stretching, controlled opening exercises, muscle release. We can guide simple routines, or refer to a physiotherapist for hands-on work.
3. Stabilisation Splint
Michigan-style night guard fabricated from your digital scan. Worn nightly, adjusted across follow-up visits, reviewed at 4-6 weeks.
4. Targeted Bite Analysis
If symptoms started after recent dental work, we check whether a high spot on a new restoration is loading the joint, and adjust as appropriate.
5. Anti-Inflammatories
For acute flares, short-course NSAIDs prescribed via medical referral can break the pain cycle. We do not prescribe systemic medication ourselves beyond standard dental analgesics.
6. Specialist Referral
If symptoms persist after conservative care, we refer to a maxillofacial surgeon or oral medicine physician at a major hospital for sub-specialty assessment.
7. Surgical Intervention
Only as last resort, only by a specialist, and only when conservative care has failed and structural joint disease is confirmed. The minority of cases.
What Picasso Does NOT Do
Honest scope. Some TMJ interventions are outside what general dentists should perform, and we will not pretend otherwise.
BOTOX Masseter Injection
We do not perform therapeutic BOTOX for TMJ or masseter hypertrophy. Where indicated, we refer to an oral medicine physician or experienced maxillofacial specialist.
Arthrocentesis or Joint Surgery
Joint washout, arthroscopy and open joint surgery are maxillofacial procedures performed in hospital theatre. We refer, we do not attempt these in private dental practice.
Aggressive Occlusal Equilibration
Permanent bite reshaping (grinding down healthy enamel to alter occlusion) is irreversible and rarely the right answer. We only consider it after splint stabilises symptoms, and only with full informed consent.
Our 5-Step Process
From first phone call to treatment plan in a single visit, with structured review at 4-6 weeks.
1. History
When did symptoms start, what triggers them, recent dental work, bruxism habits, stress and sleep, prior trauma. Most diagnostic information comes from listening carefully.
2. Clinical Joint and Muscle Exam
Palpation of the joint and surrounding muscles, auscultation for clicking and crepitus, occlusal review, screening for parafunctional wear.
3. Range of Motion Measurement
Maximum opening, lateral and protrusive movements measured in millimetres. Baseline numbers we can compare against at review.
4. Imaging if Indicated
Panoramic X-ray for screening, CBCT 3D imaging if a structural concern is suspected. MRI is ordered by the specialist when surgical planning is needed.
5. Conservative Treatment Plan
Behavioural advice, splint therapy if appropriate, written quote, scheduled review at 4-6 weeks. We adjust the plan based on response.
Honest Expectation-Setting
Many TMJ cases improve over weeks to months with conservative care. Some are chronic and need ongoing management. Severe disc displacement or arthritic joint disease may need specialist intervention that is outside what we offer. We are clear about what we can and cannot solve before treatment begins, and we will tell you if your symptoms point away from a primary jaw cause toward ENT, rheumatology or neurology review.
Your TMJ Care Team
Picasso has no registered TMJ specialist or oral medicine physician on staff. Conservative TMJ care is delivered by our senior general dentists, with referral coordinated by Dr. Emily Nguyen when sub-specialty input is needed.
Dr. Thao Tran
General Dentist. Conservative TMJ assessment, splint therapy, behavioural and occlusal management.
Dr. Nhung Duong
General Dentist. Conservative TMJ assessment, splint therapy, behavioural and occlusal management.
Dr. Emily Nguyen
Founding Clinical Director. Sets case-selection standards and coordinates referral to maxillofacial specialists for surgical or imaging-led cases.
Common Questions
Do you treat TMJ at Picasso?
Yes, for conservative care. Our general dentists examine, diagnose and manage most TMJ cases with behavioural advice, jaw physical therapy guidance and stabilisation splints. Picasso has no registered TMJ specialist or oral medicine physician on staff, so cases needing surgery, joint injection or imaging-led specialty care are referred to a maxillofacial surgeon.
What is a TMJ splint?
A stabilisation splint (Michigan-style) is a custom acrylic device worn at night over the upper or lower teeth. It protects teeth from grinding, repositions the jaw to a relaxed posture and reduces muscle and joint loading. Splints are reversible, well-evidenced for muscular TMJ pain, and our standard first-line conservative treatment.
Will a splint cure my pain?
For muscular TMJ pain driven by bruxism and clenching, splints commonly reduce symptoms substantially within weeks to months. For disc displacement or arthritic joint disease, a splint may help symptoms but does not cure the underlying joint problem. We review at 4-6 weeks and adjust the plan based on response.
Do I need surgery for TMJ?
Most TMJ cases never need surgery. Conservative care (splint, behavioural advice, physical therapy) resolves or controls symptoms for the majority of patients. Surgery is reserved for the small percentage with confirmed structural joint disease that has not responded to non-surgical care, and is performed only by a maxillofacial specialist.
Will my clicking go away?
Painless clicking is common and often does not need treatment. Clicking with pain, locking, or restricted opening warrants assessment. Conservative care reduces clicking in some patients, in others the click remains but pain resolves. We focus on function and pain, not the click itself.
Can stress cause TMJ?
Yes, indirectly. Stress drives clenching and grinding, which loads the jaw muscles and joint. Many patients report flare-ups during periods of high stress. Behavioural advice (jaw rest, awareness, sleep hygiene, stress management) is part of the standard treatment ladder.
Can TMJ cause headaches?
Yes. Temporal headaches from overactive temporalis and masseter muscles are common in TMJ patients. Ear pain, fullness and tinnitus can also be referred from the joint. Persistent headaches without clear jaw involvement should also be assessed by a physician to rule out other causes.
Do I need an MRI?
Not for most cases. Clinical examination and a panoramic X-ray are usually sufficient for first-line management. CBCT 3D imaging is added if a structural concern (arthritis, fracture, congenital anomaly) is suspected. MRI, which images the joint disc and soft tissue, is ordered by the specialist when surgical planning is needed.
Why does Picasso not have an oral medicine specialist?
Oral medicine and TMJ specialty practice is a small, sub-specialised field in Vietnam, with most specialists based at university hospitals rather than private clinics. We are honest about this: our general dentists handle conservative TMJ care to a high standard, and we refer to maxillofacial surgeons or oral medicine physicians at major hospitals when sub-specialty input is needed.
When should I see an ENT or rheumatologist instead?
See an ENT if ear pain, hearing changes or tinnitus are the dominant symptoms and there is no clear jaw involvement. See a rheumatologist if jaw pain accompanies symptoms in other joints (hands, knees), morning stiffness, or known autoimmune disease. We will tell you when the picture points away from a primary jaw cause.
Start Here
Jaw Pain?
Start with a Diagnostic Exam.
Book a diagnostic exam. We will examine your joint and muscles, measure your range of motion, recommend conservative care if appropriate, and refer transparently if your case needs a maxillofacial specialist.