TMJ Disorders: Tongue Pain and Related Symptoms

Temporomandibular joint, small white spots on the tongue, and pain when pressure is applied to the throat?

Hello Doctor: I have been experiencing issues with my temporomandibular joint (TMJ) for a long time.
Whenever I open my mouth slightly, there is a clicking sound that has persisted for over a year.
Sometimes it is mild, and other times it is more severe, to the point that people sitting next to me can hear it.
However, since it doesn't cause pain, just some discomfort, I haven't sought treatment.
Recently, I have been experiencing pain at the tip of my tongue, which I initially thought was due to excessive heat causing an ulcer, but yesterday I noticed a small white spot that hurts when touched.
This morning, while washing my face, I discovered that pressing on the area between my chin and neck causes pain.
I now feel discomfort in my TMJ and around my ear, with some soreness, but it's not unbearable.

Additionally, I have a recurring pain point that has appeared occasionally over the past two years.
This pain is so intense that I cannot stand and must lie down.
It starts in my teeth (or cheek area), and at first, I thought it was a toothache.
As the pain progresses, it radiates to my neck, then to my stomach, and finally to my back.
These pain points persist intensely, forcing me to sit or lie down to rest and endure it.
After about half an hour, the pain gradually subsides.

This pain does not occur at specific times, and I have not been able to identify the triggers; it just happens suddenly.
I have noticed that if I start to feel the pain coming on, drinking some water helps alleviate it, preventing it from becoming severe, but it still affects my stomach and back.
(Recently, I also experienced stomach pain that radiated to my back.) I apologize for feeling like I have many issues, but I believe they are minor problems that can be bothersome.
I would like to ask which specialty I should consult for these issues.
Thank you.

Linda, 40~49 year old female. Ask Date: 2017/07/04

Dr. Chen Taicheng reply Family Medicine

● If your temporomandibular joint (TMJ) is consistently making sounds and feels stiff, it may lead to joint wear.
Please consult an oral and maxillofacial surgeon or an otolaryngologist at a major hospital.
● Small white spots on the tongue may simply be ulcers, which typically heal on their own within one to two weeks; seek medical attention if you have concerns.
The same applies to pain points between the chin and neck.
● Considering your TMJ issues and the pain points you described, some symptoms may resemble fibromyalgia (illustration: https://goo.gl/zhHfxP) (Taiwan University Neurology educational article: https://goo.gl/qKUOpn).
Other conditions such as myofascial pain syndrome, chronic fatigue syndrome (which may include muscle pain, sore throat, memory issues, and extreme fatigue), hypothyroidism, or rheumatic or autoimmune diseases may also present similar symptoms.
● Please seek further evaluation from a rheumatologist or neurologist.
Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital Family Medicine Department cares about you.

Reply Date: 2017/07/04

More Info

Hello! Thank you for sharing your concerns regarding your health issues, particularly related to temporomandibular joint (TMJ) disorders and the associated symptoms you are experiencing. It sounds like you have been dealing with a variety of symptoms that are causing you discomfort and concern, and I appreciate your willingness to seek guidance.

Based on your description, it seems you are experiencing a combination of TMJ-related symptoms, tongue pain, and possibly referred pain that extends to other areas of your body. TMJ disorders can manifest in various ways, including clicking or popping sounds when opening the mouth, pain in the jaw or surrounding areas, and even discomfort that radiates to the neck, shoulders, and head. The pain you are experiencing in your tongue, particularly the small white spot, could be indicative of a few different issues, such as a canker sore, oral thrush, or even irritation from grinding your teeth, which is common in individuals with TMJ disorders.

The pain that you describe as starting from your teeth and extending to your neck, back, and even stomach is concerning and suggests that there may be a more complex interplay of symptoms at work. This could be related to muscle tension, nerve involvement, or even gastrointestinal issues that are exacerbated by stress or pain. It is not uncommon for individuals with chronic pain conditions to experience referred pain, where discomfort in one area of the body manifests as pain in another.

Given the range of symptoms you are experiencing, I would recommend that you consider seeing a healthcare provider who specializes in TMJ disorders, such as a dentist with experience in this area or an oral and maxillofacial surgeon. They can perform a thorough examination of your jaw and assess for any structural issues, muscle tension, or signs of bruxism (teeth grinding), which could be contributing to your symptoms.

Additionally, if the pain in your stomach and back persists, it may be beneficial to consult with a gastroenterologist to rule out any underlying gastrointestinal issues that could be contributing to your discomfort. It’s important to address all aspects of your health, as symptoms can often be interconnected.

In the meantime, there are several self-care strategies you can implement to help manage your symptoms. These include:
1. Jaw Exercises: Gentle stretching and relaxation exercises for your jaw can help alleviate tension. Avoid wide yawning or chewing hard foods that may exacerbate the clicking or popping sounds.

2. Heat and Cold Therapy: Applying a warm compress to your jaw can help relax the muscles, while cold packs can reduce inflammation if there is any swelling.

3. Hydration: Staying well-hydrated can help with overall muscle function and may alleviate some discomfort.

4. Stress Management: Since stress can exacerbate TMJ symptoms, consider incorporating relaxation techniques such as deep breathing, meditation, or yoga into your routine.

5. Dietary Adjustments: Soft foods may be easier to manage while you are experiencing discomfort, and avoiding caffeine and alcohol can also help reduce muscle tension.

6. Pain Management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, may provide temporary relief from pain and inflammation.

It’s crucial to keep track of your symptoms and any triggers you notice, as this information will be valuable for your healthcare provider in determining the best course of action. Remember, while it’s easy to feel overwhelmed by multiple symptoms, addressing them one step at a time with the help of a qualified professional can lead to significant improvements in your quality of life.

Please don’t hesitate to reach out to a healthcare provider for a comprehensive evaluation. Your health and well-being are important, and seeking help is a proactive step towards feeling better. Take care!

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