Guía: Valoración de ATM y dolor mandibular en Valencia: qué revisamos cuando duele al masticar, la mandíbula hace clic o se bloquea

Valencia, 06.10.2026, by Dr Veronika Strauchs, Dentist · veroDENT

In summary:

If your jaw hurts when chewing, you hear clicking in the temporomandibular joint (TMJ), you notice locking or it is difficult to open your mouth, there may be a craniomandibular dysfunction (CMD, known in English as TMD). It is not a single problem: it may affect the chewing muscles, the joint itself or the way the teeth fit together, and often several at once. That is why the first step is not a splint "just in case" or an adjustment of the bite, but a structured, individual assessment of the TMJ and jaw pain.

At veroDENT in Valencia, Dr Veronika Strauchs devotes much of her practice to functional diagnosis and TMJ treatment. She trained in dentistry at the University of Regensburg (Germany), completed a specialist curriculum in Craniomandibular Dysfunction in Frankfurt (2022–2023) and has worked as a responsible dentist with a special focus on CMD and orthodontics. In her assessment she examines joints, muscles, bite and jaw function in line with clinical guidelines. The aim is clear: to identify which structure is causing the discomfort and to choose, first, reversible and well-indicated treatments.

The problem in detail: what is craniomandibular dysfunction?

Scientific societies define craniomandibular dysfunction as pain and/or dysfunction in the jaw region. Pain may present as pain in the chewing muscles, joint pain or tooth pain caused by overload (for example, from clenching). Dysfunction may appear as restricted movement, excessive mobility or lack of coordination, as changes within the joint (with or without pain) or as dental contacts that interfere with movement.

Put simply, "I have TMJ problems" is not yet a diagnosis. The latest interdisciplinary classification puts it this way: the term CMD only indicates where the problem is, not what is happening. It covers very different symptoms, painful and non-painful, some needing treatment and some not. This classification sorts cases into four main groups:

Muscular origin (myopathy): tension or pain in the muscles that move the jaw.
Joint origin (arthropathy): changes in the disc or in the joint surfaces.
Occlusal origin (occlusopathy): problems related to the bite and teeth.
Comorbidities: other influencing factors, such as stress, anxiety or chronic pain.

The most common symptoms

Discomfort when chewing

They usually result from muscle overload or joint irritation. Limited or asymmetric movement, with or without pain, may indicate that the main component is muscular.

Clicking

The typical click occurs when the articular disc has moved forward and, when the mouth opens, the mandibular condyle moves back over it. This is known as disc displacement with reduction.

Locking

Some people feel the jaw "catch" for a moment and release it with a small movement. Behind this is usually a very mobile disc with elongated ligaments that becomes intermittently trapped; if the joint is painful, the cause is usually inflammation of the synovial membrane (synovitis).

Limited mouth opening

According to international criteria, we speak of restriction when opening (the distance between the incisal edges plus the vertical overlap) is less than 40 mm. Above this value it is not considered restriction, even if the person feels it is. For eating, an incisal distance of at least 30 mm may be sufficient, but patients experience this reduction as a significant discomfort.

Who is affected?

Not only in adults: a Swedish study of 28,899 young people aged 12 to 19 found painful CMD symptoms in 4.2%. The frequency increased with age and was clearly higher in girls (6%) than in boys (2.7%). There is also a link with bruxism: the German S3 guideline on bruxism (2026) reports that people who clench or grind their teeth more often have muscle or joint pain, headache and muscle tension.

Patients' concerns

We often hear the same questions. We answer them with evidence.

If my jaw clicks, my joint is wearing out.

Not necessarily. International literature indicates that disc displacement with reduction, without pain or functional problems, does not on its own require splint treatment. The same applies to a ligamentous click without other findings, or to joint changes that have already adapted, provided there is no relevant psychosocial impact. A painless click is usually a finding to monitor, not an emergency.

Will my mouth be locked forever?

Intermittent locking almost always resolves on its own with a compensatory movement. Even when the disc no longer returns to its position, many patients regain normal mobility over time; if there are no symptoms, treatment is usually not needed. According to the German S3 guideline on idiopathic condylar resorption, invasive intervention to relieve discomfort is only rarely necessary in disc displacement without reduction.

I'm sure I'll need surgery or a full bite change.

It is one of the most widespread myths. The German guideline on occlusal splints (2024) reminds us that prosthetic or restorative measures to treat CMD are only needed in very rare and justified exceptions.

I also have head, neck or ear pain. Could it be linked?

It can be. Discomfort in the head (ears, face, eyes) often coexists with discomfort in nearby areas such as the neck and shoulders, although a direct cause-and-effect relationship is not always present. Therefore, intense or long-lasting pain, or pain that significantly affects daily life, should be distinguished from other orofacial pain and, if necessary, assessed together with other medical specialties.

What a TMJ and jaw pain assessment involves

Guidelines consider functional diagnosis a prerequisite for any individual treatment. Its aim is to identify the main symptoms and affected structures, and to distinguish which component predominates: muscular, joint, occlusal or comorbidities.

In practice, the assessment includes:

Clinical interview: When the discomfort started, what it is like, what makes it worse, whether there is locking, clenching or grinding habits, stress and sleep quality. Sleep disorders can increase both muscle tension and pain perception.
Examination of the chewing and accessory muscles, with palpation of tender points.
Examination of the joints: palpation and auscultation to identify clicks or crepitus (a rough friction that may indicate changes within the joint).
Measurement of jaw mobility: opening, lateral and forward movement, observing range and symmetry.
Bite analysis: premature contacts, interferences during sliding movements and signs of wear.
Screening for risk factors: excessive stress, anxiety, depression or chronic pain, as recommended by the guidelines.

What about imaging?

Magnetic resonance imaging (MRI) can confirm disc displacement when clinically suspected. However, it does not replace examination: muscular or joint pain can also limit opening and may be misinterpreted on imaging as a disc problem.

Current state of knowledge: differing views

The role of the bite: an open debate

For decades it was believed that a poor bite was the main cause of jaw pain. Today the picture is more nuanced. The German guideline on instrumental functional analysis (2022) acknowledges that occlusion as a triggering factor is internationally controversial. At the same time, it stresses that functional pain is multifactorial and that it is rarely necessary to systematically remodel, grind or reconstruct tooth surfaces to treat it. Therefore, if CMD is suspected before a prosthesis is placed, the guideline recommends prior functional treatment, for example with a splint, rather than simply copying the current bite.

Splints: useful, but not for everyone

Meta-analyses show that splints for muscular and joint discomfort significantly reduce pain compared with placebo splints or no treatment. In two studies, about 60% and 62% of patients treated with a relaxation splint achieved at least a 50% reduction in pain intensity and frequency. With relaxation therapy alone, the figure was 17% and 32%, and with brief education alone, 23%. However, mouth opening did not improve. There are important caveats. In one randomised trial, adding a splint to multimodal treatment (muscle exercises, cognitive behavioural therapy, self-care and mandibular manipulation) did not provide an additional effect. One review suggests that patients with a greater psychosocial burden benefit most from also treating these factors alongside the splint.

Repositioning splints: realistic expectations

In some cases of painful clicking or intermittent locking, splints that slightly advance the jaw (repositioning splints) are used. Immediately after fitting them, MRI shows a normal disc-condyle relationship in 74–92% of cases, but follow-up checks at one year increasingly reveal failures. For this reason, they are now used mainly to relieve pain and unload the joint for a limited time, not to "reposition" the disc permanently. The name itself is misleading: the splint allows the condyle to pass back under the disc again, but does not guarantee that the disc is repositioned.

Debate conclusion

The guidelines agree: after diagnosis, first information and advice, then self-care guidance according to the predominant component and, at the core of treatment, reversible therapies, which are preferable to invasive dental procedures. Irreversible measures in orthodontics, prosthetics or surgery should be reserved for strict indications, such as skeletal causes or loss of support in the posterior areas.

Solutions: a plan for your diagnosis

The 2024 guideline recommends defining treatment goals and explaining its possibilities, limits and consequences so that patient and clinician can decide together. The options, depending on the case, are:

Information and self-care: habits that protect the jaw, home exercises and self-observation (for example, noticing when you clench during the day).
Custom occlusal splint: alone or as part of a combined treatment, to relieve symptoms and with a specific indication. If it is to be worn for more than a month, it should preferably be made of hard resin, cover all teeth in the arch and rest on all posterior opposing teeth. It requires check-ups to adjust and assess it.
Physiotherapy: in clinical practice, combining manual therapy with home exercises is recommended. Depending on the case, the aim is to restore mobility, control hypermobility, reduce muscle spasm or calm inflammation. For limited opening, a splint combined with exercises gave better results than a splint alone.
Complementary measures: depending on the case, physiotherapy, short-term use of medication, biofeedback or psychotherapeutic support, in coordination with other specialists when pain is chronic.
Surgery: only in selected cases, starting with minimally invasive techniques such as arthrocentesis or arthroscopy; open procedures are reserved for advanced stages.

A reassuring detail: when the splint relieves symptoms, in most cases it can be gradually weaned off. The fact that it helps does not on its own justify permanent rehabilitation of the bite.

Summary

Pain when chewing, clicking, locking or limited opening may come from the muscles, the joint, the bite or several factors at once.
A painless click without functional problems usually does not need treatment, only monitoring.
The TMJ assessment checks joints, muscles, bite and movement to find out what is wrong and why.
Treatment starts with reversible options: information, self-care, a well-indicated splint and physiotherapy.
Reshaping teeth, changing the entire bite or surgery is needed only very rarely.

If you have jaw discomfort, Dr Veronika Strauchs sees you by appointment at veroDENT.

You can book by phone at +34 962 324 155, or by WhatsApp at +34 613 834 469 or at www.vero-dent.es.

(This article is informative and does not replace a clinical assessment.)