Lower back pain is the hallmark symptom of ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA). However, the joint diseases can also impact other parts of the body, including the jaw. Painful jaw movement can make it difficult to swallow, eat, speak, and even open your mouth.

Jaw pain is a common complication for people with ankylosing spondylitis and other types of arthritis. Research shows that between 4 percent and 35 percent of people with AS experience jaw pain. On MySpondylitisTeam, more than 260 members report jaw pain as a symptom.

Temporomandibular joint (TMJ) syndrome — also called temporomandibular joint disorder, or TMD — involves the temporomandibular joints located on either side of your face, directly in front of your ears. They connect your lower jawbone to your skull and help with eating and talking. More than 120 members report having TMJ disorders along with spondylitis.

“OMG! The jaw pain! Does anyone else have it?” one member wrote. “It goes from side to side and just won’t quit! I have spent a fortune with the orthodontist getting mouthpieces I wear day and night. They help, but it still hurts!”

Talking to your doctor about jaw pain is a vital first step to finding out what’s causing it and how it can be effectively managed.

What Does Ankylosing Spondylitis Jaw Pain Feel Like?

Along with discussing pain in the back, neck, hips, and shoulders, a lot of MySpondylitisTeam members describe experiencing pain in their jaw. This pain is chronic, and it varies from person to person. For some, it’s mild, and for others, it’s very severe.

Often, it’s worse in the morning upon waking. Some members share that the pain is in both sides of their jaw or moves from one side to the other. For others it’s associated with teeth-grinding, or bruxism.

Here are some examples of how MySpondylitisTeam members describe their jaw pain and dysfunction:

• “I’m tired and my jaw is very tender.”
• “My jaw and neck are tight and sore.”
• “The pain and swelling in my jaw persist.”
• “I’m having pain in my ear into my jaw and nothing’s helping.”
• “Jaw and ear pain, and my entire upper back will spasm as well as my neck.”
• “My throat is hurting, and I can’t really open my mouth because my jaw is so inflamed.”

Others say the jaw pain is accompanied by headaches and sometimes trouble maintaining balance. “I have TMJ in my jaw,” one member shared. “My balance has not been great either. I never related that before, but my hubby says I walk into him while walking but don’t mean to.”

What Causes Jaw Pain in Ankylosing Spondylitis?

A large study on the prevalence of TMJ in people with ankylosing spondylitis found that it’s more common for them than the general population. The researchers suggested that people with AS have a greater risk for developing TMJ, possibly due to high levels of inflammation that affect the joints and ligaments.

How Ankylosing Spondylitis Causes Jaw Pain

The places where joints, ligaments, and tendons attach to the bone are called the entheses. Inflammation of the entheses is a hallmark symptom of AS and may occur in multiple parts of the body. These places are called “hot spots.” When the jaw joint becomes inflamed, it becomes swollen and tender.

Research shows that the inflamed tissues in the entheses may swell enough to put pressure on the nerves in the area, causing pain. In at least one case report, someone with AS developed ankylosis of the mandibular joint, similar to the bone growth and fusion that can happen in the spine.

Talking to Your Doctor About Jaw Pain

Jaw pain may not be an obvious thing to talk to your rheumatology specialist about, but it’s important to report it. This is true of any other symptoms as well, since spondylitis can affect many different parts of your body outside your joints, including your eyes and nails.

Don’t worry about complaining too much, and don’t assume jaw pain is not related to your lower back pain. Reporting any and all symptoms helps your doctor get a clear view of your overall health and make recommendations for the most effective ways to treat your condition.

Even if you’re not sure your symptoms are related to AS, it’s always best to ask the question.

Managing Jaw Pain in Ankylosing Spondylitis

MySpondylitisTeam members have discussed many treatment options for alleviating AS-related jaw pain. Following are some of the nonsurgical treatments members have reported to be effective.

Before trying any of the options below or others you hear about, talk to your doctor. With their approval, experiment with different methods until you find approaches that work for you. Your rheumatologist may decide which treatment to recommend partly based on whether your axSpA is active or stable.

Medications

Jaw pain is treated together with the other symptoms of AS. Many members take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. NSAIDs are considered first-line treatments for AS and have proved effective for easing pain — including jaw pain.

If NSAIDs aren’t helping your symptoms, your doctor may prescribe other anti-inflammatory medications. These include disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine, methotrexate, and biologics like adalimumab (Humira) and certolizumab (Cimzia). In rare cases, steroid injections have proved useful to temporarily alleviate TMJ pain symptoms.

Your doctor may also prescribe medication to help you manage your symptoms. “Muscle relaxers at night help some. It’s throbbing into the ear, eye, and neck that really pushes my limits,” one member shared. “Sometimes heat and ice help as well.”

Complementary and Alternative Medicine

Complementary and alternative medicine treatments may be helpful for AS-related jaw pain. These could include acupuncture (when administered by a trained professional) and yoga.

Biofeedback, Splint Therapy, and TENS

Some people experience severe jaw pain that prevents them from opening their mouths completely. Biofeedback therapy — a nondrug treatment involving electrical sensors — can help. Through the therapy, people learn to control muscle tension.

Transcutaneous electrical nerve stimulation (TENS) is a low-level electrical current applied to the jaw joint (from the outside). This technique may reset the body’s pain signals and help muscles relax.

Some people also find relief through splint therapy, which involves wearing a mouth guard custom-made by a dentist.

Physical Therapy

The muscles in the jaw, and the jaw joint itself, often respond to physical therapy approaches. These include:

• Exercises to strengthen the jaw muscles and improve range of motion
• Heat, in the form of heating pads and gargling warm water, to improve blood circulation
• Ice to reduce pain and swelling
• Massage to reduce muscle tension
• Practicing correct posture and jaw alignment

Be sure to get a referral from your doctor for a physical therapist with experience treating TMJ.

Surgery

Surgery is rarely required to treat jaw pain. However, in severe cases, a doctor may recommend replacement of the jaw joint. Early prosthetic options for jaw replacement were often uncomfortable, but research has led to improved, custom-fitted prostheses that are more comfortable after surgery.

Several MySpondylitisTeam members report having had jaw surgery. “I have been dealing with TMJ for about 40-plus years,” wrote one member. “I’ve had three surgeries and have a headache everyday!” Another wrote, “I was diagnosed with spondylitis back in 2007, after my jaw became dislocated from eating an apple. I had no prior issues with my TMJ, but it literally disintegrated — 14 surgeries in five years, with a total joint replacement in my jaw.”

Lifestyle Changes

People with AS-related jaw pain may find relief — and improve their overall health — by making certain lifestyle changes. Some common recommendations include:

• If you smoke, consider stopping. Giving up isn’t easy, but it’s possible with support, and the benefits are enormous.
• Exercise (gently) for 150 minutes per week.
• Eat well to keep other conditions, like diabetes and high blood pressure, under control.

Always talk to your doctor before making changes to your diet or activity levels. They can help you make a plan that is best for your individual needs.

Find Your Team

MySpondylitisTeam is the social network and online support group for people with spondylitis and their loved ones. Here, more than 95,000 members come together to ask questions, give advice, and share their experiences of living with spondylitis.

Do you experience jaw pain with nr-axSpA or ankylosing spondylitis? Have you found effective ways to manage the pain? Share your tips in the comments below or by posting on your Activities page.