Temporomandibular Joint Disorder (TMD), often referred to as TMJ disorder, is a condition that affects the jaw joint and surrounding muscles, leading to pain, dysfunction, and a host of other uncomfortable symptoms, including headaches. While many factors contribute to TMJ/TMD and headaches, one often-overlooked cause is a tongue tie, or a restriction in the lingual frenulum, the tissue that connects the tongue to the floor of the mouth.
In almost every list search for symptoms of TMJ/TMD you will find headaches noted. Conversely, on every list search for causes, there is no mention of tongue tie.
Interestingly, several symptoms of tongue tie overlap with symptoms of TMD. Speech therapists trained in monofunctional and feeding techniques look for recruitment in muscles. Often this recruitment for help causes dysfunctional patterns to emerge.
Recruitment is the process of borrowing from one muscle group or area of the body to assist a deficit in another area or muscle of the body. In this case, the limited range of motion and strength exhibited by a tied tongue requires recruitment of the jaw and surrounding muscles.
Understanding TMJ/TMD and Headaches
The temporomandibular joint (TMJ) is one of the most complex joints in the human body, allowing for a range of movements necessary for speaking, chewing, and swallowing. When this joint is not functioning properly, it can lead to TMJ disorder (TMD), which encompasses a variety of symptoms, including:
Jaw pain or tenderness
Experiencing pain or tenderness without obvious injury to your jaw is the first overt sign of having used the jaw poorly. Repetitive actions such as sliding or gliding left to right or jutting forward when performing speech and feeding tasks can lead to a breakdown in the joint. First, you’ll feel tenderness, then it progresses to pain.
Difficulty opening or closing the mouth
Before pain arrives, there can be noticeable limits in the range of motion. Feeling stuck, as if you can’t open wide, and then feeling “off” as you close. The molars may feel as if they do not touch and line up as you open and close the mouth.
Clicking or popping sounds in the jaw
If you’re experiencing clicking or popping sounds then the alignment is sliding out of sync in transitions from the open and closed stages. The subtle movements are difficult to maintain, and the jaw is jumping from one position to the next roughly.
Facial pain
Pain can radiate from its origin to other regions of the face. Experiencing tension or pain in the tongue, chin, or cheeks demonstrates overcompensation and indicates poor function.
Earaches or ringing in the ears (tinnitus)
We might see the pain radiate from the jaw into the ear canal, but often one does not realize the source of pain is in the jaw not the ear.
Chronic headaches or migraines
Headaches associated with TMJ/TMD often present as tension-type headaches or migraines due to the strain on the jaw and surrounding muscles.
Patients suffering from TMJ-related headaches frequently experience pain radiating from the jaw to the temples, forehead, or even behind the eyes. The connection between TMJ/TMD and headaches is well established as we see from this research:
Di Paolo C, D’Urso A, Papi P, Di Sabato F, Rosella D, Pompa G, Polimeni A. Temporomandibular Disorders and Headache: A Retrospective Analysis of 1198 Patients. Pain Res Manag. 2017;2017:3203027. doi: 10.1155/2017/3203027. Epub 2017 Mar 21. PMID: 28420942; PMCID: PMC5379086.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5379086
In their conclusions the authors noted:
“This study is consistent with previous literature in showing a close relationship between headache and TMD. Data underlines that headache makes pain parameters more intense and frequent, complicating dysfunctional diseases both in the diagnostic phase and in treatment. Therefore, it is desirable to perform an early and multidisciplinary treatment of TMDs in order to avoid the overlay of painful events that could result in pain chronicity.”
We’ve established that headaches are symptoms of TMD but the underlying causes of TMJ dysfunction are still being explored. One such cause that deserves attention is tethered oral tissues, specifically a tongue tie. Let’s take a closer look at this one.
What is a Tongue Tie?
A tongue tie, or ankyloglossia, is a condition in which the lingual frenulum is abnormally short, thick, or tight, restricting the movement of the tongue. While tongue ties are most commonly recognized in infants who struggle with breastfeeding, they can persist into childhood and adulthood, affecting oral function in numerous ways.
Tongue ties can impact: speech articulation, swallowing patterns, oral rest posture, breathing patterns, jaw development, and muscle tension in the face and neck.
When the tongue is restricted in its mobility, it can lead to compensatory behaviors, including altered jaw function, forward head posture, and increased tension in the surrounding musculature. These adaptations can contribute to TMJ/TMD and headaches over time.
How a Tongue Tie Contributes to TMJ/TMD and Headaches
A tongue tie can contribute to TMJ dysfunction and headaches in several ways:
1. Altered Oral Rest Posture
The tongue plays a crucial role in maintaining proper oral rest posture, which involves the tongue resting on the roof of the mouth, the lips gently closed, and nasal breathing. When a tongue tie prevents the tongue from achieving proper placement, the result is often an open-mouth posture, forward head positioning, and compensatory jaw movements—all of which place strain on the TMJ and surrounding muscles.
2. Compensatory Jaw Movements
Since a restricted tongue cannot perform its natural movements effectively, individuals with a tongue tie often develop abnormal compensation strategies, such as excessive jaw movement when speaking, eating, or swallowing. Over time, these movements create stress on the TMJ, leading to dysfunction and pain.
3. Muscle Tension and Myofascial Strain
A tongue tie leads to increased strain on the muscles of the jaw, neck, and face. When the tongue cannot function optimally, other muscles must work harder to compensate, leading to chronic tension, trigger points, and myofascial pain. This tension frequently manifests as headaches, neck pain, and even shoulder discomfort.
4. Impaired Swallowing and Breathing Patterns
Proper swallowing requires a coordinated movement of the tongue, jaw, and throat muscles. A restricted tongue can disrupt this process, leading to inefficient swallowing patterns that place strain on the jaw and exacerbate TMJ/TMD symptoms. Additionally, tongue ties can contribute to mouth breathing, which further impacts jaw alignment and overall craniofacial development.
5. Impact on Dental and Orthodontic Health
Tongue ties can influence dental occlusion and contribute to malocclusion, crowding, or an open bite. These structural issues can place further strain on the TMJ, leading to an increased risk of developing TMJ disorder and associated headaches.
Identifying a Tongue Tie as a Contributing Factor
While many people may not immediately connect their TMJ/TMD symptoms and headaches with a tongue tie, a thorough evaluation by a professional trained in tethered oral tissues—such as a myofunctional therapist, speech-language pathologist, or dentist specializing in airway and oral function—can help determine if a tongue tie is playing a role.
Not sure you want to take the time to get a full evaluation? Check out my Tongue Tie Self-assessment HERE and if you find you might be tied, reconsider the value of an experienced therapist.
They can help with both the tongue tie and the TMD, two for one!
Causes of TMJ/TMD and Headaches
When considering causes of TMD we can reference the Mayo Clinic at:
https://www.mayoclinic.org/diseases-conditions/tmj/symptoms-causes/syc-20350941
Where they summarize the following about TMJ Disorders:
The temporomandibular joint combines a hinge action with sliding motions. The parts of the bones that work together in the joint are covered with cartilage and separated by a small shock-absorbing disk. This disk usually keeps the movement smooth.
Painful TMJ disorders can happen if:
- The disk erodes or moves out of its proper relationship between the ball and socket of the joint.
- Sprain or strain occurs in the ligaments or soft tissues associated with TMJ disorders.
- Arthritis damages the joint’s cartilage.
- A blow or another impact damages the joint.
- Jaw muscles are associated with TMJ spasms.
Many times, the cause of TMJ disorder has a variety of causes and is hard to identify.
Risk factors
Factors that may raise the risk of getting TMJ disorders include:
- Different types of arthritis, such as rheumatoid arthritis or osteoarthritis.
- Jaw injury.
- Habits such as gum chewing, nail biting, and grinding or clenching of teeth.
- Certain connective tissue diseases.
- Stress, post-traumatic stress disorder, anxiety or depression.
- Conditions such as fibromyalgia, ankylosing spondylitis and sleep disturbances.
- Smoking.
Analysis of Causes and Risk Factors TMJ/TMD and Headaches
Now, we’ve noted some common causes above, but is that a root cause? Let’s analyze this!
Disc Eroded or Displaced
The first cause noted is that the disk erodes or moves out of its proper relationship between the ball and the joint socket. Ok, we have an eroded disk. How did the disk become eroded or displaced? What causes that to happen?
Well, we scan the Risk Factors list to see if any of these apply to us. Do you have arthritis? Were you injured by banging your jaw? Do you have connective tissue disease?
If so, then you have your true root cause. However, most TMD cases do not have an injury or disease condition to point to. If you’ve ruled out these as possible causes of disk erosion, then why did the disk erode or become displaced?
Even the Mayo Clinic concludes that many times, the cause of TMJ disorder has a variety of causes and is hard to identify.
When the tongue is tied, it is not resting in the palate, and it causes the jaw to move in compensatory ways to adjust for the limited tongue mobility. This can then be the root cause of the erosion of the disk. Through repeated movements, that the jaw was not expected to make, the disk wears down.
Overlap of Tongue Tie and TMJ/TMD Risks
In fact, each risk factor listed here can be directly connected to tongue tie. Habits such as nail biting, grinding, and clenching of teeth are also red flags of a tongue tie. As are anxiety and depression, which appear after poor sleep.
Sleep disturbance is linked to poor REM due to low resting tongue posture and open mouth breathing when asleep. The poor alignment of the tongue blocks the airway and reduces nasal breathing. Nasal breathing allows for optimal oxygenation and deep restorative sleep.
Tongue tie is the root cause of poor tongue-jaw dissociation, the ability of the tongue to move independently of the jaw. Leading it to be the root cause of TMD. All we need to do is take one deeper step into the identified causes and risk factors.
This leads us to the conclusion that TMJ/TMD and Headaches are directly linked to tongue ties.
In fact, there is research on the relationship between the tongue and the jaw. Such as in this paper Tongue function and swallowing in individuals with temporomandibular disorders.
Rosa RR, Bueno MDRS, Migliorucci RR, Brasolotto AG, Genaro KF, Berretin-Felix G. Tongue function and swallowing in individuals with temporomandibular disorders. J Appl Oral Sci. 2020 Apr 3;28:e20190355. doi: 10.1590/1678-7757-2019-0355. PMID: 32267377; PMCID: PMC7135951.https://pmc.ncbi.nlm.nih.gov/articles/PMC7135951/
Such research helps to solidify that if there is dysfunction in the tongue, there can be dysfunction in the jaw.
Treatment Options TMJ/TMD and Headaches
1. Myofunctional Therapy
Myofunctional therapy is a specialized therapy that focuses on retraining oral and facial muscles for proper function. Exercises designed to improve tongue mobility, oral rest posture, and swallowing patterns can significantly alleviate strain on the TMJ and reduce headaches associated with tongue ties.
2. Frenectomy or Frenuloplasty
A frenectomy is a minor surgical procedure that releases a restrictive lingual frenulum, allowing for improved tongue mobility. When combined with myofunctional therapy, this procedure can be highly effective in addressing the underlying causes of TMJ dysfunction and headaches. Adults often note a great sense of tension release throughout the oral musculature and jaw immediately following the surgical tongue tie release.
3. Orofacial Myofascial Release
Myofascial release therapy targets tightness and restrictions in the muscles and connective tissue surrounding the jaw and neck. This form of manual therapy can help relieve tension, improve circulation, and restore proper function to the TMJ and associated musculature.
4. Postural and Breathing Training
Addressing poor posture and improper breathing patterns (such as chronic mouth breathing) is crucial for reducing strain on the TMJ and preventing headaches. Breathing exercises, along with postural training, can significantly enhance jaw stability and reduce discomfort.
Conclusion TMJ/TMD and Headaches: Can a Tongue Tie Be to Blame?
For individuals struggling with chronic TMJ/TMD and headaches, identifying the underlying cause is key to effective treatment.
While tongue ties are often overlooked in discussions about jaw dysfunction, their impact on oral function, posture, and muscle tension is significant.
By recognizing the role of tongue ties in TMJ dysfunction and headaches, patients can pursue targeted interventions such as myofunctional therapy, frenectomy, and postural training to alleviate symptoms and restore optimal function.
If you suspect that a tongue tie may be contributing to your TMJ/TMD symptoms and headaches, seeking an evaluation from a trained professional can be the first step toward lasting relief.
Check out this website dedicated to Tongue Ties where preferred providers are listed by state, Tongue Tie Life, to find a provider near you.
Interested in learning more about tongue ties? Head over to our BLOG where we share tons of information on all things tied together by tongue ties!