Hypermobility and TMJ Disorders: Why Flexible Joints Can Mean More Jaw Pain

Some people are naturally more flexible—able to touch their thumb to their forearm or bend joints beyond the usual range. While this is often considered benign, for many, joint hypermobility is linked to chronic musculoskeletal pain, including temporomandibular disorders (TMD).

A woman showcases how hypermobile joints affect orofacial structures, emphasizing the potential for heightened pain and discomfort.

What Is Joint Hypermobility?

Joint hypermobility occurs when joints move beyond the normal range due to laxity in connective tissues. It can be localized or part of a systemic condition such as hypermobility spectrum disorders (HSD) or Ehlers-Danlos Syndrome (EDS). When it affects the temporomandibular joint (TMJ), it may lead to instability, disc displacements, and myofascial pain.

How Is Hypermobility Assessed?

One of the most widely used tools to assess generalized joint hypermobility is the Beighton Score, a 9-point clinical scale that evaluates flexibility in the elbows, knees, fingers, thumbs, and spine. A score of 5 or more out of 9 in adults typically indicates generalized joint hypermobility. Studies have shown that individuals with a high Beighton score are at increased risk for temporomandibular joint dysfunction, disc displacements, and chronic musculoskeletal pain, particularly in females and younger patients (Bevilaqua-Grossi et al., J Oral Rehabil, 2018).

The Hypermobility–TMD Connection

Several studies suggest that individuals with hypermobility are more prone to TMD. The TMJ relies on soft tissue structures—like ligaments and the joint capsule—for stability. In hypermobile patients, these structures can’t always provide adequate support, leading to microtrauma, increased strain on the masticatory muscles, and eventually chronic pain.

Evidence from the OPPERA Study

One of the most comprehensive investigations into TMD risk factors is the OPPERA (Orofacial Pain: Prospective Evaluation and Risk Assessment) study. This large-scale, NIH-funded study followed over 3,000 adults to identify risk factors for first-onset TMD. It found that individuals with increased bodily awareness and physical characteristics like joint hypermobility were more likely to develop TMD over time (Slade et al., J Pain, 2013). The findings highlight the importance of systemic musculoskeletal traits—not just local jaw mechanics—in predisposing people to chronic facial pain.

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What the Meta-Analyses Show

A 2020 meta-analysis by Bevilaqua-Grossi et al. concluded that generalized joint hypermobility is significantly associated with a higher prevalence of TMD, especially in females. The review emphasized that both biomechanical and central pain mechanisms may explain the increased vulnerability.

In another 2022 systematic review, Saccomanno et al. found that patients with joint hypermobility were more likely to experience TMJ disc displacements, particularly during adolescence and early adulthood, suggesting a developmental and structural link between the two conditions.

TMD Treatment Considerations for Hypermobile Patients

For hypermobile patients, TMD management must go beyond standard bite splints or muscle relaxants. At our Seattle clinic, we tailor treatment to your specific musculoskeletal profile—whether that involves joint stabilization techniques, trigger point therapy, neuromuscular retraining, or custom oral appliances designed to support joint function without overloading fragile structures.

References

• Slade GD et al. J Pain. 2013;14(12 Suppl):T14–T27.

• Bevilaqua-Grossi D et al. J Oral Rehabil. 2020;47(6):742–751.

• Saccomanno S et al. J Clin Med. 2022;11(17):5172.

• Ferreira CLP et al. Clin Oral Investig. 2017;21(3):843–850.