Temporomandibular Disorders

The temporomandibular joint (TMJ) is a hinge-type joint that connects your jaw to the temporal bone of the skull. It lets you move your jaw up and down and side to side for talking, chewing, and yawning. Temporomandibular disorders (TMD), which are commonly referred to as TMJ, or TMJD, are problems with the jaw and the facial muscles that control it. They can cause varying degrees of pain and sometimes complete malfunctioning in one or both jaw joints. People who suffer from TMD experience tenderness, headaches and limited jaw movement. The condition frequently spreads to the ears, neck, and shoulders causing other health problems.

Causes of TMD

The cause of temporomandibular disorder varies from person to person and isn’t always easy to identify. Symptoms can arise from problems with the facial/jaw muscles or structural issues within the joint. Some of the common causes of problems in the TMJ include:

• Weak neck extensor muscles
• Misalignment of joints due to bite or denture problems
• Misalignment of the upper neck vertebrae or bones of the skull
• Improper tracking (movement) of the disc within the TMJ
• Tension, clenching, and grinding
• Injury (eg. whiplash)
• Arthritis and fibromyalgia

Signs and Symptoms

TMD often causes severe pain and discomfort that may be temporary or may last for many years. It may involve one or both sides of the face. In addition to pain within the jaw joint, symptoms may include:

• Tender jaw muscles or a tired feeling in the face
• Clicking, popping or misalignment of the joint
• Difficulty opening the mouth or jaws that get “stuck” or “locked”
• Ear pain or ringing in the ear
• Headaches
• Dizziness
• Lower jaw shifts when chewing
• Increased pain in the morning

Treatment of TMD

In some cases, the symptoms of TMD may go away without treatment. If pain persists or is limiting your activities your dentist or doctor may recommend some treatment options. Typical treatment options are pain medications, splints or mouth guards and in extreme cases surgery.

Before considering some of these treatments a more hands-on approach should be your first option. Massage, acupuncture, and physical therapy can all be very beneficial in relieving symptoms and addressing the root cause of the problem.

A physical therapist can assess the joint mechanics and determine if your muscles are firing correctly. When problems are discovered they can work with you to develop a plan to stretch overly tight muscles and strengthen weak muscles so that the joint works better.

Acupuncture is a great therapy to address pain. Specific points are chosen that activate pain centres in the brain, stimulating the release of endorphins (the body’s natural pain killers). Acupuncture is also very effective at treating chronic stress which is often at the root of muscle tension and clenching or grinding of the teeth that underlie TMD. Local needling into the tight muscles helps relax tension in the muscle and provides relief from pain as well as better joint mechanics. A British study found that 85% of study participants using acupuncture for TMD had pain relief of 75% or more.

Massage therapy is also effective at relaxing tight muscles and relieving stress. Special intraoral massage techniques address the deep muscles involved in chewing which are often tight and difficult to stretch. Releasing these muscles can provide instant relief from pain.

Lifestyle

In addition to seeking treatment, there are some small lifestyle changes you can make to improve the outcome.

Be aware of stress in your life and any stress-related habits you might have that contribute to jaw issues. These can include clenching your jaw, grinding your teeth, chewing on pens or cracking your jaw. Learn more about stress and what it looks like here: Stress.

Avoid overusing the muscles of the jaw, especially if they are painfully tight. Eat softer foods and cut food into smaller pieces to limit chewing. Avoid chewing gum and eating sticky foods.

Follow the stretching/strengthening plan developed by your therapist. You may have been given stretches and jaw exercises to help treat your TMD. Be diligent in following the plan. If you weren’t given any exercises this article from Healthline has some good videos of typical exercises recommended for TMD.

Apply warm, moist heat to the muscles of your face/jaw. Heat relaxes muscles and improves local blood flow. Good blood flow is how tissues (such as muscles) get the oxygen and nutrients they need to heal. If there is swelling or extreme pain using ice for 10 minutes can dull the nerves that send pain signals to the brain providing some pain relief.

Resources

https://www.mayoclinic.org/diseases-conditions/tmj/diagnosis-treatment/drc-20350945

https://www.webmd.com/oral-health/guide/temporomandibular-disorders-tmd

https://www.practicalpainmanagement.com/pain/maxillofacial/tmj/acupuncture-new-approach-temporomandibular-disorders

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