The Temporomandibular Joint (TMJ)

What is the TMJ and why can it cause me so much pain?

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What is the TMJ?

The TMJ, short for temporomandibular joint, refers to the joints inside your mouth that connect your jawbone to your skull. You have two of these joints, located on each side of your head. Both joints work together, along with a complex system of ligaments, muscles, nerves, discs and bones to create different movements allowing you to chew food and speak!

When damage or injury occurs to any part of the complex TMJ system then this can create localised pain around the mouth, head or neck. This is known as temporomandibular joint syndrome or temporomandibular disorder (TMD).

What are the symptoms of TMD?

Common symptoms of TMD include:

  • Pain and tenderness of the jaw
  • Pain in the muscles around the face and jaw, usually on one side.
  • Pain or difficulty chewing
  • Pain that can radiate to the ear
  • Locking or clicking of the jaw that makes it difficult to fully open the mouth
  • Headache, usually on the same side as the jaw pain
  • Neck, shoulder or upper back pain
  • Swelling on the side of the face

What are the common causes of TMD?

There are many causes of TMD ranging from the anatomical to the traumatic and even the psychological. However in some cases symptoms can appear with no obvious reason. The list below explains a few common causes for TMD.

Anatomical
The temporomandibular joint is made up of a hinge joint which allows for the opening and closing action of the mouth. Between the hinge joint is a shock absorbing disc which allows for the smooth movement of the jaw. In some cases the disc can be affected be it due to the misalignment of the disc or the presence of osteoarthritis in the TMJ. This in turn can be a cause of an individual’s jaw pain.

Traumatic
Any trauma or injury to the jaw, TMJ, neck or muscles of the head and neck such as from a car accident can cause TMD. This can impact the normal alignment of the TMJ, in turn causing dysfunctional movement of the jaw.

Psychological
Bruxism is the term used to describe excessive teeth grinding or clenching. This can happen both during the day and at night and subsequently increases the tension in the muscles surrounding the TMJ. The cause of excessive teeth grinding has been linked to increased levels of stress and anxiety.

How is TMD diagnosed?

During your consultation your osteopath or physiotherapist will take a precise case history of your symptoms and carry out a thorough physical examination. This will aid in diagnosing and understanding the cause of your TMJ pain.

During the case history the practitioner may ask you questions such as;

  • When did the pain and symptoms start?
  • Were you doing anything when the pain started?
  • What is the nature and duration of the pain?
  • Have you had any previous injury to the head or neck area?
  • Do you have any underlying medical conditions?

During the physical assessment the practitioner may carry out a series of tests including a postural assessment. They will also have a feel of the jaw for any areas of tenderness and observe the range or motion as you open and close your mouth.

In some cases and depending on the severity of the symptoms, imaging such as X-rays or MRI’s might be needed to understand the exact cause of the TMJ pain.

What are the treatment options for TMD?

There are many treatment options for TMD. The type of treatment depends on the severity and cause of the symptoms.

Conservative treatment includes:

Osteopathy and Physiotherapy: visiting a physical therapist such as an osteopath or physiotherapist can help with relieving your discomfort and pain. The treatment would include a range of different hands on techniques that aim to:

  • Improve blood flow and circulation to the TMJ, which helps improve the body’s natural healing response.
  • Release and stretch tight muscles to allow for improved movement and function.
  • Release endorphins. These are hormones that circulate the body and act as natural pain relief.
  • Reduce tension in the neck and shoulder area using soft tissue massage and gentle articulations of the neck and upper back. Your physical therapist may also give postural advice and may prescribe a few exercises to help increase the strength and flexibility of your neck, shoulders and TMJ.

Your osteopath will also advise you about pain management techniques, including the use of hot and cold therapy. Using a heat pack on the muscles around your neck, shoulders and jaw is a great way to help relax the muscles.

Medication: if you decide to visit your GP, depending on the severity of your pain your GP may prescribe you with some oral medications to help relieve your symptoms:

  • Over the counter painkillers and anti inflammatory medications to help with pain relief.
  • Prescription muscle relaxant medication may be prescribed to help with muscle spasms. These are usually only prescribed for a few days
  • If the pain is really severe then your GP may prescribe antidepressants. In low doses these types of medications can help with pain relief as well as bruxism control.

Lifestyle alterations: reduce stress, eat soft foods, keep hydrated, get enough sleep and participate in regular physical activity.

Acupuncture – is classed as an alternative therapy and may reduce stress and tension in the body. Fine needles are placed in certain areas of the body, including the neck, shoulders, face and jaw.

Counseling – Counseling is one method that can be used to understand your triggers and behaviors that aggravate your pain. Once you know what they are you will be able to avoid them. Triggers can include teeth grinding, clenching or nail biting.

Stress and anxiety is one trigger for teeth clenching. Meditation or taking time out of your day to concentrate on deep breathing are great ways to help reduce stress.

Mouth Guard – when other treatments have not worked you may be advised by your dentist to wear a mouthguard. This type of treatment can help in preventing teeth clenching and grinding.

Visit your dentist – your dentist may be able to ascertain whether corrective dental treatment is required. This may include procedures to improve your bite and align your teeth.

Surgical treatments include:

When conservative treatments haven’t worked your dentist or doctor may suggest surgery to help with your pain. Your consultant will make sure you are aware of the pros and cons to the procedure. Below are a few surgical options for TMD.

Arthrocentesis – this is the least invasive type of surgery for the TMJ. It involves insertion of a small needle into the joint. Once the needle is inserted fluid is passed through the joint to help remove any debris or inflammatory waste products. The fluid also lubricates and reduces friction of the joint.

Arthroscopy – This procedure is a little more invasive than arthrocentesis. An arthroscope is a tiny camera that is inserted into the joint through a cannula. This allows the surgeon to have a look at the integrity of the joint. The surgeon can then pass small surgical tools down the cannula to remove scar tissue, smooth the bone or reposition the disc if needed.

Open joint surgery – This procedure is very invasive and is usually only performed if all other treatment options have not been successful. An incision is made over the joint so that the surgeon can:

  • Remove bony growths and excess scar tissue.
  • Repair or reposition the disc.
  • Replace the disc it is damaged.

How long does TMD last?

The prognosis for TMD is dependent on the cause. For some patients symptoms may occur for a few days to a few weeks, this is known as acute TMJ. For others it may be a more long term pain with episodes or sharp pain that may occur for a few months to years.

Suffering with TMJ pain? Book in for a free 15 minute consultation with one of our osteopaths to see how they can help you and your pain.

What are the best self massage techniques for TMD?

  1. Masseter self release: place each hand on the side of your face making sure your fingertips are at the level of the joint in your jaw. Gently sink your fingers into your cheeks. You might feel slight tightness or tenderness in your jaw or cheeks. Slowly pull your fingers down the side of your face, this will help stretch the masseter muscle.
  2. Pterygoid release: insert your index finger into the upper cheek. Place the tip of your finger where the upper and lower jaw meet. With a light pressure, press your finger against any tightness or tenderness in the cheek. Hold for 30 seconds and repeat 5 times.
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