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Do you ever forgo that juicy thick steak, because you know your jaw will suffer afterwards? Can’t get your mouth around that big burger? Does that clicking in your jaw give you a headache when you chew gum? Perhaps you are suffering from temporomandibular disorder (TMD). TMD is not just one disorder, but a group of conditions, often painful, that affect the jaw joint (temporomandibula4r joint, or RMJ) and the muscles that control chewing. If you have questions about TMD you are not alone. Researchers too are looking for answers as to what causes TMD, what are the best treatments, and how we can prevent these disorders.
The TMJ connects the lower jaw, called the mandible, to the temporal bone at the side of the head. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of your head. A disc that works as a “shock absorber” during jaw movements lies between the mandible and the temporal bone. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew, and yawn. Muscles attached to and surrounding the jaw joint, control its position and movement.
There are various potential causes of TMD. We know that direct trauma to the jaw or TMJ can cause TMD. A heavy blow can fracture the bones of the joint or damage the disc, disrupting the smooth motion of the jaw and causing pain or locking. Arthritis in the jaw joint may also result from injury. Any sort of whiplash injury to the neck is known to often affect the jaw. Whiplash can occur not only in a motor vehicle accident but also with falls, for example, while skiing. There is some debate among the experts that problems including poor alignment of the teeth and/or orthodontics can trigger TMD. Muscle and joint problems of the upper neck as well as physical and mental stress can contribute to jaw problems. People with TMD often clench or grind their teeth at night, which can tire the jaw muscles and lead to pain.
A variety of symptoms are linked to TMD. Pain in the chewing muscles and/or jaw joint, are the most common symptoms. Others include: limited movement of the neck, “jaw locking”, headaches, earaches, dizziness, pain in the face, neck or shoulders, painful clicking, popping or grating sounds in the jaw joint when opening or closing the mouth, and/or a sudden major change in the way the upper and lower teeth fit together. Occasional discomfort in the jaw joint or chewing muscles is common and is generally not a cause for concern.
Diagnosing TMD can be confusing. In about 90% of cases, however, a person’s description of symptoms, combined with a simple physical examination of the face and jaw, provides information useful for diagnosing these disorders. Checking a person’s dental and medical history is very important, and addressing any neck issues, as they can both be directly related to TMD.
Self-care practices are useful in easing TMD symptoms. POSTURE is VERY important. If you sit up straight and bite your teeth together, you will notice a difference in how your teeth fit together as opposed to slouching and then biting together. It becomes pretty clear just how much your pelvis, back and neck position affects your jaw!! Eating soft foods, applying heat or ice packs, avoiding extreme jaw movements (such as wide yawning, loud singing, and gun chewing ) and learning special techniques for relaxing and reducing stress may also help deal with pain that is accompanied with TMD. A good way to “relax” the jaw muscles is to keep your top and bottom teeth slightly apart, and touch the roof of your mouth or the front of your top teeth with your tongue. An exercise to relax the “Masseter muscle” of the jaw is to bite down on the tongue gently, and press your thumb into the chin, thereby putting force onto the tongue for about 12-15 seconds.
If self management doesn’t resolve your problem, physical therapy is an excellent choice for addressing these problems. A physical therapist with experience in TMD is necessary. They will focus on posture education, range of motion and muscle function of the neck, jaw and back. They will also address any issues with the “Trigeminal Nerve” which is an extremely important nerve when it comes to head, jaw and facial pain. Physical therapy can provide relief of pain as well as education to avoid pain and/or reoccurrence of pain and muscle spam. Dentists may recommend anti-inflammatory medications and/or an oral appliance, also called a splint or bite plate, which is a plastic guard that fits over the upper or lower teeth. The splint can help reduce clenching or grinding, which eases muscle tension. If symptoms continue over time or come back often and do not respond to conservative treatment check with your doctor or dentist. He/she can suggest other options available. Be sure to have them explain to you, in words you can understand, the reason for the treatment, and the risks/benefits involved.
Simple self-care practices are often effective in easing symptoms. If more treatment is needed, conservative treatment such as physical therapy is strongly recommended, before considering invasive treatments. Even when the TMD problem has become chronic, most people still do not need aggressive types of treatment. If you feel you may suffer from TMD and the self-care practices are not helping, you may with to discuss problems with a trusted physical therapist or your dentist.
This article was written by physical therapist Paula Ashbaugh, MPT ATC.
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