What is a TMD?
The temporomandibular joint (TMJ) is the name of the joint located on either side of your head, just in front of your ears. These joints connect your mandible (jawbone) to your temporal bone (skull). The TMJ, which can rotate and move forward, backward and side to side, is considered by the Canadian Dental Association to be one of the most complex joints in the body.
The TMJ allows us to chew, speak, swallow and yawn. When you have a problem with one of the structures in the TMJ complex (muscle, bone, ligament or disc) you have a temporomandibular disorder (TMD).
What are Common Causes?
Studies suggest most TMJ problems are due to dysfunction of the masticatory muscles related with parafunction and/or emotional stress.
However, many factors can influence the TMJ function and lead to a TMD, such as:
- Dental and orthodontic work
- Inadequate occlusion
- Cranial default
- Psychological stress
- Postural stress
- Systemic disease e.g. arthritis
- Congenital defect
Considering this list, we can say that 80% of the time the TMD is caused by one or many of the above factors.
What are the symptoms when you suffer from a TMD?
The symptoms we hear the most amongst patients are the clicking or grinding of the jaw. Other common symptoms include pain in the ear, cheek, teeth and temples. Symptoms can also include stiffness of the neck, pressure behind the eyes or difficulty swallowing. In some cases people won’t consult until they experience pain, but all symptoms should be mentioned to your health professional.
If we take ear pain as an example, studies have shown that when an ear infection is ruled out, one third of patients had a TMJ disorder, one third of patients were suffering from a cervical spine disorder (CSD), and the final third of patients experienced pain from both areas. The same can be said for forehead pain. When the sinuses are ruled out as being the cause, the pain will come from the neck musculatures.
When someone is experiencing pain with their teeth, it is better to see the dentist first to ensure there is nothing wrong with a tooth or a nerve. A panoramic radiograph will be made in some cases, or medication will be prescribed by your doctor, but remember that teeth pain is also a symptom of TMD.
TMD diagnoses we find in Physiotherapy are hypomobility and hypermobility of the TMJ, anterior disc displacement with and without reduction, musculature syndrome, osteoarthritis, and post injection syndrome.
There is also an important relationship between TMJ function and posture. Studies point to the influence of an anterior head position as an important factor on the masticatory function. There is evidence to prove that changes in body posture influence the muscle tension on the TMJ. Furthermore, studies are discussing the relationship between the dental occlusion and the posture. Nowadays, the influence of the teeth in the orofacial balance and masticatory muscle is recognized.
To conclude, this is why an assessment and treatment of the TMJ includes neck function and posture as well as cranial mobility. It is a joint like any other in the body with a complexity added by the disc in the TMJ. Statistics say that 70% of people will have a TMD, but will not consult a professional until they experience pain.
TMD is manageable in Physiotherapy with manual therapy, electrotherapy, and specific exercises for this joint.
Gabrielle Milot-Lavergne M. Sc. PT, Vestibular Rehab, TMJ Rehab, Sports First Responder
Gabrielle graduated with a Bachelor’s and Master’s degree in physiotherapy from Université Laval in Quebec City. She started her career working in her father’s clinic, himself a Sports Physiotherapist, where she worked for four years treating a wide range of clientele, following multiple sports teams and covering many different sporting events.
She has a strong interest in head and neck dysfunctions and is qualified in treating vestibular and temporo-mandibular dysfunctions. Her course in Cranial Manual Therapy makes her specialized in treating concussions, headaches, dizziness, head and neck pain.