TMJ Dysfunction

TMJ Dysfunction

TMJ Dysfunction

Argh! Did you wake up this morning with a headache or face pain? Do your jaw joints make noise? Do you have limited movement to open or close your mouth, or get “stuck” in one position during movement? Do your ears sometimes ring? Are you clenching or grinding your teeth? It’s possible you have TMJ Dysfunction or TMD.

TMJ is short for TemporoMandibular Joint. It is the ball and socket joint of your jaw that is separated by a thin, soft piece of cartilage, often referred to as the Articular Disc. These joints can be felt in front of your ears. 

TMJ Dysfunction or TMD is the imbalance or change in normal function of the bones, ligaments, capsule, muscles, disc or nerve components of the TMJ complex.

Some signs and symptoms of TMJ dysfunction can include facial pain, headaches, joint noise (clicking, popping), and limited movement or locking. Other symptoms include ear pain/ringing, hearing troubles, tooth pain, neck or shoulder pain and facial tingling or numbness. 

TMD could be caused by head/facial trauma, a motor vehicle accident, dental issues, stress induced clenching or grinding of teeth, poor postural habits, and many others. 

Clinically, the most common disorders seen are related to muscular overuse and dysfunction, as well as disc displacement disorders creating abnormal positioning of the articular disc within the joint. 

Proper assessment, diagnosis, and successful treatment rely on a skilled physical therapy practitioner, with expertise in TMJ management.  Treatment of TMD is often focused on desensitizing muscles or improving joint mobility through hands-on mobilization; restoration of normal functional movement pattern through exercise; and providing education regarding prognosis and self applied maintenance. Treatment may also include other muscle re-education techniques such as Intramuscular Stimulation (IMS).  We look at other mechanical influences such as neck disorder and posture, to assist in maximizing treatment management. In some cases, we work with your oral practitioner (dentist, orthodontist, oral surgeon) – and other practitioners who deal with behavioral modification – to optimize results.

Vince Cunanan is a Senior Physical Therapy Clinician at Sun City Physiotherapy. He has with over 22 years of experience in the field of orofacial disorders and headache management. 

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Phone: 250-762-6313
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Phone: 250-766-2544
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Phone: 778-699-2006
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What is a TMD and what are the symptoms?

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 
  • Trauma 
  • 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. 

Conclusion 

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. 

A recipe for jaw pain

The fact of the matter is jaw pain can be down right miserable. Talking and eating are two of our most important functions in daily life and the jaw plays a large role in both. If wrapping your teeth around a big juicy Okanagan apple has lost its sweet satisfying crunch and been replaced by pain, then seek some help.
Many structures in and around the jaw can contribute to pain. The teeth and their attachment to the jaw and skull are obvious contributors that your dentist is well equipped in managing. Infection or dysfunction within the ears, sinuses, salivary glands or lymph nodes are problems best addressed by your family doctor. However, other structures such as the jaw joint (temporomandibular joint) and associated ligaments and tendons are common contributors to jaw pain that are often left untreated. Dysfunction in the neck can also refer pain and/or dysfunction to the jaw. Another, often overlooked contributor to jaw pain, is the effects of our mental health. It is well documented that stress, anxiety, exhaustion or depression will not only effect our head and neck postures but also how the nervous system reacts to messages sent from dysfunctional tissues, such as those in and around the jaw. A sensitized nervous system can increase one’s experience of pain.
Pain is complex but treatment doesn’t have to be. An assessment by your family doctor, dentist or physiotherapist with special interest in temporomandibular dysfunction will ensure you are referred to the correct health professional for managing your problem. If the problem relates to dysfunction of the jaw joint, the first step is to address any habits outside of normal jaw function, such as teeth grinding, pen chewing or jaw clenching. A restriction in joint mobility is common, affecting your mouths ability to fully open, in which case, the sleeve (capsule) of the joint is susceptible to strain and inflammation. Clicks and pops are very common but are rarely related to the cause of your pain.
Try this – gently place your finger tips about 3cm above your temples, then clench your teeth on and off. You will feel the temporalis muscle tightening under your fingers. Now gently place your fingers 5cm directly below your temples on the sides of your jaw and clench your teeth. You will feel the masseter muscles tightening. You have just located two of the most important muscles for eating. Both the temporalis and masseter muscles and their tendons are common contributors to jaw pain that respond well to hands-on soft tissue treatment techniques. In addition, many people can relate to how these muscles might be clenched a bit tighter in times of stress and anxiety, thereby contributing to the muscles overload.
The important message is that many structures, behaviours and feelings contribute to the experience of jaw pain and effective management is best achieved through identifying all factors involved.

TMJ Dysfunction Part 2

Argh! You woke up with another headache, and your teeth hurt from clenching yesterday at work, as you just met another stressful deadline. As you massage your temples and face, which actually feels relieving, your significant other tells you about your loud teeth grinding last night. As you look in the mirror while brushing your teeth, you are always intrigued by how your jaw “wiggles” side to side when you open your mouth. It’s done that for years but hasn’t created any other problems to your jaw function. Sound familiar? You are presenting with Myofascial Pain Dysfunction (MPD) of the Temporomandibular Joint, the TMJ.

The TMJ is the ball and socket joint that connects the Mandible (jaw bone) and the Temporal bone (one of the bones of your skull). It’s the small joint located in front of your ear. There is a cartilage cushion in between the ball and socket, referred to as the Disc. The disc is supported by special Ligaments, which keep the disc in place. Movement problems of the disc can be responsible for creating many symptoms in the TMJ, such as clicking, crepitations, locking, muscle spasm, and pain. There are several muscles which support and control movements of the TMJ. Symptoms can often be related to these muscles. These include temporal pain, headaches, muscle spams, tinnitus and ear pain, and even teeth pain.

TMJ Disorder/Dysfunction, or TMJD/TMD, is seen more commonly in women than men. There is a 3:1 incidence in females to males, and can include one or both jaw joints. In most instances, the dysfunction is a result of an imbalance or change in the normal function of the bones, ligaments, muscles, disc, or nerve components of the TMJ complex.

MPD can be due to various causes of increased muscle tension and spasm. In some instances, MPD can be a physical manifestation of psychological stress. Often, there is no disorder of the joint itself. There is often a history of facial pain and temporal headaches, secondary to Nocturnal (night time) jaw clenching and Bruxism (teeth grinding). Dental issues may have influenced symptoms over time. This might have lead to the use of a nighttime splint. There may also be ear pain, fullness, or tinnitus. Erratic movement patterns of the jaw during opening and closing are related to lack of neuromuscular control, which requires re-education through physical therapy.

The TMJ specific muscles involved in MPD are the Temporalis and Masseter. The temporalis is a fan-shaped muscle that fills the temporal space, and inserts onto the mandible. Its function is to raise the mandible to close your jaw. The masseter is a thick and strong muscle attached at your cheekbone and runs to the angle of the mandible. Its function is to also raise the mandible to close your jaw. Try this: clench your teeth several times and press your fingers firmly on your temples; now on your cheeks. Did you feel tenderness? Aching? Maybe even a sensation like a toothache? WHAT IS THE SIGNIFICANCE? These muscles become subjected to fatigue and overuse with prolonged and persistent clenching and bruxism, which leads to MPD symptoms. It’s like these muscles are running a marathon without rest, everyday!

Proper assessment, diagnosis, and successful treatment rely on a skilled physical therapy practitioner, with expertise in TMJ management. Treatment of MPD is focused on desensitizing muscles through hands-on mobilization, restoration of normal functional movement pattern through exercise, and providing education regarding prognosis and self applied maintenance. Treatment may also include other muscle re-education techniques such as Intramuscular Stimulation (IMS). We look at other mechanical influences such as neck disorder and posture, to assist in maximizing treatment management. At times, we often work with your oral practitioner (dentist, orthodontist, oral surgeon), and other practitioners who deal with behavioural modification, to optimize results.

Vince Cunanan is a TMJ Specialist and registered physiotherapist and associate at Sun City Physiotherapy Downtown Kelowna. He can be contacted at downtown@suncityphysiotherapy.com.

TMJ Dysfunction Part 1

Did you wake up this morning with acute facial pain and inability to open your mouth? When you think to yesterday, you remember taking a big bite from an apple and experienced a sharp pain in your jaw joint. Today, you can’t really open or fully close your mouth. That unexplained clicking in your jaw that you’ve had for two years has suddenly gone away. Now, there’s just facial tenderness in front of your ear and you’re worried that you can’t eat! If you experience this, you likely have a “locked jaw”, or Acute Disc Displacement. This is one of the common disorders of the Temporomandibular Joint, more known as the TMJ.

The TMJ is the ball and socket joint that connects the Mandible (jaw bone) and the Temporal bone (one of the bones of your skull). It’s the small joint located in front of your ear. There is a cartilage cushion in between the ball and socket, referred to as the Disc. The disc is supported by special Ligaments, which keep the disc in place. Movement problems of the disc can be responsible for creating many symptoms in the TMJ, such as clicking, crepitations, locking, muscle spasm, and pain.

TMJ Disorder/Dysfunction, or TMJD/TMD, is seen more commonly in women than men. There is a 3:1 incidence in females to males, and can include one or both jaw joints. In most instances, the dysfunction is a result of an imbalance or change in the normal function of the bones, ligaments, muscles, disc, or nerve components of the TMJ complex.

Disc Displacement is a mechanical problem that occurs when the disc ends up in the wrong position within the ball and socket. In this case, it is likely that the disc has become displaced due to the wide opening, creating increased stress and strain on the ligaments, resulting in pain around the joint and spasm in the facial muscles. There is also a longstanding history of unexplained clicking in the joint, which may be a pre-disposing factor to this problem. In essence, the disc needs to be properly re-educated to find its’ normal resting position again, and the mechanics restored to the muscles and joint. Specialized physical therapy care would assist in restoration of disc position, to restore movement and function, as well as normalize the pain.

Dysfunction in these tiny joints can have many causes. These can include trauma such as blow to the head, whiplash, falls, sports injuries, arthritis, dental occlusion, dentures, history of joint noises, stress (clenching, grinding), poor habits (posture, physical, oral), and many others. Signs and symptoms may include facial pain, headache, neck pain, ear pain, sudden changes in bite, tooth pain, ringing in the ears, shoulder pain, and facial tingling or numbness.

A physical therapist can help you understand and manage your TMJ dysfunction. Often it is obvious that the TMJ is the cause of symptoms you experience. However, for many people, the symptoms they experience can be widespread, and may not make it so obvious. As mechanics for the human body, physical therapists can properly assess, diagnose, and treat the TMJ and most of the possible influences. We provide a specialized hands-on approach to treatment, education, and exercise program. Treatment may also include other muscle re-education techniques such as Intramuscular Stimulation (IMS). In many instances, we often work with your oral practitioner (dentist, orthodontist, oral surgeon) to ensure the best outcome possible for your TMJ. Treatment can be very effective in a short period of time. A self-applied approach with a little guidance from specialized physical therapy practitioners will help with long-term benefits.

Acute Disc Displacement is only one of several diagnoses of TMJ dysfunction. Keep connected to read about other problems that these tiny joints can give you. Don’t stop eating apples though…

Vince Cunanan is a registered physiotherapist and associate at Sun City Physiotherapy’s Downtown Kelowna and Glenmore clinics. He can be contacted at info@suncityphysiotherapy.com