The temporomandibular joints (TMJ) are two joints that connect your lower jaw to your skull. More specifically, they are the joints that slide and rotate in front of each ear and consist of the mandible and the temporal bone. The temporomandibular joints are among the most complex joints in the body, therefore, these joints along with several other muscles, allow the mandible to move above and below, side to side, and forward and back.
Temporomandibular joint disorder (also known as TMJD, TMJ disorders, or TMD) is an on-going pain in the area near the ear, your jaw, or the muscles on the side of your face, possibly accompanied by a clicking or popping sound or restricted jaw movement. TMJ disorders describe a group of conditions characterized by pain and dysfunction of the TMJ and / or the muscles surrounding it. Unfortunately, studies have not yet found an answer as to what causes these symptoms linked to this condition, however, there have been TMD cases that resolve themselves with the help of conservative treatments.
Causes & Symptoms
In some cases, the causes for TMJ disorders remain unknown although some patients report trauma to the jaw or joint to be the case that leads to TMD. In addition, there are also other health conditions that may be associated with the development of TMJD, such as the following:
There are several types of arthritis that can affect the jaw of an individual. These types of arthritis include infectious arthritis, traumatic arthritis, osteoarthritis, spondyloarthropathies, and rheumatoid arthritis. Generally, jaw arthritis can range from mild to severe and may worsen over a period of time.
Erosion of the joint
Similar to the degeneration of the joint, sometimes this is the cause of excessive strain on the jaw joints and the muscle group that controls chewing, swallowing, and speech. The strain may also be a result of ‘bruxism’; this is the habitual, involuntary clenching or grinding of the teeth. But trauma to the jaw, the head, or neck may cause TMJD.
Structural jaw problems present at birth
Some female patients who have pre-existing TMJ disorders may exacerbate the problem during and post-pregnancy due to stress. Stress from being pregnant, hormonal issues, and even poor sleep, which can lead to more clenching and / or grinding. This additional stress on the jaw and body can lead to worsened TMJ pain and discomfort than before pregnancy.
Other known causes linked to TMJ disorders include:
- Orthodontic braces
- Other inflammatory musculoskeletal disorders
- Misalignment to the teeth or jaw
- Poor posture
Overall, the signs and symptoms of TMJ disorders may depend on the severity and cause of the condition; here are some symptoms accompanied by TMJD:
Some patients with TMJ disorders may hear a clicking, popping, or grating sound moving from the temporomandibular joint when opening or closing the mouth. This is typically caused by a shifting of the disk inside the joint. A person standing next to you might even be able to hear this clicking sound. Clicking by itself is actually not a significant symptom, because one-third of all people have jaw joints that click. However, if the clicking is accompanied by pain or limited jaw function, the jaw getting “stuck” in an open or closed position would further indicate TMJ disorders.
This can be felt in the cheeks and temples (temporalis muscle), where the two big pairs of jaw-closing muscles are located. If you feel soreness upon waking up in the morning, it is often related to habits such as clenching the teeth at night.
Other symptoms include:
- Ringing in your ears
- Neck and / or shoulder pain
- Tooth pain
- A sudden tired feeling in your face
Who gets TMJ Disorders?
You can get TMJ disorders with or without the risk factors associated with it. However, the more risk factors you have, the higher the chance of developing this disorder. Certain risk factors for TMJD include:
Most patients report TMJ disorder symptoms between the ages of 20-40 years old. Younger adults and elders ages over 40 are less likely to experience this condition.
TMJ disorders are more likely to occur in women rather than men. Studies have shown that female jaw muscles are more prone to injury and increased levels of inflammation and exhaustion. As a result, women tend to receive less blood and less oxygen to their faces; their jaws in particular. When you lack the proper amount of oxygen and blood, your muscles begin to produce additional amounts of lactic acid. Increased levels of lactic acid generally lead to cramping, spasms, and pain; thus leading to TMJ disorders due to these symptoms.
Certain health problems can raise your chances of developing TMJ disorders, including arthritic problems like osteoarthritis or fibromyalgia, jaw or facial deformities, past jaw injuries, and psychological problems (such as stress).
Some other habits that may raise your risk of TMJ disorders include biting your lip and biting your nails constantly.
How Does it Affect You? How Serious is it?
TMJD can lead to numerous uncomfortable symptoms and has the potential to cause severe complications if left untreated. Some of these complications include the following below:
Long-term dental problems
Having dental problems is extremely common in patients suffering from TMJ disorders. When an individual has this condition, they tend to alter their bite. In doing so, they place the teeth and jaw in an unusual position. When the natural bite is thrown off, it places extra stress on the teeth and can also lead to orthodontic issues and brutish. Because of all the stress being built from TMJ disorders, patients with this condition are likely to have thinner, weaker tooth enamel. As a result, these patients are more likely to suffer from dental complications such as tooth decay and infection.
Pain is often the very first sign that a person is suffering from TMJ disorder. Although TMJ disorder directly affects the joint that connects the jaw and skull, this condition can cause many different types of discomfort. TMJ disorder is most commonly known to cause headaches, facial pain, and tooth pain. However, pain can also extend to the neck, shoulders, and even the ears. Unfortunately, pain caused by TMJ disorders can be substantial. Most patients with TMJ disorder suffer from chronic pain, meaning that it is something they deal with on nearly a daily basis.
Limited jaw function
TMJ disorder has an enormous impact on the health and function of the jaw. Patients suffering from this condition are more likely to have limited jaw mobility. In addition, it may be difficult to open the mouth fully which can limit jaw functions and make it harder to eat and chew. In severe cases, some patients can even suffer from “lockjaw”, a condition in which the jaw temporarily sticks in place, so that the mouth cannot close or open.
Recommended Treatment & Rehabilitation
Throughout a diagnosis for those suffering from TMJ disorders, it is first diagnosed through a dental checkup. First, a healthcare provider will observe the range of motion when you open and close your mouth. Secondly, he or she will press on your face and jaw to determine areas of discomfort. Lastly, your healthcare provider will feel around your jaw joints as you open and close your mouth.
Additionally, an X-ray may be taken alongside other physical examinations, such as:
- CBCT scans – Cone-Beam Computed Tomography (CBCT) scans capture thousands of images of your teeth, jaws, and facial bones. These images are then stitched together for an in-depth 3-Dimensional picture.
- Magnetic Resonance Imaging (MRI) scan – An MRI may be used to view soft tissues in and around the jaw joints. These images show the position of the disk, inflammation, and possible jaw locking. This can show your healthcare provider whether the TMJ disc is functioning properly.
- Dental X-ray – This type of X-ray shows a broad overview of your teeth, jawbone, and TMJS.
During physiotherapy for TMJ disorders, a physiotherapist can help you restore the natural movement of your jaw and decrease your pain. Based on the severity of your condition, your therapist will design a specific treatment program that will work best for your needs. These types of physiotherapy treatments may include:
If a patient sits with his / her head in an increased forward position, she / he is placing a great amount of strain on the muscles beneath the chin, causing the lower jaw to pull back and the mouth to be in an open position even when resting, increasing stress on the temporomandibular joint. You might also be overworking the jaw muscles to force the jaw closed so your mouth isn’t open all the time. Therefore, your physiotherapist would teach you to increase your awareness of posture so that you can improve the resting position of your jaw, head, neck, breastbone, and shoulder blades when you’re sitting and walking.
Improving your jaw movement
Your physiotherapist will use his / her skilled hands-on techniques (also known as manual therapy) to gently increase movement and relieve pain in tissues and joints. Your physiotherapist may use this therapy method to stretch the jaw in order to restore normal joint and muscle flexibility or break up scar tissues that sometimes develop when there is constant injury.
There are certain exercise examples that can help relieve pain due to TMJ disorder symptoms. These exercises can help strengthen jaw muscles, relax the jaw, and increase jaw mobility. Here are a few methods you can freely try at home or elsewhere:
Begin by resting your tongue gently on the top of your mouth behind your upper front teeth. Allow your teeth to come apart while replacing your jaw muscles.
With your shoulders back and chest up, pull your chin straight back, creating a “double chin”. Finally, hold for three seconds and repeat 10 times a day.
With your tongue touching the roof of your mouth, slowly open and close your mouth.
Forward jaw movement
Place a quarter-inch object between your front teeth. Next, move your bottom jaw forward so your bottom teeth are in front of your top teeth.
Side-to-side jaw movement
Place a quarter-inch object between your front teeth and slowly move your jaw from side to side.
Two most common non-surgical treatments include wearing splints or a night guard and taking medications, as described below:
Night splint or night guard
Splints and night guards are mouthpieces that can fit over your upper or lower teeth. When either of these wearable items is worn, the mouthpieces provide stable tooth contacts during closure. The difference between splints and night guards is that night guards are only worn at night while splints are worn full time.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen may provide relief to pain and swelling. Additionally, muscle relaxants, especially for patients who grind or clench their teeth, can help relax tight jaw muscles. A small dosage of antidepressants can also help to reduce or manage pain. However, antidepressants must be given as a prescription by a healthcare provider.
Alternative & Homeopathic Treatment
Many homeopathic treatments include eating softer foods to applying ice packs. Here are some alternative treatments for you to try:
Soft food consumption
To keep your jaw from working overtime, eat soft foods such as yogurt, mashed potatoes, soup, fish, and cooked fruits. It is recommended to avoid eating hard and crunchy foods to prevent further pain due to TMJ disorders.
Ice and heat application
Apply an ice pack to the side of your face and temple area for 10 minutes for acute pain. After applying ice, place a warm towel or a heat pack to the side of your face for 5 additional minutes to increase blood circulation.
Avoid severe jaw movements
Avoiding extreme jaw movements can lessen jaw pain. For example, keep yawning and chewing to a minimum pace, do not rest your chin on your hand or hard surface for an extended period of time, and keep your teeth slightly apart as often as you can to relieve pressure on the jaw.