Have you ever experienced pain in your jaw while chewing, yawning, or simply just opening your mouth? You may be suffering from something that we refer to as Temporomandibular Joint Disorder (TMD.) Many people may be more familiar with the term TMJ; however, the medical profession deemed that acronym to be a misleading term. TMJ stands for “Temporomandibular Joint,” which is a joint everyone has. The term TMJ does not necessarily indicate any pain or dysfunction present, which is why we have begun to use TMD to describe an issue with the jaw joint.
TMD is the most common cause of orofacial pain associated with local pain around the jaw, headaches, and referred face pain. 5% of the population is suffering from TMD at any point in the US, and it tends to be more common in women.
What anatomy is involved?
The TMJ is the point where the mandible (jaw bone) joins the skull; you can feel this joint directly when you place your fingers posterior to your cheek and anterior to your ear when your jaw is moving up and down, chewing. The TMJ is the articulation of the mandible with the mandibular fossa of the temporal bone in the skull.
The Temporomandibular joint is like any other joint in the body. It is the point where two bones articulate to create movement. The joint is held together passively by ligaments and moved by the contraction of multiple little muscles. It even has its own shock absorber disk similar to the meniscus in the knee!
Ligaments play an integral role in supporting the temporomandibular joint; however, the muscles of mastication (chewing) are extremely important as well and are often the site of dysfunction. Many muscles influence the TMJ because the movement of the jaw is not simply opening and closing. To open our jaw requires two consecutive motions.
First, the mandible (your jawbone) must hinge in the groove that sits in on the skull (picture a ball in socket joint.) This movement creates more space for the jaw to move. This movement is then followed by a slight forward gliding motion which allows for the depression of the mandible and opens the jaw. The multiple steps involved in opening our jaw and the complexity of the movement are part of the reason temporomandibular dysfunction is so common. If any of the muscles acting on the jaw are out of sync, the jaw will not move smoothly. This can lead to dysfunction and inflammation, ultimately progressing to pain.
There are many muscles acting on this joint. Some of the muscles involved in moving the jaw are the masseter, the medial and lateral pterygoid, digastric muscle, sternohyoid, geniohyoid, mylohyoid, buccinator, and the temporalis. Many of these are tiny facial muscles most people would have never heard of. With so many components acting on one joint, there is plenty of room for things to go wrong.
The synovial cavity of the TMJ is separated into the superior and inferior chambers by an articular disk. The articular disk allows for a lateral and medial excursion (side to side movement) of the mandible. The disk can be compared to the meniscus in our knee. It acts as a shock absorber between articulating bones.
How do we develop TMD?
In many cases, it is challenging to determine the initial cause of TMD. However, in acute cases, it can be due to trauma to the jaw, head, or neck. This is most commonly from sports, MVA, or dental procedure traumas. Less severe traumas can also lead to injuries to your jaw, such as a deep yawn or strenuous depression of the jaw.
On the other hand, when someone develops TMD without a trauma, it can be caused by many micro traumas such as teeth grinding, gum chewing, nail-biting or dental work. In some cases, it can arise simply from being under a lot of stress, in which case many of us will clench our jaw more, leading to dysfunction.
Some ways to determine what your triggers may include the time of day it is present. Does your pain arise when you wake up? You may be grinding your teeth at night. If it is worse after a stressful day, you may be clenching your jaw without knowing it. All factors should be considered when determining the cause.
Dr. Seuss discusses some TMD, and what types of treatments are available at our office!
What can be done about TMD?
There are many different treatment options for a person who is suffering from TMD. For temporary relief of the pain associated with TMJ, people can try to treat the pain and discomfort by eating soft foods, applying ice to the area, trying to avoid eating hard or chewy foods that may aggravate their joints in their jaw. These, unfortunately, are not long-term solutions, but early on in the acute stage of dealing with TMD, sometimes removing the aggravating factors are necessary.
When altering your diet and avoiding chewing harder items is no longer effective, treatment to the TMJ may be required. As chiropractors, there are multiple ways that we can influence your jaw biomechanics and help with your pain.
At Health-Fit Chiropractic in Boca Raton, soft tissue muscle release such as Active Release Techniques are used and extremely effective in treating TMD. As described above, often, the pain and dysfunction are a result of a muscular imbalance. After adequately identifying which muscles influence the aberrant motion, we can help release some of the offending muscles. You may find that some of the muscles are incredibly tender and very tight. These are signs that the muscles may require treatment.
Spinal adjustments to the upper cervical spine (upper neck) may also influence the TMJ’s function and have been shown to help manage temporomandibular dysfunction and treat the musculature.
Other tools available to help manage the pain include working through the root cause of the jaw pain. As we previously alluded to, many people are completely unaware, but the main cause of their TMD is not from chewing food but instead grinding their teeth in their sleep. It is very common to grind your teeth without any knowledge while you sleep and this can put significant stress on the muscles, ligaments and the joint of your jaw. Your dentist may be able to identify this by evaluating your teeth for any signs of grinding. You may be prescribed a mouth guard to wear at night, which can reduce the wear and tear if you do grind your teeth while you sleep.
The TMJ is a very complex joint that can become very painful. Many people are unaware of the conservative treatment options that are available. A well-trained chiropractor and dentist working together can profoundly impact mitigating and improving the pain in your jaw.
REFERENCES
Saladin, K. S. (2012). Anatomy & physiology: the unity of form and function (7th ed.).
New York: McGraw-Hill. Pearson Education, HealthDent.com/tmj
https://www.nidcr.nih.gov/oralhealth/topics/tmj/tmjdisorders.htm
