TMJ mechanics and Dysfunction

By April 21, 2016No Comments

This condition is often overlooked. Do you suffer from

  • Pain in the front of the ears, especially on waking.
  • Persistent pain in the muscles of the face, on one or both sides.
  • A click or ‘popping’ sensation in the joint when opening the mouth.
  • Difficulty opening the mouth because it seems ‘stuck’,
  • An episode when the jaw was stuck open
  • Pain with chewing
  • Recurring headaches
  • Chronic neck and shoulder pain and stiffness
  • Ringing of the ears

If you answer yes to any of the questions above, you may have Temporal Mandibular Joint Syndrome/dysfunction.

Anatomy

The temporal-mandibular joint is a structure that connects the lower jaw to the paired temporal bone on the side of the head with the joint located in front of the ear. This joint is unusual in that there is one jaw bone with two joints on either side, so that one side can influence the other. The large temporal muscles, together with other muscles and ligaments, allow the joint to move properly while chewing and speaking. If any component is adversely affected due to muscle tension, arthritis, a head injury, or incorrect mastication or opening too wide, the movement of the joint becomes restricted, resulting in pain.

Description

Because of our need to speak and eat, humans have a jawbone with a wide range of movement. The joint that connects the lower jaw, or mandible, to the temporal bone of the skull is like a hinge with a small disc of cartilage that protects the contact surface between the two bones and allows for easy movement. TMJ syndrome is the term that indicates pain or some other disorder in this area.

Almost everyone experiences some discomfort in the temporal-mandibular joint at some time. Simply yawning widely or eating something in an incorrect way can result in pain or a clicking noise when the jaw is moved. This situation is usually temporary and often resolves itself spontaneously without treatment. In some cases, however, the patient feels pain radiating throughout the face, even reaching down to the neck and shoulders. This is a chronic case of TMJ that could be linked to other disorders.

Causes

In most cases, TMJ syndrome results from excessive effort in using the jaw muscles; dislocation of a disc in the joint, whiplash when the head is snapped back, fall injury to the face or chin, a degenerative joint disease; or sometimes a combination of these and other elements. The most common cause, however, is simply an excess of effort used in the repetitive motion of opening and closing the jaw or opening the mouth too wide, which has resulted in ‘wear and tear’. This effort may result from clenching the jaw or grinding the teeth, but it can also result from structural misalignment, such as a protruding jaw, misalignment of the teeth, or badly fitting dentures. Other factors can include chronic poor posture because when someone slouches for long periods of time, the head is moves forward resulting in the lower jaw hanging from the skull and not allowing the jaw to be in a normal resting position.

The dislocation of one or both discs in the articulation of the jaw can be caused by a sudden blow or trauma to the head or simply by chewing intensely or yawning too widely. Usually the displaced disc returns to its correct position without causing any permanent damage to the jaw but if the displacement happens frequently, the jaw may make a clicking sound with opening and closing indicating the disc is not in the correct position. Over time, the bony surfaces of the joints start to wear down because the disc is not protecting the two surfaces which results in a grinding sound called crepetus. These symptoms are similar to those of other degenerative joint diseases, such as osteoarthritis and rheumatoid arthritis, where inflamed articulation gives rise to pain and stiffness.

Treatment

Taking painkillers reduces inflammation and relieves pain, but this does not solve the underlying cause of the problem. Patients with TMJ need to comprehensively assess their lifestyle, from everyday stresses that cause tension to eating foods that cause an excessive load on the jaw. In cases where the alignment of the dental arches is incorrect, a dentist knowledgable in treating TMJ syndrome should be consulted. Besides advising the individual to chew properly, an osteopath can also use manipulation techniques to increase the range of motion of the head, neck, shoulders and upper back.

Prevention

To prevent involuntary muscular effort or an unbalanced pressure on the jaw, do not sleep with the head turned to one side, or with the entire weight of the head on the chin, a position common in people who sleep prone. Try to sleep on your side, or on your back, without a pillow. Ideally a soft diet is recommended especially when you are having discomfort. If you feel tension in your jaw when waking up, clenching the jaw or grinding the teeth, something that can happen involuntarily while sleeping may cause it. Consult a dentist or an orthodontist regarding the use of a night guard that protects the bite and seek treatment for stress reduction such as meditation and EFT.

The resting positon of the jaw is slightly relaxed with the tip of the tongue on the roof of the mouth. Effort should be made to try to find this balance. Correct sitting posture is also essential because when the alignment is balanced all the joints in the body are relaxed, including the jaw joint.

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