The initials TMJ literally refers to the jaw joint (Temporo-Mandibular Joint) but has come to be recognized as shorthand for jaw pain and related problems. TMD or TMJD (Temporo-Mandibular Joint Dysfunction) is probably more accurate. Whatever you call it, the issues that accompany it can be numerous and debilitating: Everything from pain opening your mouth and jaw locking, to vertigo and dizziness, ringing in your ears, migraine like headaches, and more. The sum of these head, face, and mouth issues is referred to as orofacial pain.
The bottom line is, there are any number of issues of the neck, face, and head that can be traced back to the jaw joint and related muscles, even if they don’t seem like they are related.
Three Main Factors That Contribute to TMJ Dysfunction Symptoms
- Misalignment of teeth (Occlusion)
- Asymmetric muscle tightness/weakness
- Problems in the joint itself, particularly the articular disc that cushions and lubricates the joint.
These 3 factors seldom work in isolation and more often than not, multiple factors are involved.
Misalignment of Teeth
When considering the source of jaw pain, clicking, or any other issues, alignment and fit of the upper and lower teeth is the first thing to consider.
There is an easy way to check the basic alignment of your bite. With a relaxed jaw and face, close your mouth with your lips together. There should be about a credit card’s worth of space between your upper and lower molars. If that’s the case, you probably have a good fit. I say “probably” because differences in fit from one side of the mouth to the other or individual pairs of teeth can also cause problems when chewing, etc. If your teeth—particularly your molars—are touching, your alignment is off. A dentist will be able to give you a definitive answer on the alignment of your bite and discuss options to address it. Once those alignment issues have been corrected, there are usually residual soft tissue concerns that neuromuscular therapy can help with.
Asymmetrical Muscle Tightness & Weakness
Clenching, grinding, and uneven bite can cause some muscles to overwork and become tight, while other muscles underwork and are inhibited from working properly. I like to think of these muscles like guitar strings. When they are all in tune, everything sounds great. But when some strings are sharp (too tight) and others flat (too loose), it sounds bad.
This combination of overworking and underworking muscles misaligns cranial bones, the jaw, and the joint itself. And this can cause pain or discomfort in the ears, sinuses, mouth, eyes, teeth, and even headaches. Neuromuscular therapy helps to relax overworking and tight muscles and “wake up” muscles that are underworking. By gentle manual manipulation of the muscles around the jaw, we can equalize muscular tension and allow related structures to realign themselves.
The Temporo-Mandibular Joint is one of the most complex joints in the body. There is a small disc, similar to cartilage, between the jaw bone (Mandible) and the Temporal Bone that forms the joint. This disc provides cushioning and lubrication of the joint as it rotates (Mandibular Fossa) and then slides along the bone (Articular Eminence) when the mouth opens.
Upon opening the mouth (A to B in illustration below), the jaw rotates in its “socket,” the Mandibular Fossa (circled in green). Further opening (B to C), the jaw slides forward along the Articular Eminence of the Temporal Bone.
Clenching, grinding, bite issues, and trauma can damage or malform this disc, which can cause the disc to slip too far forward (most common) or backward. When the disc is displaced forward it can cause clicking, popping, locking, or prevent the jaw from opening completely. This can happen with or without pain. Here again, manual manipulation of the muscles around this joint and gentle jaw decompression can help encourage the disc to move back into place. This often results in long term relief, although in some cases, periodic sessions are needed to maintain disc alignment.
A Modern Approach to TMJD Therapy
It’s important to have TMJD issues addressed as early as possible because TMJD is progressive and can result in permanent damage to the joint. Early treatment and self-care follow-up can be very effective.
During your initial session, I will evaluate your posture, talk about sleeping habits, and discuss the type of work and other activities you do in order to determine what could be contributing to your TMJD. Through manual therapy we will address any postural issues and work on the muscles of your head and neck. This helps to maximize the benefits of work done directly on the muscles around your jaw: gentle manipulation done in short 30 second intervals both externally and intra-orally. During the entire therapy, you are control of the experience. My goal is to gently and as painlessly as possible bring you relief.
Although a level of relief can be achieved in 1 or 2 sessions, a series of 3 to 8 weekly treatments are generally recommended to repattern the dysfunction for long-lasting relief. Along with this manual therapy, there are self-care techniques that I teach to help you maintain pain relief and disc alignment.
Following initial treatment, people who have had long-term TMJ issues often require regular, but less frequent maintenance sessions to retain a healthy level of TMJ function.
If you are suffering with TMJD, I can help. 1-805-252-8617 www.santabarbaratmjtherapy.com