jaw pain man

image from www.towncaredental.com

Jaw pain, you may have had it at some time, but that doesn’t necessarily mean it’s a larger problem. When it is ongoing and starts to interfere with eating or is causing headaches, then it’s time to seek help.

Several patients have come in, reporting, that they have a “TMJ.”  Well, that’s true, and its true for all people, we all have a TMJ. TMJ stands for temporomandibular joint—a long word for the joint of your jaw.  What they really meant to say was that they had “TMD,” which is temporomandibular disorder.  TMD is defined as disorders associated to the jaw, ie difficulty opening, pain with chewing, yawning, locking jaw, etc.

I had a temporary issue when I had a lot of dental work in my teens. Wearing that darn headgear sent my jaw muscles into spasm and my mouth completely locked in the open position.   Read on to find out why it might be happening and what to do.

What is the TMJ? The TMJ is a hinge-type joint, connecting the lower jaw (mandible) to the temporal bone of the skull, immediately in front of the ear.  It is a joint, much like other joints in your body, containing cartilaginous surfaces. The TMJ also includes a disc, which slides forward and back when opening and closing the mouth.

muscles of mastication collage

Muscles of Mastication & TMJ; http://droualb.faculty.mjc.edu

What causes TMD? TMD can occur when the muscles of mastication (chewing) or muscles of the neck and face and/or joints are imbalanced.  Sources of imbalance include:

  • Grinding (Bruxism)
  • Habitually chewing on one side of the mouth
  • Eating large foods, requiring the mouth to open wide
  • Dental work that leaves the mouth open for long periods or manipulates the jaw such as headgear
  • Tension-holding habits, caused by stress, leading to muscle strain and tension of the face and neck–Do you bite your inner lips, hold your jaw tight, elevate your shoulders?
  • Dislocation of the disc at the TMJ
  • Osteoarthritis of the TMJ
  • Faulty posture and likely contributing to faulty breathing patterns, ie “chest breathing”

Symptoms of TMD: Your physician or dentist will likely diagnose you as having TMD. The physician or dentist may perform a X-ray to check out the joint and possibly a MRI to assess the soft tissues (ie the disc) to see if these are contributing. But most likely, they will send you to conservative treatment, such as a physical therapist for assessment and treatment. A physical therapist can help assess and treat the source. If they do not refer you to physical therapy, you should ask for a referral and seek one out on your own. Common symptoms of TMD are:

  • Pain or tenderness in the jaw joint area
  • Pain into the sides or front of the face
  • Possible pain into the neck muscles and tops of the shoulders
  • Headaches
  • Pain with chewing, yawning, talking
  • Popping or clicking in the jaw joint
  • Jaw that gets “locked” or stuck in the open position

Common Findings & What it Means:

  • Jaw opening (Mandibular Depression)
    • Should be 40-50mm or two knuckle
    • Clicking or popping may indicate TMD, but if present, it does not mean that you have TMD.  It is TMD if it is associated with dysfunction.
    • Deviation toward the restricted side without return to midline, suggests disc dislocation without reduction (DDWOR)
    • Deviation toward restricted side with return to midline (DDWR, ie S-curve), suggests disc dislocation with reduction
  • Side to side motion (Lateral Excursion):
    • should be 8-11mm, equal side to side
    • Limitations suggest adhesions of the joint or DDWOR
  • Jaw protrusion:
    • Lower teeth should pass upper teeth
    • Deviation toward restricted side
    • Due to joint adhesions or DDWOR
  • Tenderness or pain in masseter, temporalis
    • These muscles can cause pain to lower teeth, lateral face, area around the eye (referral pain)
Muscles of the Floor of the Mouth

Muscles of the Floor of the Mouth; http://droualb.faculty.mjc.edu

Treatment Options:

  1. TMD of joint origin (disc/joint surface) = focus on impairments of joint pain and reduced joint ROM
    • Conservative management will not substantially alter disc displacement or joint surface degeneration
  2. Posture may play a big part—treat postural corrections
    • Mindfulness about posture, see this link for post on Posture
    • Myofascial work–see a skilled massage therapist or your favorite PT
    • Postural strengthening–see your favorite PT
    • Postural stretches, see this link for videos of Neck Stretches
    • Watch for gripping in the jaw, see image of Omohyoid which has attachments to the floor of the mouth and the collar bones and neck muscles–ie RELAX that tongue and the jaw throughout the day
  3. It’s a joint much like any other joint….if it’s a sprain: ice/heat, immobilize, ease movement, move towards painfree AROM
  4. Hypermobility (too much movement/loosey goosey):
    • Strengthen around the TMJ, isometrics (ie, yawn position using fist under chin, teeth apart, side-to-side movements)–see your favorite PT
    • Avoid large mouth movements, ie eating apples
  5. Hypomobility (too little movement/stiffness):
    • Use heat
    • Mobilizations, distractions–see your favorite PT for help
    • Stretching and myofascial work–see your favorite PT for help
    • Soft diet (avoiding hard foods, chewing gum, gummy candies)
  6. Grinding (Bruxism):
  7. Stress Reduction/ Lifestyle Changes: see above in Bruxism for breathing and body scan links. And look into your life for triggers–work, significant other, finances?  There are countless ways we could be triggered to hold more tension.

The good thing is, this condition is sometimes easily treated by integrative techniques: hands-on therapy, posture and breathwork and compassionate individual lifestyle guidance (nutrition, meditation, wellness coaching). If you are experiencing any of the topics above, I encourage you to seek out support to assist you in doing the things you want to do again!

I welcome your feedback and hope that if you find this helpful, you will share with your colleagues and your friends. Click here to Contact Tianna to see how she can help you if you are experiencing pain in the jaw, face, or neck and would like to be able to eat, yawn, talk and enjoy life without pain. 

References:

  1. Harrison, A., Thorp, J., & Ritzline, P. A Proposed Diagnostic Classification of Patients With Temporomandibular Disorders: Implications for Physical Therapists. Journal of Orthopaedic & Sports Physical Therapy, 44, 182-197. Retrieved March 1, 2014, from http://www.jospt.org/doi/abs/10.2519/jospt.2014.4847#.U2pNPeZdUvk
  2. Temporomandibular Joint Disorders (TMJ): Symptoms, Treatment and More. (n.d.). WebMD. Retrieved May 6, 2014, from http://www.webmd.com/oral-health/guide/temporomandibular-disorders
  3. HomePage. (n.d.). HomePage. Retrieved May 6, 2014, from http://droualb.faculty.mjc.edu

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