What is TMD?
Temporomandibular Joint Disorder (TMD) is a condition involving the muscular and articular components of the Temporomandibular Joint (TMJ) or jaw joint. Dysfunction of this joint leads to pain, dysfunction (ie popping, clicking, grinding), and eventually degeneration.
What causes TMD?
Muscle hyperactivity, trigger points, fascial restrictions, and/or functional muscle imbalances are some of the causes of muscular TMD. Some triggers of muscular TMD include excessive grinding of the teeth, clenching the jaw together, postural dysfunctions, a forward head posture, and direct trauma.
Some common contributors to TMD are nail biting, biting of lips, mouth breathing, and playing a musical instrument. Being in poor physical fitness and being overweight are also some known contributing factors to TMD as well. Sleeping less than 5 hours and sleeping greater than 9 hours each night increases the rate of TMD. Psychological disturbances including stress and depression are other recognized factors of TMD. People that experience TMD have elevated incidences of suffering from migraine headaches.
Symptoms of TMD
Typical symptoms people might notice if they may have TMD include: clicking, popping, restricted opening of the mouth (not being able to open wider than 3 fingers tall), locking and pain. You may also notice chewing becoming painful if you have TMD.
Pain is generally described as an ache located immediately in front of the ear canal, but pain could refer or transfer to other areas such as the face, head, neck, and shoulders. Some spinal pain and tenderness are common finding in TMD.
Over half of people who have TMD suffer from neck pain and headaches, suggesting a common link arising from the upper cervical spine. Therefore, TMD can be a cause of pain in the upper most part of the spine. A common occurrence in people with TMD includes cervical spine weakness and lack of mobility. They exhibit cervical spine motion limitations, mostly in the upper segments.
Here’s What our Exam May Find
The way to examine if you have TMD is by assessing the movement/function of the jaw. To do this we will need to visualize and feel how the jaw moves and opens when you open and close your mouth.
While observing someone with TMD you will be able to see an abnormal joint movement upon opening. You may notice when the bottom jaw opens it may deviate to one or both sides instead of straight up and down. When a person with TMD moves their jaw they or another person may feel clicking at the joint when the jaw is in motion. Palpation may also reveal tenderness and/or knots in the surrounding jaw muscles and neck/upper back muscles.
Palpation and examination may also reveal lack of motion/mobility in the joints of the upper back as well as tension and trigger points in the neck musculature.
Treatment of TMD
When dealing with TMD a non-surgical intervention has been shown to be just as effective as a surgical intervention. Management can be very simple and includes manual therapies, exercises, and avoidance of aggravating activities/motions. Some activities to avoid include chewing gum or eating “rubbery” foods like steak or candies.
One of the most effective techniques used to help reduce pain and improve opening of the jaw is intra oral myofascial therapy. Intra oral myofascial therapy is a manual technique/massage on the muscles inside the mouth. Joint manipulation (a passive movement of a joint beyond the active motion to attempt to restore full joint mobility) of the cervicocranial (where the spine meets the skull), cervical, and thoracic spine can be very helpful with pain and stiffness that has occurred from TMD.
Exercises to improve posture and TMJ function have been beneficial as well. Another thing someone with TMD can do is stretching the surrounding muscles of the jaw to address tightness. Those with TMD may also ice and heat around the joint. Additionally Acupuncture and Dry Needling may provide pain relief.
Someone with TMD should focus on keeping their jaw in the relaxed position. Those with nighttime symptoms should consider getting a custom mouth guard, avoid stressful activity before bedtime, and be aware of their sleeping position. A custom-fitted mouthguard can help minimize clenching of the jaw which will help relax the muscles surrounding the jaw. Stress management techniques, such as biofeedback, will help patients learn to relax the surrounding muscles.