If you have pain in your jaw on one or both sides, recurring headaches/neck aches, popping/clicking in the jaw joint, jaw locking, ringing in the ears (called tinnitus), and/or clenching or grinding of your teeth, you may have a condition called Temporo-Mandibular Joint Disorder, or TMD (also referred to as “TMJ”). Your jaw may hurt, the muscles of your face may feel like they are in spasm, and you may feel clicking and catching in your jaw. These symptoms may make eating and talking painful or impossible.
There are many different treatments for TMD. You may benefit from oral medications (steroids, muscle relaxers, anti-anxiety), removable mouthpieces (to reposition/align the jaws), tooth aligners (braces or Invisalign), dental implants (for missing tooth replacements), partial dentures, physical therapy, massage therapy, ultrasound, muscle injections (anesthetic or Botox), and some people even have surgery to correct the problem. Physical or massage therapy for TMD is another option to help you relieve jaw pain.
So what can you expect from the TMJ Guys to help you if you have these symptoms?
Signs and Symptoms
Temporomandibular joint disorders, known as TMD (or “TMJ”), is a condition that can cause significant difficulty using your jaw. The condition is marked by pain in your jaw that limits your ability to comfortably open and close your mouth. You may also experience clicking or “catching” while chewing food, yawning, or talking. Chronic (long term) problems can result in significant headaches or neck aches as well.
Symptoms of TMD tend to come on gradually with no specific injury or event. You may notice that the pain starts after eating hard foods. The pain typically is intermittent in nature, and it usually comes on after using your jaw to eat hard foods or opening your mouth wide, as you would during yawning.
Anatomy of the Temporomandibular Joint
Your temporomandibular joint is formed by the articulation of your mandible (lower jaw) to the glenoid fossa of the temporal bone of your skull (resembling a ball and socket). There is a small piece of cartilage called an articular disc that resides between the two jaw bones. When you open and close your mouth, the disc slides as your jaw bone rotates and glides forward and back, making movement possible.
Various muscles attach near your temporomandibular joint. These muscle help to open and close your jaw, allowing you to talk, eat, and swallow. (the jaw joint is the most complicated and most used joint in your body). Several small ligaments attach the bones together, increasing the stability of the joint.
What Can Go Wrong?
What causes problems with your TMJ? How can things go wrong with the joint? There are many causes of TMD. These may include:
- Missing back teeth (causing the jaw joint to compensate and absorb excess forces)
- Misaligned teeth (called a malocclusion)
- Displacement of the articular disc in the joint
- Muscle spasms
- Injury to the head, neck, or jaw
- Forward head posture (typically associated with upper airway issues)
- Stress
- Clenching or grinding of your teeth (known as bruxism)
Whenever the joint is over-stressed, it can cause pain and joint movement dysfunction. This may lead to inflammation of the joint or of the muscles and ligaments surrounding the temporomandibular joint.
Diagnosis
If you are experiencing TMD problems, you should visit one of the TMJ Guys Diagnostic Centers where we can determine the cause of your pain and can properly diagnose your condition. Diagnosis of TMD is made largely by clinical examination.
Your doctor or therapist will palpate (touch) your jaw joint and the muscles around it, feeling for tenderness or clicking while you open and close your mouth.
Your doctor or therapist will also examine your jaw’s range of motion, looking for any deviations in movement. Sometimes your jaw may open well on one side and not the other, making your jaw move to one side as you open your mouth.
Our TMJ Guys Diagnostics Centers will acquire 3D X-rays of your jaws and jaw joints to check if your temporomandibular joint has arthritic changes, and to examine the position of the articular disc in your jaw joint. We will also acquire a 3D image of your teeth using a 3D camera (called an intraoral scanner).
If your doctor rules out TMD, there may be other causes of your jaw pain. These may include:
- Tooth decay or cavities
- Facial neuralgia
- Neck arthritis
Once a diagnosis of TMD is made, you can begin treatment.
Initial Treatments
At your first visit, initial treatment will likely involve a combination of oral medications and a soft mouthpiece to relieve any immediate pain. Once it’s determined that repositioning your jaw proves successful, our doctors may prescribe a more definitive mouthpiece made of hard plastic for day time and night time wear. You will also be referred to our certified TMJ Spa where one of our physical or massage therapists will begin addressing the muscle component of TMD (which is predominantly the source of pain).
Our doctors may also recommend and perform trigger point injections directly into the muscle causing the pain. These injections involve the use of long lasting local anesthetics that will break up the pain and muscle spasm cycle. If it proves beneficial, the doctor may also recommend a more long lasting solution using a Botox derivative to relax the problem muscles for several months at a time.
Long term solutions may include orthodontics (braces or Invisalign) for misaligned teeth, or tooth replacements such as dental implants or partial dentures. Your TMJ Guys doctor will make the appropriate choice and referral for your particular need.
Physical or Massage Therapy Evaluation
Our doctors will refer most patients to our certified TMJ Spa. This visit involves a doctor prescribed visit with one of our physical or massage therapist. Your therapist will take time to discuss your condition. They will ask you questions about how your jaw pain started and what activities make your symptoms better or worse. He or she will also discuss eating habits and other activities that may be irritating to your jaw.
Your therapist will also ask about previous treatments you may have had for your TMD pain. A thorough review of your medical history may also be done.
During the physical therapy evaluation, several tests may be performed to get a baseline measurement of your TMD condition. Components of a TMJ Spa evaluation may include:
- Assessment of posture
- Measurements of neck range of motion
- Measurement of jaw range of motion in various directions
- Palpation of structures around your jaw
- Measurement of the strength of your jaw and postural muscles
Once your evaluation is complete, your physical therapist will discuss with you the findings and make a plan of care to start treating your TMD. Be sure to ask questions about your condition and what you should expect from therapy. Your therapist will also work with you to develop goals for your course of therapy.
Therapist Treatments
Your therapist may use various treatments for your TMD. These treatments are designed to decrease inflammation and pain, improve posture, improve jaw mobility, and help you regain normal function of your jaw. Treatments may include many potential methods for rehabilitating your joint.
Application of Heat or Ice
Heat may be used on your jaw to relax muscles and decrease pain and muscular spasm. Ice is sometimes used for TMD to decrease inflammation and pain around your jaw.
Ultrasound
Ultrasound is a treatment used in therapy to provide deep heat to tissues and improve cellular mobility. It is sometimes used in the treatment of TMD pain. One study in the Journal of Physical Therapy Science found that the addition of ultrasound in conjunction with home exercises provided greater pain relief and improved mobility when compared to exercise alone.
Massage
Your therapist may use various massage techniques to treat your jaw pain. Massage may be applied to your jaw muscles, facial muscles, and neck and shoulder muscles. The goal of massage is to relax muscles and improve circulation to them, allowing for a normal motion to occur in your temporomandibular joint.
Temporomandibular Joint Mobilizations
Your therapist may utilize mobilizations to your jaw to help improve the mobility of the joint. Mobilizations can restore normal joint motion and may help relocate a displaced articular disc in your jaw joint. The mobilizations your therapist performs may be a bit uncomfortable; many involve your therapist placing her thumb or finger in your mouth along your teeth to mobilize your jaw. (Don’t worry, gloves will be worn for this procedure.)
Postural Instruction
Sitting or standing with a forward head and rounded shoulder posture may place excessive stress and strain on your jaw joint. If your therapist assesses that your posture is contributing to your jaw dysfunction, he or she may instruct you in proper posture.
Shoulder and neck strengthening exercises may also be prescribed to improve your overall postural awareness.
Exercises
Exercise for your jaw is one of the most important components of your TMD treatment program. Your therapist will likely prescribe exercises to improve that way your jaw opens and closes. They may have you use a mirror so you can see how your mouth and jaw are moving and so you can ensure that they remain in proper alignment while exercising. The goal of exercise for TMD is to restore normal, pain-free jaw motion.
If you have any questions about your rehab program for TMD, ask your therapist. They will likely be happy to help you understand your therapy program and make adjustments so you can get the most out of therapy.
What to Avoid
If you have TMD, there are certain things you should avoid as part of your treatment program. These things—often referred to as parafunctional activities—are things that you may be doing that are not necessary for function but are placing undue stress on your TMJ. Parafunctional activities may include:
- Chewing gum
- Biting pens or pencils
- Leaning your chin in your hand
- Eating hard foods
Avoiding these things can help take pressure and stress off your jaw joint and muscles and allow things to heal.
Timeline for Healing
Most cases of temporomandibular joint pain get better within six to eight weeks. More chronic, long term TMD problems may need months to see resolution. Working with your therapist and performing regular exercises can help in your recovery. Some cases may take longer, and some people continue with symptoms after treatment.
If this is the case, you should return to your doctor for follow up care. Some patients benefit from other treatments such as Botox type injections, wearing a mouth guard while sleeping, or surgery for their TMD.