Chewing gums or grinding your teeth can lead to jaw pains. To fully understand the cause of temporomandibular joint Disorder (TMD), you will need to learn the physiology of the temporomandibular joint. Further discussions will include symptoms, diagnosis, treatment, and recovery.
The Temporomandibular Joint (TMJ) is the joint in your jaw. There is a TMJ located on each side of your head, two in total. You can find it in front of the ears. To get an exact location, open your mouth and let your jaw drop. Put your fingertips in the area in front of your ears while opening your mouth. You will feel the joint moving around below your fingers.
The TMJ consists of two bony joints. You can find one of them on the side of the head behind the ears. The joint has a shallow hollowing shape, which is called TMJ fossa. The other joint, the mandible bone, is a part of the lower jawbone. The joint has round knob-like shape. The name of it is condyle. When you move the TMJ, you can open or close your mouth to sing, speak, yawn and chew.
There is a disc that sits between the TMJ fossa, temporal bone, and the condyle bone. The disc has soft tissues that protect the jaw when the condyle moves forward and backward as it opens and closes. If the disc weakens, it can cause pain and dysfunction of the joint.
The temporomandibular joint has various ligaments and muscles attached to it. The ligaments and muscles keep the joint stable as well as enabling it to move around. When the joint is stable, the bones stay in the right anatomical position and function the way they should.
The primary role of the ligaments is to keep the joints in place. Of all the ligaments of the TMJ, the most prominent one is the temporomandibular joint. The location is between the mandible and the temporal bone. Other massive ligaments that attach themselves to the jaw are stylomandibular and sphenomandibular.
Muscles that Support the Temporomandibular Joint
Apart from the joints, two large muscles include the temporalis and the masseter muscle support the temporomandibular joint. You can feel these muscles when you clench your jaw or if you are chewing. You will feel the temporalis over the temples, and the masseter muscles are the ones that bulge near the jaw.
Two other important muscles that help the jaw to move around are the medial and lateral pterygoids. The muscles are on each side of the jaw. The primary function of the medial pterygoid muscle is to close the jaw. It works with the masseter muscle to accomplish its task. The lateral pterygoid mainly moves the jaw to one side. Both work together on each side of the jaw to assist in opening the mouth.
Causes of Temporomandibular Disorder (TMD)
There are no known TMD causes. However, there are underlying factors that affect the joint.
Congenital Jaw Physiology
The size of the jaw, how it rests on the face, and how the teeth are situated can add to the wear and tear of the TMJ. The facial anatomy in combination with other factors can add to TMD causes.
Injured Joint – Chewing
Minor and prolonged injuries to the jaw can contribute to the misalignment of the temporomandibular joint. Minor injuries, or macro trauma, include a punch in the jaw, fracture, dislocation, or a car accident. Microtrauma (prolonged injuries) include the opening of the mouth for extended periods during dental treatment, continuous gum chewing, and nail or pen chewing. The injuries create tension in the muscles and eventually wear down the articular disc.
Teeth Grinding and Clenching
Another example of microtrauma is teeth grinding or clenching. It could contribute to TMD causes. When some people feel stressed, they clench or grind their teeth. Other examples of clenching include chewing gum, fingernails, or chewing pen. Doing those actions repeatedly could injure the TMJ and cause joint pain.
People who grind their teeth normally do so at nights when they sleep. If the grinding is intense, it can wear the teeth down and sometimes break them. When teeth clenching occurs frequently, it adds stress to the temporomandibular joint. If the clenching of the teeth is mild, the symptoms may not be that noticeable.
The joints wear down as you get up in age. The same goes for the TMJ. Osteoarthritis is an example of wear and tear on the TMJ; it causes pain in the joints.
Position of the Body
Poor posture can affect the TMJ. For example, if you bend your neck for extended periods of time that will directly affect the TMJ because of the proximity. People who frequently use the computer tend to shift their heads forward. The entire weight of the head is in front of the body. It will cause additional stress on the neck whereby affecting the position of the temporomandibular joint.
Chronic pain such as fibromyalgia or rheumatoid arthritis can contribute to TMJ pain. Other factors that contribute to TMJ pain include psychological stress, tumors, and some ear, nose and throat problems. A doctor will need to do a thorough examination to rule out anything else.
The following list shows the various TMD symptoms:
- Feeling pain or aching in the jaw bone
- Pain in the jaw muscles, head, neck, face, and ear
- The patient will feel the pain below the ear or the muscles surrounding the jaw. Additionally, the patient may feel worse in the morning, which could indicate teeth are grinding or clenching.
- When the jaw is in motion, there is a clicking, popping, grinding or grating sound. This could be a result of an injury to the joint structure. Some people may hear sounds coming from their TMJ without feeling pain.
- People experience difficulty moving the jaw or opening and closing the mouth widely.
- The jaw locks and stays in one position; either in the open or closed position. This experience is a result of the TMJ functioning abnormally.
- The area over the TMJ swells up.
- There is difficulty yawning, moving the mouth, chewing or eating.
- The bite position does not feel the same.
- Tinnitus (ear ringing)
- Ears feel full
A physiotherapist will review your medical history for any symptoms before diagnosing your pain. These are some of the questions presented: When you eat certain foods, do you feel pain chewing? Do you feel pain when you open or close your mouth? Do you feel any pain when you yawn? Does the following ease your pain: ice, heat, or massaging the joint?
Additionally, the therapist will ask for the exact location of the pain and if you are taking any medication to help numb the pain. More questions include: Have you had any recent dental work done? Does your jaw lock? Have you noticed changes in your bite? Have you had any recent illnesses? Have you had any aches or pains in the muscle?
Moreover, the therapist will examine the TMJ. They will ask you to move your jaw around and open and close your mouth. This is to figure out your range of motion. During this exercise, the therapist will determine how coordinated the TMJ muscles are. The therapist will also ask you to clench your jaw to examine your teeth and note the bite occlusion. He or she will peer inside your mouth to see if your teeth have any wear and tear.
Furthermore, the therapist will place his or her fingers over your TMJ to see how well the joints move. He or she will listen to hear if there is any clicking or pop in the joint. The therapist will check for muscle tension in the jaw, especially the temporalis and masseter muscles in the lateral skull jaw. Additionally, he or she will examine the smaller muscles such as the pterygoids by feeling the jaw. The therapist may explore inside the mouth using a glove to feel the muscles and the motion of the TMJ.
Finally, the therapist will examine the motion in your neck joints to see if there is any stiffness or laxity that would affect the TMJ. He or she will examine your posture by observing the way you sit or stand to determine how your head, neck, jaw, face and shoulders rest. He or she will also check the muscles for strength and flexibility.
Your therapist will work with your dentist and ask you to obtain X-rays or MRI to aid in diagnosing TMJ problems. X-rays will pinpoint the condition of the bones and joint cartilage. The MRI will give a reading of the soft tissue structure of the TMJ, especially the articular disc and ligaments. The therapist may also ask for bite impressions, which you can get from your dentist. The investigation will help determine the cause of your TMJ pain.
Treatment of Temporomandibular Disorder
Temporomandibular disorder (TMD) treatment will vary due to the cause of the problem and how severe the symptoms are. The physiotherapist will work with the dentist or orthodontist when administering TMD treatment. The doctor might prescribe a pain killer. If it is a chronic case, the doctor may administer anti-inflammatory injection directly into the TMJ. Additionally, the therapist may ask you to consult with your orthodontist to check for any mouth splint or if any dental work required to repair TMJ tissues, which is a part of the TMD treatment.
The Recovery Process
The therapist assigned to you will introduce a variety of techniques to aid your pain and to avoid any future TMJ dysfunctions. He or she will give you educational materials to assist in managing your TMJ. You will get hands-on treatment, which includes massage or any other techniques to help ease tension in both the large and small TMJ muscles.
More hands-on work includes externally and internally mobilizing the TMJ and also stiff joints in the neck or upper back. The massages relieve pain emanating from the TMJ. It also reduces the stress that affects muscle tension. Additionally, the therapist will teach you massaging techniques to do at home. The methods include massaging the muscles inside and outside of the mouth.
The therapist will also use equipment to alleviate the pain such as ultrasound, laser, transcutaneous nerve stimulation (TENS) or other electrical apparatus. Ice or heat may also be helpful for relieving pain during therapy. Another method that may help with TMJ dysfunction is acupuncture.
Moreover, the therapist will show you the correct posture to maintain throughout the day to help you manage TMJ dysfunction. Posturing will affect your lower jaw, head, and neck. You will get exercises that strengthen your jaw, neck, and torso.
Additionally, you will get sleeping tips to ease any TMJ pressure. The therapist will advise against resting your jaw on your hands. Also, the therapist will ask you not to chew gums, bite your nails, or chew on pens. Furthermore, you will be advised not to eat foods that cause you to open your mouth widely such as burgers or large sandwiches. You will also know how to yawn correctly. The exercises enable you to control the TMJ muscles.
If the case of TMJ dysfunction is unmanageable, the therapist may suggest surgery.
The TMJ plays a vital role in your life. It enables you to speak, yawn, and chew. When the joint weakens, the pain can be excruciating. Seek the help of a physiotherapist. He or she will teach you massage techniques to help you control TMJ pain.
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