Jaw Pain and the Temporomandibular Joint

What is the Temporomandibular Joint (TMJ)?

The TMJ (Temporomandibular Joint) is situated at the junction where our mandible (jaw) meets the temporal bone of the skull. Both these structures feature fibrocartilaginous surfaces, with an articular disc positioned between the temporal bone and mandible, effectively separating the joint into upper and lower compartments.

The anatomical functions of the jaw (mandible) include opening (depressing), closing (elevating), protruding (pushing the jaw forward), retracting (pulling the jaw back), and lateral deviation (moving side to side). A variety of muscles are involved in executing these movements. These muscles play a crucial role in essential functions such as breathing, eating, and swallowing, while also contributing to bruxism, commonly known as teeth grinding. Bruxism often occurs during sleep (Nocturnal Bruxism) and times of heightened stress, both of which can increase the likelihood of TMJ dysfunction and disorders.

What are the symptoms of TMJ dysfunction?

A patient with dysfunction of the TMJ can have one or many of the following symptoms:

• Pain in the jaw or side of the head.

• Difficulty opening the mouth fully for eating or yawning.

• Difficulty biting down or chewing.

• Clicking and/or grinding, which can be felt when opening or closing the jaw.

• Headaches

• Ear pain and tinnitus.

What causes TMJ dysfunction?

There are many different reasons why someone may develop TMJ pain. Typically, a patient will have one of the conditions listed below, however occasionally there can be overlap between these conditions. A careful assessment will be able to determine the contribution from each of these factors.

• Damage to the joint as a result of trauma, such as a knock to the jaw or side of the head.

• Wear and tear of the joint’s cartilage (osteoarthritis).

• Overactivity of the jaw muscles, such as in patients who frequently clench or grind their teeth

• Referred pain from the upper cervical spine due to neck dysfunction.

• Chronic irritation of the temporomandibular joint due to incorrect jaw posture/position.

• Dysfunction or displacement of the articular disc within the joint.

Treatment of TMJ dysfunction

A chiropractor will start by assessing your jaw range of movement, muscle strength, muscle length, motor control and movement patterns. This can help determine if your symptoms are related to one of the following:

• TMJ (Joint) disorder

• Cervical spine pathology

• Muscle disorder

• Developmental 

• Locked open joint disorder (intermittent or permanent)

• Jaw occlusion

• Arthritic

• Inflammatory / inflammation

• Dislocation or derangement of disc/condyle
  

The primary goal of TMJ dysfunction is to reduce pain, increase oral motor function with activities such as chewing or talking and improve joint mobility/health.

Techniques to treat TMJ dysfunction may include manual therapy (either through external means or internal techniques) to reduce pain and increase range of movement, joint mobilisation techniques, muscle stretching exercises (passive and active), dry needling, postural exercises and muscle strengthening exercises.

Your chiropractor may recommend you see your dentist for advice about the use of an occlusal splint when sleeping or potential botox injections.