McGovern Physical Therapy Associates - The Personal Care Professionals

TEMPOROMANDIBULAR JOINT DISORDER

What is the temporomandibular joint?

TMJ stands for TemporoMandibular Joint, or the jaw joint. You have two TMJ’s, one in front of each ear, connecting the lower jaw bone (the mandible) to the skull. The joints allow movement up and down, side to side, and forward and back. The joints are typical sliding "ball and socket" joints which have discs sandwiched between them. The TMJ is used many hundreds of times a day in moving the jaw, biting and chewing, talking and yawning. It is one of the most frequently used joints in the whole body.

The temporomandibular joints are highly complex and are composed of muscles, tendons and bones. Each component contributes to the smooth operation of the TMJ. When the muscles are relaxed and balanced, and both jaw joints open and close comfortably, we are able to fully function without pain.

Who is Affected by TMJ Disorders?

The National Institute of Dental and Craniofacial Research (NIDCR) of the National Institutes of Health (NIH) states that over 10 million people in the United States suffer from TMJ problems at any given time. While both men and women experience TMJ problems, the majority of those seeking treatment are women in their childbearing years.

What are TMJ disorders and how are they caused?

TMJ disorders are a group of complex problems related to the jaw joint. Because muscles and joints work together, a problem with either one can lead to problems. The following are some common behaviors or conditions that can lead to TMJ disorders:

1. Teeth grinding and teeth clenching (bruxism) increase the wear on the cartilage lining of the TMJ. Patients may be unaware of this behavior unless they are told by someone observing this pattern while sleeping or by a dental professional noticing signs of wear and tear on the teeth. Many patients awaken in the morning with jaw stiffness and pain.
2. Habitual gum chewing or fingernail biting.
3. Dental problems and misalignment of the teeth (malocclusion). Patients may complain that it is difficult to find a comfortable bite, or that the way their teeth fit together has changed. Chewing on only one side of the jaw can lead to, or be a result of, TMJ problems.
4. Trauma to the jaws. Previous history of broken jaw or fractured facial bones.
5. Stress frequently leads to unreleased nervous energy. It is very common for people under stress to release this nervous energy by either consciously or unconsciously grinding or clenching their teeth.
6. Occupational tasks such as holding the telephone between the head and shoulder.
7. There are also other, less common causes including, genetics, hormones, low-level infections and auto-immune diseases.
   

What are the common symptoms of TMJ disorders?

Pain is the most common symptom. TMJ pain is often described as a dull aching pain in the jaw joint and nearby areas, including the ear, which comes and goes. Some people, however, report no pain, but still have problems using their jaws. Other symptoms can include:

• Being unable to open the mouth comfortably
• Clicking, popping or grating sounds in the jaw joint
• Locking of the jaw when attempting to open the mouth
• Headaches
• A bite that feels uncomfortable or “off”
• Neck, shoulder and back pain
• Swelling on the side of the face
  

Additional symptoms may include: ringing in the ears, ear pain, decreased hearing, dizziness and vision problems. Also, improper posture may be to blame. It is not uncommon for a TMJ patient to have a forward head posture. This abnormal posture causes the head to be positioned forward. It stretches the anterior neck muscles and pulls the lower jaw backward into the patient's ears. This abnormal posture may be due to the adjustment of the body to mouth breathing and the need to hold the head forward to breathe better. In severe cases, forward posture can cause thoracic outlet syndrome on top of TMJ problems.

How are patients evaluated when TMJ problems are suspected?

Diagnosing TMJ diseases and disorders can be difficult and confusing. For example, facial pain can be a symptom of many conditions, such as sinus or ear infections, decayed or abscessed teeth, various types of headache, and facial neuralgia (nerve-related facial pain).

A complete dental and medical evaluation is often necessary and recommended to evaluate patients with suspected TMJ disorders. Damaged jaw joints are suspected when there is popping, clicking, and grating sounds associated with movement of the jaw. The teeth may be worn smooth, as well as a loss of the normal bumps and ridges on the tooth surface. Ear symptoms are very common. Panoramic dental x-rays and computer tomography (CT) scanning help to define the bony details of the joint, while magnetic resonance imaging (MRI) is used to look at the soft tissues of the joint.

How can TMJ be treated?

The mainstay of treatment for acute TMJ pain is moist heat & ice, appropriate exercise and massage, a soft diet and anti-inflammatory medications.

1. Jaw Rest: It can be beneficial to keep the teeth apart as much as possible. It is also important to recognize when tooth grinding is occurring and devise methods to cease this activity. Patients are advised to avoid chewing gum or eating hard, chewy, or crunchy foods such as raw vegetables, candy, or nuts. Foods that require opening the mouth widely, such as a big hamburger, are not recommended.

2. Heat & Ice Therapy: Assists in reducing muscle tension and spasm. However, immediately after an injury to the TMJ, treatment with cold applications is best. Cold packs can be helpful for relieving pain.

3. Medications: Anti-inflammatory medications such as ibuprofen (Advil, and others) and naproxen (Aleve, and others) can help control inflammation. Muscle relaxants, such as diazepam (Valium), aid in decreasing muscle spasms

4. Physical Therapy: Passively opening and closing the jaw, manual therapy to the head, face, neck and jaw, in addition to electrical muscle stimulation to greatly help decrease pain and increase the range of motion and strength of the joint.

5. Stress Management: Stress support groups, psychological counseling, and medications can also assist in reducing muscle tension.

6. Occlusal Therapy: A custom made acrylic appliance which fits over the teeth is commonly prescribed for night, but may be required throughout the day. It acts to balance the bite and reduce or eliminate teeth grinding or clenching (bruxism).

7. Correction of Bite Abnormalities: Corrective dental therapy, such as orthodontics, may be required to correct an abnormal bite. Dental restorations assist in creating a more stable bite. Adjustments of bridges or crowns act to ensure proper alignment of the teeth.

8. Surgery: Surgery is indicated in those situations where medical therapy has failed. It is done as a last resort. TMJ arthroscopy ligament tightening, joint restructuring, and joint replacement are considered in the most severe cases of joint damage or deterioration. Physical therapy should also follow any surgical procedures.

Many TMJ practitioners believe that since a person's jaw is hurting, they simply should have them do a lot of jaw and neck exercises. While exercises are extremely helpful in improving the range of motion and strength of the joint, it should not be the only technique used in treating TMJ disorders.

McGovern Physical Therapy Associates believes in treating the body as a whole. Just because the jaw is where there is the most pain, it may not be the cause of the pain. Only doing exercises on the jaw may increase pain because they pull on already irritated muscles and do not address the actual sources of the pain.
 
The true sources of pain are different for each patient. One cause may be tight muscles from other parts of the body pulling on the jaw forcing it out of alignment, and therefore causing pain. MPTA specializes in ergonomics, posture training and body alignment. We look at the entire body and devise personalized treatment plans to improve your overall posture and body alignment, while treating your acute TMJ symptoms. In addition to appropriate therapeutic exercises, MPTA focuses on manual therapies which may include myofascial release, joint mobilization, traction and massage. We use modalities such as electrical muscle stimulation, therapeutic ultrasound and moist heat and ice.  
McGovern Physical Therapy Associates will help bring you through the body’s natural healing stages and help you train to reduce and prevent future TMJ problems.
 
McGovern Physical Therapy Associates, the personal care professionals, is a multispecialty provider of outpatient physical therapy care. Voted “Best PT Practice 2004” by ADVANCE for Directors in Rehabilitation magazine, our clinicians offer personalized manual therapy and exercise expertise, including a variety of customized treatment options. Combining innovation, experience and excellence, our staff of clinicians, as well as dedicated office personnel, work as a team to provide caring, convenient and professional service for total patient recovery.

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