The temporomandibular joints (TMJ) are important to us for a very big reason, they control the mouth. There are few things scarier than a locked jaw that affects our ability to eat, as well as speak. TMJ disorders affect women more than men and there is a higher incidence among teenagers.
The effect of age and gender on the onset of symptomatic temporomandibular joint disk displacement.
“Teenage girls were found to run a risk of developing disk displacement that is three times greater than the risk for teenage boys, and girls were found to run a risk during puberty that is four times greater than their risk later in life.”
This is a complex joint, involving the work and study of different professions, and therefore the need for specialization is important.
TMJ or TMD?
Great question! We all have two temporomandibular or jaw joints, TMJ’s. TMD simply means temporomandibular disorder. This suggests that you have a problem with your TMJ. To be honest when you have a TMJ problem you typically know it and that is why you are seeking dental or medical help. Adding the word ‘disorder’ does not help us understand or treat why a person is having a problem with their jaw. It does say this joint has a problem though.
Causes of TMD
Facial or jaw injury
A scar on the chin is a good indication of a TMJ injury and potential problem.
A chronic bite interference with clenching
Your teeth may not fit well together and this can strain the ligaments of the TMJ over time as we clench.
After a dental procedure, joints can get sprained
While not common, an injury during a dental procedure can occur. The joint can get sprained.
Can happen during or after orthodontic treatment
While your teeth are moving your bite is changing. Sometimes this can put an extra stress on the joints. A joint that has some minor issues but is not painful can be exacerbated and start to cause problems during or following orthodontic treatment.
Related to systemic issues
Bacteria can be found in the TMJ. This is true of chlamydia infections. There is a higher incidence of joint inflammation and muscle pain in patients diagnosed with Polycystic Ovary Syndrome or PCOS. Rheumatoid arthritis can affect the TMJ.
“We confirm the higher incidence and severity of disorders of the TMJ in patients with PCOS and suspect that chronic low-grade inflammation may play a part in the aetiology of the disease.”
Symptoms of a TMJ problem
Jaw and facial pain
Clicking or grinding sounds that you can hear
Pain with chewing food on the opposite side of your mouth
Loss of mouth opening
Locking open or closed of your jaw
Changes in our bite
A painful or symptomatic temporomandibular joint with disc displacement showed a very high correlation with tinnitus. Having a potential musculoskeletal cause for tinnitus, stemming from a TMJ or cervical problem, is good news as treatment for tinnitus is possible in these cases. There is a direct connection between the disc of the TMJ and the inner ear, the discomalleolar ligament.
A jaw tracking problem
There is a condition that affects the muscles of the jaw, including the base of the skull and upper neck. Jaw tracking is not smooth with jaw deviations or deflections occurring. In this situation the TMJ is not inflamed. It may have some prior injury and even disc displacement. Treatment is very successful in these cases.
Notice that headaches are not part of a TMJ problem. While people with headaches can have a TMJ problem a TMJ joint that is injured, swollen and inflamed does not trigger headache pain. Pain is very localized to the joint itself and can cause facial pain. It is other systems that can trigger headache pain.
Headaches are not caused by a TMJ injury
Muscle of mastication pain or myofascial pain is common and can occur with an asymptomatic TMJ. This is usually related to clenching or grinding.
Pinky finger in the ear, put pressure forward. Is there pain?
Open and close your jaw, do you hear any noise? Look for popping, clicking and grinding sounds.
The jaw does not fully open.
Is there a hard block that can be painful while opening your mouth?
Do your teeth fit together? An anterior open bite or difficulty bringing your front teeth together has a higher incidence of a TMD.
Who should you see?
There is a certification process for TMJ specialists within the Physical Therapy and Dental professions. The better certification processes take years to complete and have an oral as well as practical exam alongside a written test. The more advanced certifications take days to complete the testing. Find a specialist that has these credentials when seeking care.
That said should you see a dentist or physical therapist? The main difference between these professions is their approaches to treatment. Dentists will focus on the teeth as well as medication and possibly injections. A dentist will most likely recommend a dental appliance. Physical Therapist TMJ Specialists will look at the function of the jaw as well supporting systems like the neck. They provide a hands-on approach in the diagnosis and treatment of temporomandibular joint problems.
I am over simplifying the perspective of these professions. Personally I think both professions working together can be a great approach to solving a TMJ problem. Some problems are more teeth or bite related, while others are a more complex musculoskeletal problem.
Certifications to look for
CFC – Cranio Facial Certification
AAOP – American Academy Orofacial Pain
AACFP – American Academy of Craniofacial Pain
Look for any training that has Rocabado listed as the foundation for their training. Mariano Rocabado is a Physical Therapist from Chile that has shaped the world of TMJ Disorders and has mentored many Physical Therapists and Dentists in many countries over the last 4 decades.
Do you need to have a dental appliance?
If your bite is the same and has not changed over years but now you have a TMJ problem then a dental appliance is less likely. With acute TMJ injuries it is more important to help the TMJ heal and a dental appliance may be prescribed. There is more on this subject in another post.
Treatment for TMJ issues
Restoring jaw tracking or mouth opening to a smooth and efficient motion while resolving pain is our goal with treatment. Dry needling for muscle trigger points and pain, joint mobilization techniques of the jaw and neck, and exercises to restore normal jaw motion are the most common approaches for treatment.