TMJD: Temporomandibular Joint Dysfunction
Temporomandibular joint dysfunction (TMD) is a term used to describe abnormal functioning of the jaw. This dysfunction can include the joint itself (temporomandiubular) and the surrounding soft tissues (muscles, tendons, ligaments. TMJD very common and usually affects adults between the ages of 20 and 40.
Although TMD is not considered a life-threatening condition, it can become a major concern especially when it becomes more severe and chronic.
What is the Temporomandiubular Joint?
The temporomandibular joint is a unique joint that connects the mandible (jawbone) to the temporal bone of the skull. It is different from many other joints because it contains a complex network consisting of a joint capsule and articular disc, which is meant to cushion and allow for proper movement of the joint.
The temporomandibular joint also differs from other joints due to it’s dual function as a hinge and sliding joint. During normal opening of the jaw (speaking, chewing, etc.), the jaw bone begins with a hinge movement and as it opens further it slides forward along the temporal bone. with normal function, the disc remains in the middle of the joint acting as a cushion throughout the entire movement.
Temporomandiubular Joint Dysfunction
Because TMD refers to symptoms related to abnormal joint and soft tissue mechanics, there are different causes and types of dysfunction. People with TMD often complain different “clicking” and “popping” sounds. These can consist of single loud pops, grinding, or other abnormal noises while opening or closing the jaw.
Many times these sounds can indicate the problem associated with the exact cause of the dysfunction. Here are some simple references relating the sounds heard with TMD with the function of the joint:
Clicking during opening or closing:
The disc has been displaced during movement.
“Clunk” with full opening:
The jaw becomes displaced in front of the temporal bone of the skull.
Grinding (Crepitus):
Degeneration and arthritis in the joint - occurs commonly with side-to-side movements.
Locking:
The disc or jaw becomes displaced far enough where it is not able to readily move back into position.
Causes of Temporomandibular Dysfunction:
Many factors can cause dysfunction of the temporomandibular joint and the condition may be precipitated by tight/weak jaw musculature, joint degeneration, or abnormal mechanics. Some of the causes may be genetic, anatomical, or due to acute or chronic trauma. Here are some common causes of TMD:
Degenerative Joint Disease
Trauma
Emotional Stress
Grinding of the teeth (Bruxism)
Abnormal bite
Poor Posture
Other connective tissue disorders
Symptoms of Temporomandibular Joint Dysfunction:
The most common symptom of TMD is clicking, grinding, or locking of the jaw. Once this dysfunction becomes bad enough, pain may develop. Because the temporomandibular joint is so close to the ear and surrounding structures, many people may notice symptoms relating to the ear with more chronic cases. Although symptoms of TMD can affect both sides of the joint, they most commonly only occur on one side. Here are some common symptoms of TMD:
Pain in the jaw, face, or ear
Locking of the joint
Difficulting chewing
Asymmetric movement of the jaw
Asymmetric face and facial expressions
Hearing loss
Ringing of the ears
Dizziness
Headache
Treatments for Temporomandibular Dysfunction:
Due to the fact that TMD may have multiple causes and become chronic over time, it can sometimes be a difficult condition to treat. A key to treatment with TMD is finding the direct source of dysfunction and tailoring the treatment plan to address it, while also incorporating rehabilitation to prevent reoccurrence.
Finding a skilled healthcare professional that can properly diagnose the source of the problem is important when managing TMD. Once a practitioner is found, TMD can be treated through a number of different therapies:
Mobilization:
Mobilization of the temporomandibular joint involves lightly stretching the joint capsule and associated muscles to help reestablish normal movement. This is performed by a skilled practitioner and involves gentle movement of the jaw help take pressure off of the joint.
Manipulation:
Temporomandibular joint manipulation is simply a more forceful version of mobilization. It involves a quick thrust, often occurring with an audible release (popping sound) to help restore joint mechanics.
Soft Tissue & Trigger Point Therapy:
Soft tissue and trigger point therapy of the temporomandibular joint focuses primarily on the muscles and soft tissue of the joint. This often is performed by the practitioner using manual pressure and massage-like techniques to the muscles of the jaw, neck, face, and head. Many skilled practitioners often use a technique which requires them to insert their hands into the mouth to reach a key group of muscles (pterygoid muscles) related to TMD.
The goal of soft tissue therapies in TMD is to help reduce muscle spasm and relax the muscles of the joint, leading to less pain and improved joint mechanics.
Jaw Exercises:
Practitioners treating TMD will often incorporate jaw exercises to help strengthen muscles and improve motor control of the joint. These exercises can be done in-office or may be given as “homework” that can be done by the patient throughout each day. Incorporating jaw exercises into treatment is an excellent way to prevent symptom recurrence.
Here are some common exercises that may be prescribed to treat temporomandibular joint dysfunction:
Tongue Clicks:
Place the tip of your tongue on the top of your mouth to form a suction. Drop the jaw to release suction and produce a clicking sound.
Isometric Holds:
The practitioner will instruct to place a hand on the jaw and apply pressure to resist various movements (opening, closing, lateral deviation).
Jaw Protractions:
The practitioner will educate you on how to gently pull your jawbone down and back to relieve pressure.
Jaw Distraction:
Keeping the neck straight, the practitioner will instruct you to repeatedly push the jaw forward and pull it back slowly.
TMJ Recapture:
Sitting upright, the practitioner will have you place your finger on the strong side of your jaw an press in. They will instruct you to do the following:
Open mouth as far as you can or until it clicks
Close your jaw while sticking it as far forward as possible
Slowly pull jaw back when teeth come together
Chin Retraction:
Sitting in an upright position, the practitioner will have you push your chin directly backward & repeat.
Postural Improvements:
TMD is strongly associated with the posture of the head and neck. Abnormal posture is a strong risk factor for TMJ-related problems and fixing poor posture is an essential part of treating the condition and keeping the symptoms from returning.
When we are at rest, our face muscles are meant to be completely relaxed with our head upright and forward. A common cause of posture related TMD is stress, which can lead to tensing of the facial muscles and grinding of the teeth.
The Bottom Line:
TMD is a very common condition which has many causes and can lead to a wide range of symptoms. Although difficult to deal with, it is treatable through a proper treatment plan. It is important to be proactive and seek treatment for TMD from a skilled practitioner so that the condition doesn’t become chronic and more difficult to treat.