So what’s the TMJ?

The temporomandibular joint (TMJ) is the small joint of the jaw located between the temporal bone of the skull and the lower jaw bone called the mandible [1]. These two bones are separated by a disc which acts as a cushion between these bones as the jaw opens and closes and moves side to side [2]. The TMJ plays an important role to functions we do on a daily basis – chewing and speaking, yawning and swallowing.

Temporomandibular disorder (TMD) occurs when the TMJ and its associated structures and musculature stop functioning correctly and can result in pain, clicking, popping and locking within the joint [3]. However sometimes jaw pain is not so straight forward.  For example, pain may be felt in the jaw but may actually originate from other areas of your body such as the neck [2]

 

How common is it?

TMD is a very common problem affecting up to 33% of individuals within their lifetime[4]. More women than men experience TMD which may be related to hormonal factors, and it is more common in people between the ages of 20 and 40[2]. Approximately one third of the population have at least one TMD symptom [4].

 

Common causes and contributing factors to TMD:

  • Injury to the jaw, temporomandibular joint, or muscles of the head and neck – such as from a heavy blow or whiplash [5]
  • Grinding or clenching the teeth, which puts added pressure on the TMJ.  Grinding and clenching particularly at night is called bruxism [2].
  • Disc dysfunction where the disc is displaced forward and causes a click as the mouth opens and closes [6].
  • Presence of osteoarthritis or rheumatoid arthritis in the joint [1]
  • Habitual overuse of facial muscles – for example biting fingernails [2]
  • Missing teeth and/or having an underbite or overbite [5]
  • Poor posture [7]

 

 Common symptoms of TMD include:

  • Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide (pain may occur on one or both sides of the face) [8]
  • Limited ability to open the mouth very wide [1]
  • Jaw may get get stuck or lock in an open or closed mouth position [9]
  • Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain) or chewing [6]

Other symptoms of TMD include toothaches, headaches, neck aches, dizziness, earaches, hearing problems, upper shoulder pain and ringing in the ears (tinnitus) [10].

 

How can physio help?

Physiotherapy is recommended before expensive dental splints or surgery are considered because it has been shown to reduce pain and disability associated with TMD [3, 11].  In fact, studies have shown that physiotherapy may be more effective when compared to dental splints [12-13].

 

What can I expect from my physiotherapy consultation?

  • We will take a thorough history to understand your current condition and relevant past history
  • This is followed by a physical examination to examine the TMJ and its associated structures.  You will be asked to perform certain movements which will allow us to assess any impairments. A gloved finger may be used to assess the jaw and its muscles [1].
  • Postural assessment and movement of the upper neck, middle back and muscle tension will be included [7].
  • An explanation of the findings from our examination and education on your condition
  • A treatment plan tailored specifically to you and your symptoms which may include manual therapy, soft tissue release and a tailored home exercise program [4].
  • Referral to other health practitioners or for imaging if needed [1].

 

If you are worried by pain and clicking in your jaw and/or have headaches give us a call. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, as well as advice on the best course of action for your condition to get you back in action sooner than you could’ve imagined. All our physiotherapists an expertise in musculoskeletal physiotherapy and are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, and West Pymble. So give one of our physiotherapists a call on (02) 8411 2050 to get started on a journey to a better you. 

 

References

1. Magee, D.J., Orthopaedic Physical Assessment. 2008, St. Louis, Mo: Saunders Elsevier.

2. Dym, H. and H. Israel, Diagnosis and treatment of temporomandibular disorders. Dent Clin North Am., 2012. 56(1): p. 149-61, ix. doi 10.1016/j.cden.2011.08.002.

3. Murphy, M.K., et al., Temporomandibular Joint Disorders: A Review of Etiology, Clinical Management, and Tissue Engineering Strategies. The International journal of oral & maxillofacial implants, 2013. 28(6): p. e393-e414.

4. Wright, E.F. and S.L. North, Management and Treatment of Temporomandibular Disorders: A Clinical Perspective. The Journal of Manual & Manipulative Therapy, 2009. 17(4): p. 247-254.

5. Sharma, S., et al., Etiological factors of temporomandibular joint disorders. National Journal of Maxillofacial Surgery, 2011. 2(2): p. 116-119.

6. Naeije, M., et al., Disc displacement within the human temporomandibular joint: a systematic review of a 'noisy annoyance'. J Oral Rehabil, 2013. 40(2): p. 139-58.

7. Ries, L.G.K. and F. Bérzin, Analysis of the postural stability in individuals with or without signs and symptoms of temporomandibular disorder. Brazilian oral research, 2008. 22(4): p. 378-383.

8. Svensson, P., et al., Relationships between craniofacial pain and bruxism. J Oral Rehabil, 2008. 35.

9. Lobbezoo, F., et al., Principles for the management of bruxism. J Oral Rehabil, 2008. 35.

10. Manfredini, D. and F. Lobbezoo, Relationship between bruxism and temporomandibular disorders: a systematic review of literature from 1998 to 2008. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010. 109.

11. Haketa, T., et al., Randomized clinical trial of treatment for TMJ disc displacement. J Dent Res, 2010. 89(11): p. 1259-63.

12. van Grootel, R.J., et al., Towards an optimal therapy strategy for myogenous TMD, physiotherapy compared with occlusal splint therapy in an RCT with therapy-and-patient-specific treatment durations. BMC Musculoskelet Disord, 2017. 18(1): p. 76.

13. Amorim, C.S.M., et al., Effectiveness of two physical therapy interventions, relative to dental treatment in individuals with bruxism: study protocol of a randomized clinical trial. Trials, 2014. 15(1): p. 8.

 

 

 

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