The temporomandibular joint is probably the most used joint in the body and, as such, it takes a serious beating. Temporomandibular joint dysfunction (or TMD/TMJ) prevalence in the USA is estimated at 3-12% and has been suggested that 25% of the population will experience some TMD related symptoms in their lifetime, more commonly affecting women than men with ratios as little as 1.5:1 and up to 4:1. The impact on quality of life is substantial and it may impact your work life; roughly 18% of people with TMD will have to miss work as a result of TMD. The numbers are hard to crunch given that TMD is a complex issue involving the jaw, face, teeth, head, neck, thoracic spine, and upper quadrant. There is no standard definition or test, but a conglomeration of functional measurements of the aforementioned body parts and concomitant symptoms reported by the patient along with history. Whew! That’s a mouthful… pun intended.
How Do I Know I Have TMD?
Common symptoms of TMD include pain in the jaw, face, neck and upper back, headache, joint sounds or clicking and popping when opening or closing the jaw, ringing in the ears, jaw locking or difficulty with opening or closing, sensitive teeth, and chewing difficulty. It is important to note that some of these pain symptoms are similar to other more concerning conditions such as heart attack. If your symptoms are accompanied by chest pain, shortness of breath or arm symptoms or concern due to history of high blood pressure or previous heart issues, it is important to see your medical doctor immediately.
Your Posture Can Affect Your Jaw
Causes of TMD include bruxism or clenching and grinding of the teeth, malalignment of one’s bite, trauma to the jaw or face, and poor posture. Forward head posture actually places the condyles of the jaw deeper into their sockets, which may be a source of pain. And guess what? That oh-so-common slouched sitting that all of us are guilty of at some point in our day; it’s not just bad for the lower back, but also the neck and jaw! Slouched sitting from the pelvis up results in forward head posture as a way for the body to counter balance itself. This posture also creates altered length-tension relationships of the muscles attached to the jaw and can trigger hypertonous (increased tone or contraction) activity of some of those muscles that compress the jaw. Imbalanced muscle forces around the jaw, including the suprahyoid muscles under the chin on the front side of the neck that open the jaw, are usually weaker compared to the masseter and temporalis, which close the jaw. The correction of this muscle imbalance to restore proper length tension relationships has a great effect on reducing pain, clicking, and deviation of jaw movement.
Quick Tests To See If You Have TMD
Don’t know if your jaw deviates? Stand in front of the mirror and keep neutral posture with your head neither tilted up nor down. Neutral head on neck posture can be self assessed by creating a shelf of 4 fingers on one hand under your chin with the pointer finger touching the Adam’s Apple or thyroid cartilage and then see where your chin falls on your hand. If your chin touches the pinky finger (wiggle it up and down to assess), your head is too far forward. Once in neutral head on neck posture, put the tip of your tongue on the roof of your mouth behind the two front teeth and open your mouth only as wide as you can keep your tongue in place without letting it come free. Watch the central line of your mouth or teeth and if dysfunctional movement occurs, you can see the jaw or mandible move out of midline for a moment and come back in, much like making a skewed S curve. This is deviation and it is dysfunctional. When you opened your mouth, did you tilt your head back to make it happen? Check again; this, too, is dysfunctional.
Improve Your TMD With Physical Therapy
Treatment should include a combination of dental and physical therapy intervention for best results. A dentist will examine for evidence of bruxism and mal-alignment and could make recommendations such as a night guard, maxillary splint, or orthodontics. A physical therapist will work with you to provide a thorough biomechanical analysis and treatment program such as postural training, motor control and strengthening exercises, manual therapy techniques like massage and joint mobilization, training in jaw relaxation including breathing exercises, and education in modifications to food types and ergonomics. For specific exercises and education, it is important to make an appointment with your physical therapist for an evaluation to determine your individual needs. Give us a call or email to get started. We also have great relationships with our local dentists and can refer as needed.
Orofacial pain prospective evaluation and risk assessment study–the OPPERA study. Maixner W, Diatchenko L, Dubner R, Fillingim RB, Greenspan JD, Knott C, Ohrbach R, Weir B, Slade GD. J Pain. 2011 Nov;12(11 Suppl):T4-11.e1-2.