Charlie Kornberg's Musculoskeletal Physiotherapy Home Page

---

About Me

Disclaimer

Clinical Stuff

Upcoming Events

Newsletter

Links

Contact Me

Home

TMJ Disorders

The temporo-mandibular joints (TMJs) connect your lower jaw to your skull. There are two matching joints - one on each side of your head, located just in front of your ears. The abbreviation "TMJ" literally refers to the joint.

Anatomy

The joint is where the mandible (the lower jaw) joins the temporal bone of the skull, immediately in front of the ear on each side of your head. A small disc of cartilage separates the bones, much like in the knee joint, so that the mandible may slide easily; each time you chew you move it. But you also move it every time you talk and each time you swallow (every three minutes or so). It is, therefore, one of the most frequently used of all joints of the body and one of the most complex.

Temporomandibular joint — Normal closed position. Jawbone is separated from skull by a soft disk that acts as a cushion when you chew, speak or swallow.

Temporomandibular joint — Normal open position. Disk stays in place when jaw is in use.

Pathology of the TMJ

Many TMJ-related symptoms are caused by the effects of physical and emotional stress on the structures around the joint. These structures include the muscles of the jaw, face, and neck; the teeth; the cartilage disc at the joint.

Temporomandibular joint — Abnormal. Disk is pulled forward when jaw is in use, causing the bone structures to grind together.

For example, daily stress can lead you to clench and grind your teeth (bruxism), both during the day and at night while you sleep. Clenching means you tightly clamp your top and bottom teeth together, especially the back teeth. The stressful force of clenching causes pressure on the muscles, tissues, and other structures around your jaw.

Many people who clench also grind their teeth. Grinding is when you slide your teeth over each other, generally in a sideways, back-and-forth movement. This action may wear down your teeth and be noisy enough at night to bother sleeping partners. Poor posture can also be an important factor. For example, holding the head forward while looking at a computer all day strains the muscles of the face and neck.

Other factors identified, that might aggravate TMJ symptoms, are inability to relax, poor diet, fractures, dislocations, and structural problems present since birth, lack of sleep, teeth that do not fit together properly (improper bite), mal-positioned jaws, and arthritis.

Symptoms

Headache
Neck ache
Earache (the joint is located right in front of the ears and can easily be interpreted as      ear pain; in addition, pain may be referred to the ear from nearby muscles)
Jaw pain or tenderness of the jaw
Dull, aching facial pain
Biting or chewing difficulty or discomfort
Clicking sound while chewing or opening the mouth
Grating sensation while chewing
Reduced ability to open or close the mouth or locking of the jaw.

How Can Things Go Wrong with the TMJ?

In most patients, pain associated with the TMJ is a result of displacement of the cartilage disc that causes pressure and stretching of the associated sensory nerves. The popping or clicking occurs when the disk snaps into place when the jaw moves. In addition, the chewing muscles may spasm, not function efficiently, and cause pain and tenderness.

Both major and minor trauma to the jaw can significantly contribute to the development of TMJ problems. Chewing gum much of the day can cause similar problems. In certain cases, chronic mal-position of the cartilage disc and persistent wear in the cartilage lining of the joint space can cause further damage.

Treatment

Self-remedies

Rest the muscles and joints by eating soft foods
Do not chew gum
Avoid clenching or tensing.

Physical therapy

Mobilisation and manipulation
Massage/trigger point therapy
Exercises – Rocobardo (re-education of the jaw muscles)

Splinting

Occlusal splint – mouth guard type or new NTI-tss which fits over the top couple of      teeth
Aim is to keep your jaw in a more relaxed position, inhibit clenching, or provide some      other function
Often used as a night splint.

Surgery

Not common but quite aggressive if performed – mainly reconstructive procedure to      alter bite patterns. Results have shown that it often worse after surgery.