Temporal Mandibular Joint Dysfunction

Have you ever had pain in your jaw or cheek? Does your jaw click or pop when you open or close your mouth? Do you suffer from neck pain or headaches? Perhaps your dentist or physician has told you that you have TMD.

What is the Temporomandibular Joint (TMJ)? The temporomandibular joint connects the lower jaw, otherwise known as the mandible, to the temporal bone at the side of your head. You can feel the joint on each side of your head if you place your fingers just in front of your ears and open your mouth. These joints are flexible and allow the jaw to move smoothly up and down and side to side; thus, enabling us to talk, yawn and chew. There are muscles attached to and surrounding the jaw joints, which control the position and movement of the jaw.

So, what causes TMD? Severe injury to the jaw or temporomandibular joint, such as a heavy blow, a fall or impact from a car accident can damage the joint, fracture the jaw or contuse the chewing muscles. This damage can alter the smooth motion of the jaw and cause pain or locking. Arthritis in the temporomandibular joint may also result from injury.

However, other causes of TMD are far less clear. One theory suggests that structural malalignment between the mandible and the skull (bad bite) can trigger TMD. Some experts propose that physical or mental stress may cause or aggravate TMD. Another theory suggests a link between neck pain and TMD since neck pain is associated with TMD 70% of the time. No scientific evidence exists to link gum chewing with clicking sounds in the jaw joints, or that jaw clicking leads to TMD. In fact, joint noises or clicking of the jaw is quite common in the general population. If no other symptoms are present, then jaw clicking usually does not require treatment.

Physical therapy can offer a conservative and reversible approach to treating Temporomandibular Disorders. Physical therapists can educate patients to control bad habits such as nail biting, thumb sucking or ice chewing; instruct patients in resting position of the jaw; awareness training; educate patients regarding relaxation strategies or stress reduction techniques such as diaphragmatic breathing and imagery; diet modification; posture education; and avoiding extreme jaw movements.

Furthermore, modalities such as heat, ice, ultrasound, phonophoresis/iontophoresis or electrical stimulation can be effective in reducing pain, tightness and inflammation in the jaw joints and chewing muscles. Soft tissue mobilization or massage to the masticatory muscles (chewing muscles) and neck muscles can be effective in reducing pain and tightness in these muscles and improve jaw and neck mobility. Mandibular stretching, manual mobilization of the TMJ and home exercises to improve jaw movements may also be incorporated in the treatment of TMD disorders.