TMJ Dysfunction

TMJ Dysfunction

Article by John Miller

TMD Physio

TMJ Dysfunction

Temporomandibular Joint Dysfunction

What is Your Temporomandibular Joint?

Your Temporomandibular Joint or TMJ is the most used joint in the body. Your TMJs (jaw joints) are involved with eating, talking, breathing and, probably most importantly, expressing our feelings and emotions. When things go wrong with your TMJ it is known as Temporomandibular Disorder (TMD).

TMJ Dysfunction Symptoms

tmj dysfunction

You may or may not experience jaw pain or tenderness with TMJ dysfunction. The most common symptoms include:

  • jaw clicking
  • jaw popping
  • grinding
  • limited jaw opening, or jaw deviation while opening (which you can observe in a mirror)
  • an inability to fully clench your jaw.

TMD sufferers are often teeth grinders or clenchers.  TMD can cause jaw headaches, ear pain, dizziness and upper neck pain. Some TMJ patients report pain or inability to eat, talk or sing. Tinnitus or ear ringing can be associated with TMJ dysfunction. (Vierola et al 2012)

How is TMJ Dysfunction Diagnosed?

TMJ dysfunction can be diagnosed by your TMJ physiotherapist, a physiotherapist with advanced training in jaw dysfunction, your dental practitioner or oral maxillofacial surgeon. TMD is a clinical movement dysfunction diagnosis. They may recommend dental X-rays, CT scan or MRI to further investigate your condition.

TMJ Assessment

During your TMJ examination, your Craniofacial or TMJ Physiotherapist will assess your:

  • jaw range of motion,
  • muscle tension and length,
  • TMJ co-ordination and movement pattern.

Your TMJ Physiotherapist will be able to identify if your problem is an opening issue.

TMJ Opening problems include:

  • Muscle disorder,
  • TMJ (joint) disorder: hypermobility, stiffness or arthritis,
  • TMJ disc displacement disorder: intermittent or permanent lock, or a
  • cervical spine posture issue.

TMJ Closing problems include:

  • a locked open joint, which can be manipulated open, or an
  • occlusion problem, which may require a bite assessment from your dentist.

Locked Jaw Treatment

The locked jaw can be both temporary or permanent. Your TMJ physiotherapist is usually able to unlock your locked jaw via gentle manipulation. Should manipulation fail, you may require an Oral Surgeon to perform a manipulation under anaesthesia or another surgical procedure known as an arthrocentesis (joint washout). In chronic cases, open surgery may identify or remove any physical obstructions, in the permanently locked jaw, but this is relatively rare.

TMJ Physiotherapy Treatment & TMJ Exercises

TMJ exercises and treatment may include:

  • Posture improvement and neck treatment
  • Relaxation exercises
  • Muscle lengthening or jaw muscle massage
  • TMJ joint mobilisation
  • TMJ movement pattern and timing correction
  • Passive, active-assisted, active exercises
  • TMJ stabilisation exercises
  • Dry needling or acupuncture.

Your specific TMJ exercises prescription will follow your thorough TMJ assessment by a TMJ physiotherapist.

Summary

Every case of TMJ dysfunction is different. Please check with your Craniofacial or TMJ physiotherapist for their professional opinion. They are the best TMJ practitioner to guide your treatment direction precisely.

TMJ Dysfunction – What to Avoid?

Until you seek the advice of your TMJ physiotherapist we recommend the following:

AVOID:

  • uncontrolled, wide-opening, e.g. yawning,
  • biting hard foods, e.g. carrots, apples,
  • eating burgers or hard rolls,
  • chewing gum,
  • nail-biting,
  • jaw leaning,
  • stress, and
  • clenching pens, pencils, pipes or cigars.

TMJ Treatment Professionals.

Common Sources of TMJ Dysfunction or Jaw Pain

TMJ or jaw pain can occur as a result of various multi-factorial reasons. Most TMJ dysfunction resulting in jaw pain or clicking jaw results from two leading causes: jaw opening or closing.

TMJ Dysfunction – Abnormal Opening

Most TMJ dysfunction results in an inability to open your jaw fully or glide evenly (left to right). Luckily nearly all opening dysfunctions respond exceptionally quickly and favourably to physiotherapy assessment and intervention since teeth occlusion is not an issue.

TMJ Dysfunction – Abnormal Closing

Closing dysfunction can be due to both a teeth occlusion and an inability of the TMJ to close normally. If the problem is simply a stiff joint or poor muscle timing, then physiotherapy treatment will be very successful. However, if teeth occlusion issues exist, then you will be referred to a dental surgeon for a bite occlusion assessment.

More info:

TMJ PainJaw Pain

TMJ Headache

FAQs about TMJ Dysfunction or Jaw Pain

What Causes TMJ?

TMJ dysfunction is considered a multifaceted musculoskeletal disorder. The most common causes of TMD include:
  • Masticatory muscle dysfunction,
  • Derangement/displacement of TMJ articular disc
  • Bruxism: nocturnal grinding of teeth leads to increased pressure in TMJ and asymmetrical movement.
  • Occlusal Problems: Poor bite, Asymmetrical or Retrognathic (underbite, overbite) .
Contributory factors include:
    • Mandibular malalignment is secondary to an occlusal appliance or orthodontic treatment.
    • Removal of wisdom teeth,
    • Prolonged mouth opening, e.g. dental procedure,
    • Poor cervical posture,
    • Myofascial pain,
  • Neuropsychological factors,
  • Stress and
  • Whiplash and other less common causes include trauma (e.g., blow to the chin), infection, polyarthritic conditions, tumours, and anatomical abnormalities.

TMJ Dysfunction Classifications

What Causes TMJ The common presentations of TMJ dysfunction classify into three clinical diagnostic groups:
  • Jaw muscle disorder characterised by painful movement.
  • Articular disc displacement.
  • Arthralgia or arthritis.
(Dworkin SF, LeResche L., 1992)

What is the Cause of Jaw Clicking?

Clicking jaw is a sign of articular disc displacement, which is commonly treated by a TMJ physiotherapist. Clicking can occur during jaw opening, closing or both directions. Please seek the clinical assessment of TMJ physiotherapist for a specific diagnosis and treatment plan.

Common Sources of TMJ Dysfunction or Jaw Pain

TMJ or jaw pain can occur as a result of various multi-factorial reasons. Most TMJ dysfunction resulting in jaw pain or clicking jaw results from two leading causes: jaw opening or closing.

TMJ Dysfunction - Abnormal Opening

Most TMJ dysfunction that occurs results in an inability to open your jaw fully or symmetrically. Luckily nearly all opening dysfunctions respond exceptionally quickly and favourably to physiotherapy assessment and intervention since teeth occlusion is not an issue.

TMJ Dysfunction - Abnormal Closing

Closing dysfunction can be due to both a teeth occlusion and an inability of the TMJ to close normally. If the problem is simply a stiff joint or poor muscle timing, then physiotherapy treatment will be very successful. However, if teeth occlusion issues exist, then you will be referred to a dental surgeon for a bite occlusion assessment.

Potential Causes of TMJ or Jaw Pain

What is the Best Treatment for TMJ Dysfunction?

The best treatment for TMJ does vary based upon the clinical diagnosis, the TMJ dysfunction and the chronicity. TMJ opening disorders are more likely to be successfully treated with jaw movement improvement techniques. The techniques may include jaw muscle massage, dry needling/acupuncture, muscle stretch/relaxation/coordination exercises or joint capsule stretching techniques that are provided by your physiotherapist. Your dentist is usually involved in the management of TMJ closing disorders such as bruxism (teeth grinding) due to the addition of teeth occlusion. In some cases, an occlusion splint or bite plate can help. If you are unsure what treatment direction is best for you, we recommend that you seek the advice of your TMJ physiotherapist for pain, clicking or lack of motion when opening your mouth your dentist for problems when you clench your teeth. Either way, seek the advice of your TMJ health professional who will refer you on to the most relevant health professional suitable for your TMJ condition if they feel it is in your best care. After your TMJ assessment, your physiotherapist will commence corrective treatment if appropriate. TMJ physiotherapy usually is very successful for the treatment of TMJ opening disorders due to the problem being a movement disorder that is affected by your muscle and joint control.

How Quickly Does Physiotherapy Relieve TMJ Dysfunction?

The good news is that your TMJ physiotherapist will start treating your TMJ dysfunction, muscle tightness or coordination issue that same day as they assess you. If your TMJ dysfunction is one of the categories that physiotherapy assists, you'll usually leave the clinic with very significant improvement or full resolution after your very first treatment consultation. Alternatively, if we assess you and discover that your TMJ dysfunction will not respond to physiotherapy, we'll happily refer you to the most appropriate health professional to assist you in achieving the quickest result.

TMJ Treatment Prognosis

Prognosis is favourable in the vast majority of patients treated conservatively, and symptoms may improve without treatment. (Michelotti A, 2010). Field 2012, found that with conservative TMJ physiotherapy treatment, 75% of the TMD group resolved their condition within three months, which is certainly consistent with our clinical results. The vast majority improve within a few weeks of commencing TMJ treatment. This result compares to a more sluggish resolution in the non-physiotherapy treatment group studied by Rammelsberg in 2003, who found that spontaneous resolution occurs in a 33% of TMD sufferers over five years.

Locked Jaw Treatment

A locked jaw can be both temporary or permanent. Your TMJ physiotherapist is usually able to unlock your locked jaw via gentle manipulation. Should manipulation fail, you may require an Oral Surgeon to perform a manipulation under anaesthesia or another surgical procedure known as an arthrocentesis (joint washout). In chronic cases, open surgery may identify or remove any physical obstructions, in the permanently locked jaw, but this is relatively rare.

TMJ Physiotherapy Treatment & TMJ Exercises

TMJ exercises and treatment may include:
  • Posture improvement and neck treatment
  • Relaxation exercises
  • Muscle lengthening or jaw muscle massage
  • TMJ joint mobilisation
  • TMJ movement pattern and timing correction
  • Passive, active-assisted, active exercises
  • TMJ stabilisation exercises
  • Dry needling or acupuncture.
Specific TMJ exercises prescribed following a thorough TMJ assessment by your TMJ physiotherapist will be most beneficial.

Summary

Every case of TMJ dysfunction is different. Please check with your Craniofacial or TMJ physiotherapist for their professional opinion.

TMJ Dysfunction - What to Avoid?

Until you seek the advice of your TMJ physiotherapist we recommend the following: AVOID:
  • uncontrolled, wide-opening, e.g. yawning,
  • biting hard foods, e.g. carrots, apples,
  • eating burgers or hard rolls,
  • chewing gum,
  • nail-biting,
  • jaw leaning,
  • stress, and
  • clenching pens, pencils, pipes or cigars.
TMJ Treatment Professionals.
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