TMJ Dysfunction

The temporomandibular joint (TMJ) is the hinge joint where your mandible articulates with the skull. Temporomandibular dysfunction (TMD) is the term we use when you have a problem with your TMJ. The textbook list of TMD symptoms includes:

• Pain or tenderness of the jaw
• Pain in one or both of the TMJ’s
• Aching pain in and around your ear
• Difficulty chewing or pain when chewing
• Aching facial pain
• Locking of the joint, making it difficult to open or close your mouth
• Clicking/popping when you open or close your mouth

I would add to that list:

• Headaches
• Pain around the temples
• Hearing loss
• One sided gait problems
• Balance/equilibrium problems

When you look at the whole list, it becomes apparent that this is a pretty wide-spread problem. So why does this happen? What causes it? TMD has several common causes. These include:

• Arthritis
• Jaw injury
• Cranial/facial injury
• Long-term grinding or clenching
• Connective-tissue disorders
• Scoliosis
• Stress/tension

Far and away the most common cause I see is stress and emotional dysfunction that leads to clenching and often grinding of the teeth. An early mentor of mine had a question he would always ask TMD clients:

On a scale of 1-10, how would you rate your ability to express anger?

A question like that often takes clients aback, but it hits the problem right on the nose. However, it isn’t limited to anger. Anger is just one of many emotions that tend to stem from fear. This fear triggers the reticular activation system (RAS) of the brain and stimulates the mandibular branch of the trigeminal nerve, the nerve that controls the muscles of mastication (chewing). So what do you do about it?

First, recognize that there is a problem. You have the list of potential symptoms above, but also some simple evaluations you can do on yourself. Press into the muscles around the jaw and mouth. Is there tenderness? Put your fingers in your ears with your finger pads pointed forward and open/close your mouth. Do you feel any clicking/popping or asymmetrical movement between the two sides? Check your range of motion in opening. Put together three fingers from your non-dominant hand and try to place them width-wise into your open mouth. Do they fit? They should. Comfortably. Check for restriction is the muscles of the soft-palate. Press your tongue flat to the roof of your mouth and see how wide you can open your mouth while holding it. Can you get two fingers of your non- dominant hand width-wise into your mouth? Check how your jaw tracks. Use your hands to pull back your lips so you can see your teeth. Open and close your mouth to watch and see if upper and lower teeth stay aligned properly throughout the range of motion. If any of these tests shows abnormal, you should consider coming in for a session.

In my clinic, I take a comprehensive approach toward TMD. Cranial work, postural work, oro-facial work including dental corrections, Active Release Techniques (ART), class-IV laser, and of course emotional work are all brought to bear as needed. A night-guard and pain medications don’t have to be your only options.