More information about Temporo Mandibular Dysfunction (TMD) and what to do about it

 
Causes of TMD

TMD is caused by trauma to the structures of the joint – the disc, ligaments or muscles surrounding the joint.

You may be unaware that you have TMD because clenching and grinding the teeth can occur during the day (becoming an entrenched habit that you don’t notice) or when you sleep (night Bruxism). You will notice symptoms (see above list) though may not be aware they are caused by TMD.

Most often trauma is caused by clenching or grinding the jaw. Other causes can be

• Head Trauma from sports (ie rugby), car accident (whiplash), falls etc
• Forward Head Posture (FHP) a common body posture particularly for those working at a desk. When standing or seated your ears should align with your shoulders creating a balance through the ‘S’ curves of the spine which comfortably carries the weight of the head. As soon as the head moves forward of the central line the jaw clenches in response.
• Try it move your head forward of your body, notice how heavy your head feels? Bring your head back now, so it is over your spine and ears are aligned with shoulders, notice your head get lighter as it’s weight is distributed properly your spine from neck to tailbone?

Treatments Explained

Splint Therapy

Placement of a removable or fixed dental appliance which protects or keeps in place the injured joint parts.

A Dentist or Dental Surgeon can mould a fitting hard plastic mouth guard which is worn overnight. Costs are around $400-$600. Night splints can be hard to tolerate though they have been shown to help TMD.

Purpose – reduce inflammation and pain at the joint. Reduce pressure on teeth and joint structures. Stop grinding by not allowing sideways joint movements overnight.

A splint will not restore all of the damaged or degenerated joint but will protect teeth from clench pressure by reducing your ability to apply so much pressure in your clench overnight. Teeth can crack and fillings can pop out over time if clenching pressure occurs for years.

Orthotic Therapy

An orthotic is used to support, align, prevent or correct deformities or improve the function of the moveable parts of the body.

Purpose – provide best condyle/fossa relationship possible (bony structures of the TM Joint)

Decompress the joint – reduces inflammation

Restore correct muscle length bilaterally

Other treatments include

Manual therapies  Massage, Osteopathy etc

Relaxation therapies meditation, hypnotherapy, CBD cognitive-behavioural-therapy with a counsellor (note in the US standard treatment programmes for TMD always include prescripton of counselling or other relaxation therapies, though this is not yet standard practice in NZ)

Nutrition Naturopathy (for example Magnesium suppliments reduce muscle tension)

Medication

• topical antinflammatory creams ie Sentient Body Antiflam

• tablets that provide Antinflammatory properties (ibuprofen) and analgesic (pain relief) ie Paracetamol. 

Test your TMJs

• Can you open your mouth wide enough to comfortably fit 4 fingers between your upper and lower jaw?
• In the mirror, watch your lower jaw travel as you slowly open and close your mouth. Look at the central gap between your teeth to see whether it moves up and down in a straight vertical line or if it deviates/wobbles at some point
• With fingers in your ears pressing inward open and close – sore ears = inflammation, or you may feel clicking, popping or grinding
• Can you comfortably move your lower jaw from side to side?

TMD - When its a Muscle Problem 

When the problem is in the muscles that work the jaw the condition is called Myofascial Pain Syndrome and can occur in people with normal undamaged TM Joints

Muscular tightness in the whole body is a normal expression of emotional or mental stress. Stress can cause TMD by creating long-term tight/shortened jaw muscles from teeth clenching or grinding. Muscle stiffness results in

• Limited joint movement and can often be felt as a tight jaw in the morning or prevent you opening your mouth fully (you should be able to comfortably fit 4 fingers between upper and lower teeth)
• Spasms (painful tight muscles in the head neck and jaw)
• Trigger points (causing referred pain patterns) develop in muscles held tight for long periods.

Trigger Point Symptoms TRP's in the muscles of the jaw refer pain to other areas

Masseter muscle – refers to cheeks, lower jaw, upper and lower molar teeth, eyebrow, inside ear and around TM Joint area

Temporalis – refers pain in front of ear, can cause headaches and toothache in upper teeth

Pterygoids – refers pain into TM Joint in front of ear, inside mouth, upper outside of neck, can cause sore throats or difficulty swallowing

How can Massage help TMD?


Come and see our TMD specialist, Sarah Rule >>

Massaging the muscles of the face, head, front and back neck, shoulders and chest helps by

• Releasing spasm and chronically tight holding patterns in the muscles and returning them to a normal resting length. Spasm is caused by teeth clenching and grinding.
• Locating and releasing Trigger Points in skeletal muscles that move the TM Joint ie Masseter and Pterygoids (cheek muscles) and Temporalis (fan shaped muscle above ear) which can build up as a result of teeth clenching or grinding and may be giving you headaches, toothache or sinus pain
• Releasing postural muscles of the front and back neck and shoulders which develop tension when clenching or grinding is occurring.
• Encouraging stress management by whole-body and mind relaxation as well as relaxed breathing habits. Cortisol (the adrenal stress hormone) drops during massage
• Homecare advice to help you help yourself at home; discuss your posture, offer stretches, uses of heat packs and topical antinflammatory creams