Temporomandibular Joint Disorder (TMJ Dysfunction) describes a complex group of muscle and joint disorders affecting the TMJ, leading to pain, dysfunction and eventually degeneration. Most causes of TMD can be divided into either muscular or arthrogenous (joint).
TMJ dysfunction of muscle origin is more common (1) and may arise from: muscular hypertonicity, trigger points, fascial restrictions and/or functional muscle imbalance of the muscles used for chewing. One of the most commonly involved muscles is the masseter. Other recognized triggers for muscular TMJ dysfunction include: bruxism, clenching, neck joint dysfunction (2), postural syndromes, especially a forward head posture (3,4), and trauma (5). TMJ dysfunction symptoms may occur in up to one third of those patients involved in a whiplash injury (6). Psychosocial disturbances including stress and depression, are another widely recognized co-morbidity for TMJ dysfunction.
I heard jaw problems are because of having my teeth pulled?
Studies vary on the relationship of premolar extraction (tooth pulling) to the development of TMJ dysfunction, but recent evidence shows that tooth pulling is not related to jaw dysfunction. (7).
How common is TMJ Dysfunction?
Estimates for the incidence of TMJ dysfunction vary between 4-25% (8,9). Up to 3% of Americans seek treatment for TMJ related issues each year (21). At presentation, most patients are 20-50 years old and prevalence is 2-3 times higher in females.
What are the symptoms of TMJ Dysfunction?
Typical symptoms include: clicking, restricted opening, transient locking and pain. Symptoms may be worsened by chewing. TMJ pain is generally described as an “ache” just in front of the ear canal but may refer to other areas of the face, head, neck and shoulders (6). TMJ dysfunction patients often suffer concurrently from headaches, suggesting a common link arising from the upper cervical spine (10).
Do I need imaging for TMJ Dysfunction?
Often times, a trial of care of 4-6 weeks including treatment will proceed any imaging. If imaging is needed, CT is the imaging of choice (over 4 times better than plain films) for identifying TMJ osteoarthritis. The reliability of MRI is also excellent for detecting disc displacements and effusion (12). Diagnostic ultrasound is a non-invasive imaging option that can easily identify TMJ disc displacement.
Treatment options for TMJ Dysfunction:
Management should be conservative and simple, focusing on three main points: manual therapies, exercise and avoidance of aggravating activities.
Manual therapy is an effective treatment for TMJ Dysfunction. (30) In fact, non-surgical intervention for myogenous TMJ has been shown to be as effective as any surgical intervention (13). TMJ non-thrust mobilization is often indicated (10).Manipulation of the cerviocranial, cervical and thoracic spine may be necessary (16). Chiropractic cervical spine manipulation has been shown to increase maximal bite force (31).
Exercises to improve posture and TMJ function have been shown to be beneficial (10,17,18). Stretching exercises should address tightness in the masseter, SCM, levator and suboccipitals. Patient’s should also work on chin retractions, deep neck flexion and chin depression exercises.
Patients should avoid aggravating activities like chewing gum or eating "rubbery" type foods. Patients should also limit unnecessary talking (18,19). Glucosamine and chondroitin sulfate have shown success in managing TMJ dysufuction (34). Supplementation with bromelin or MSM may also be beneficial. A custom fitted mouth guard can help prevent clenching and promote relaxation of muscles (20). Patients with symptoms at night should avoid stressful activity before bedtime and be aware of their sleeping position.
At Creekside Chiropractic & Performance Center, we are highly trained to treat this condition. We are the only inter-disciplinary clinic in Sheboygan county that provides chiropractic, myofascial release, ART (Active Release Technique), dry needling, massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press ('19,'20,'21).
Evidence Based-Patient Centered-Outcome Focused
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