Temporomandibular Joint (TMJ) Disorder
What is the TMJ?
The temporomandibular joint is a hinge joint that connects your mandible (jaw) with the temporal bones of your skull which sit in front of your ear. It allows you to move your jaw side to side and up and down so as you can eat, talk and yawn. Pain caused by the TMJ is referred to as TMJ disorder.
What are the symptoms of TMJ Disorder?
- Pain or tenderness of your jaw
- Aching pain in and around your ear including ringing sounds in the ears (tinnitus)
- Neck or shoulder pain
- Blurred vision
- Difficulty opening/closing mouth, e.g. difficulty chewing
- Clicking/popping sensation
- Swelling on side of your face
- Jaws that get stuck/locked in an open or closed mouth position
What are the causes?
- Acute injury to your jaw
- Arthritis in the joint
- Displaced disc
- Poor posture
- Long term chronic grinding (bruxism) or clenching of teeth
- Malocclusion – teeth that don’t fit together properly
- Higher risk in females aged 20-40years
How is it Disorder diagnosed?
Your physiotherapist will first take a thorough history and conduct a physical exam to rule out other conditions and correctly diagnose TMJ Disorder. This examination may include:
- Palpation of the joint and surrounding muscles
- Observation of posture, jaw deviation
- TMJ movements, taking note of any clicking, pain, popping that may occur
- Assessment of neck/shoulder to rule out other potential conditions
- Referral for an x-ray if an acute injury or occasionally for an MRI to rule out any other medical problems
- Referral to dentist/orthodontist to exclude any dental causes
How is TMJ Disorder treated?
Address contributing factors
- Avoid excessive chewing – where possible try to eat a soft diet to avoid foods that are difficult to chew, avoid chewing gum and biting fingernails
- Correct posture
- Relaxation techniques to manage stress and ease muscle tension
- Avoid pressure on your TMJ, e.g. avoid lying on your painful TMJ during sleep or resting your chin in your hand
- Avoid extreme jaw movements
- Keep your jaw in a relaxed position with your teeth slightly apart to avoid clenching/grinding your teeth
- Massage of muscles around the joint including masseter and temporalis
- TMJ mobilisations to relieve stiffness
- Addressing any issues within the neck/shoulder region
- Postural correction exercises
- Gentle stretching exercises
- Strengthening exercises of the muscles that act on the joint
- Exercises to address issues within the neck/shoulder region
Other pain management techniques
- Ice packs can be placed on the jaw for up to 15minutes at a time
- Over the counter anti-inflammatory medications
- Self massage
- Referral to an orthodontist/dentist for an oral splint or night mouth guard to hold your jaw in a more relaxed position, correct your bite by putting your teeth position and reduce the effects of clenching/grinding. Your dentist may also wish to perform other treatments.
- Very severe cases may require surgical opinion
What is the prognosis for TMJ Disorder?
Most cases of TMJ Disorder respond really well to conservative management. Less than 1% of cases require surgery.
Blog By Kara Giannone (Physiotherapist)