Does it hurt when you chew, open wide to yawn or use your jaws? Do you have pain or soreness in front of the ear, in the muscle, cheek, the teeth or the temples? Do your jaws make loud noises enough to bother you or others? Do you find it difficult to open your mouth wide? Does your jaw ever get stuck/ locked as you open it? If you answered ”yes” to any of these questions, you may have a temporomandibular joint disorder, or TMD.
TMD is a group of conditions, often painful, that affect the jaw joint. Signs may include:
- Radiating pain in the face, neck, or shoulders
- Limited movement or locking of the jaw
- Painful clicking or grating when opening or closing the mouth
- A significant change in the way the upper and lower teeth fit together
- Headaches, earaches, dizziness, hearing problems and difficulty swallowing
For most people, pain or discomfort in the jaw muscles or joints is temporary. However, some people can develop chronic symptoms. Your doctor of chiropractic can help you establish whether your pain is due to TMD and can provide conservative treatment if needed.
What causes TMD?
TMJ disorder falls into three categories:
- Myofascial pain – discomfort or pain in the muscles of the jaw, neck, and shoulders
- A dislocated jaw or displaced disc
- Degenerative joint disease – rheumatoid arthritis or osteoarthritis in the joint.
Severe injury to the jaw is a leading cause of TMJ disorder. For example, anything from a hit in the jaw during a sporting activity to overuse syndromes, such as chewing gum excessively, or chewing on one side of the mouth too frequently, may cause TMD.
Both physical and emotional stress can lead to TMJ disorder, as well. The once-common practice of sitting in a dentist’s chair for several hours with the mouth wide open may have contributed to TMD in the past. Now, most dentists are aware that this is harmful to the jaw. In addition to taking breaks while they do dental work, today’s dentists also screen patients for any weakness in the jaw structure that would make injury likely.
While emotional stress itself is not usually a cause of TMD, the way stress shows up in the body can be. When people are under psychological stress, they may clench their teeth, which can be a major factor in their TMJ disorder.
Some conditions once accepted as cause of TMD have been dismissed – moderate gum chewing, non-painful jaw clicking, orthodontic treatment (when it does not involve prolonged opening of the mouth), and upper and lower jaws that have never fit together well. Popular theory now holds that while these may be triggers, they are not causes.
Women experience TMD four times as often as men. Several factors may contribute to this higher ratio, including sitting too long at the workplace, general posture and higher heels.
Temporomandibular Joint Disorder Diagnosis and Treatment
To help diagnose or rule out TMJ disorder, your doctor of chiropractic may ask you to put three fingers in your mouth and bite down on them. You may also be asked to open and close your mouth and chew repeatedly while the doctor monitors the dimensions of the jaw joint and the balance of the muscles. If you have no problem doing these things then it is probably not TMD. Sometimes an x-ray or MRI is needed to confirm diagnosis.
If you have TMD, your doctor may recommend chiropractic manipulation, massage, applying heat/ice and special exercises. If your Doctor of Chiropractic feels you need special appliances, he or she will refer you to a dentist or orthodontist for co-management. In addition to treatment, your doctor of chiropractic can teach you how to:
- Apply heat and ice to lessen the pain
- Avoid harmful joint movements. (chomping on an apple or hard candy, etc).
- Perform TMD-specific exercises.
In some cases, TMD may not respond to a conservative approach (for example, when there is a disc problem in the joint itself) and may require dental treatment or surgery. This should be considered as a last resort as these may be irreversible.