Talking, eating and yawning… activities you take for granted when you don’t have jaw pain. Temporomandibular joint dysfunction, or TMD, is a condition of painful and/or restricted motion of the mouth and jaw. Common signs and symptoms of TMD are: jaw pain and associated headaches or ear pain, a decreased ability to open the mouth, waking up with jaw fatigue and headaches, being told you grind your teeth at night.
What causes TMD?
TMD is rarely caused by a single event nor have a simple solution. Unlike our right and left elbows, knees or shoulders, we CANNOT move just one jaw joint. They are connected by the bone known as the mandible. Fortunately, the joint itself is very resilient and joint damage like arthritis is rarely the cause of TMD. Most TMD cases are caused by muscular dysfunction or imbalance. This may be a weakness or tightness of any of the muscles of mastication- the medical term for “chewing”. But our jaw is active during many more activities other than chewing; think talking, singing, yawning, laughing and even swallowing. Again, issues on one side will result it abnormal movement on both sides. Many TMD sufferers complain of not only pain in the jaw but also headaches, ear pain and tooth pain.
What cause the muscles to become unbalanced?
Trauma such as a long dental procedure or a direct blow to the jaw can cause muscle imbalances but often it is more subtle activities that “build up” to cause problems. People who clinch their teeth when angry or frustrated and those who grind their teeth at night often have TMD. Another cause, believe it or not, is poor posture of the neck! Poor upper neck posture will can change the length and tension of the muscles that control the jaw.
What treatment options are available for TMD sufferers?
Your dentist may offer treatment for TMD. This often includes dental work to make sure your teeth line up correctly. If your teeth do not line up, muscles may have to act differently to chew your food. A mouth guard may be prescribed to decrease nighttime teeth grinding, known as bruxism. Bruxism is linked with excessive wear on the teeth, tight and sore jaw muscles and jaw pain. Stiffness and fatigue of the jaw or headaches upon waking are common complaints. Muscle relaxers may be beneficial at bed time to decrease griding at night and these must be prescribed by your doctor.
Hopefully, your doctor or dentist knows that physical therapy is helpful in the management of TMD. Physical therapists are movement experts- I am talking about movement of any and every part of the body, from the big toe to, yes, your jaw! We evaluate joint range of motion, muscle strength and muscle flexibility. A thorough evaluation of how the upper neck and jaw are moving is required to determine which muscles are “out of balance”. We can help stretch the tight ones, strengthen the weak ones and establish a home program that allows a person with TMD to minimize the pain.
What does Physical Therapy for my jaw entail?
The first day is an evaluation. Be prepared to answer lots of questions about how long your jaw has been a problem, what makes it hurt, what makes it feel better and what, if anything, you have tried to manage your TMD. Also be prepared to answer questions about other medical conditions, past surgeries, your job and even your hobbies. The therapist will then look at your posture, the range of motion of your neck and jaw, she will test your muscle strength and likely palpate your jaw and neck muscles. This information guides the treatment approach. Everyone is different and every treatment plan will vary depending on what the patient needs. Some patients need more strengthening, some need more stretching. Others need to be taught how to relax any overactive jaw muscles (yes, I am talking about you clinchers!) Posture, as mentioned above, is important so postural exercises are often needed to address TMD.
I think I have TMD, how do I get an evaluation?
A referral is required for a physical therapy evaluation and treatment. Your doctor or dentist can send that referral. Most insurance companies cover physical therapy.