TMJ DISORDERS

TMJ disorders include a variety of conditions that cause tenderness and pain in the temporomandibular joint (TMJ). Your TMJ is the ball-and-socket joint on each side of your head where your lower jawbone (mandible) joins the temporal bone of your skull.

The lower jaw has rounded ends (condyles) that glide in and out of the joint socket when you talk, chew or yawn. The surfaces of the condyle and the socket of the temporal bone are covered with cartilage and separated by a small disk, which absorbs shock and keeps the movement smooth. The muscles that enable you to open and close your mouth stabilize this joint.

Between 5 percent and 15 percent of people in the United States experience pain associated with TMJ disorders, according to the National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health. Women are more likely than men to develop TMJ disorders.

In most cases, pain and discomfort associated with TMJ disorders can be alleviated with self-managed care or nonsurgical treatments, but more severe cases may need to be treated with dental or surgical interventions.

Signs and symptoms of TMJ disorders may include:

  • Pain or tenderness of your jaw
  • Aching pain in and around your ear
  • Difficulty chewing or discomfort while chewing
  • Aching facial pain
  • A clicking sound or grating sensation when opening your mouth or chewing
  • Locking of the joint, making it difficult to open or close your mouth
  • Headache
  • Uncomfortable bite
  • An uneven bite, because one or more teeth are making premature contact

You may feel pain or tenderness, even when you aren't moving your jaw. But in most cases, the pain or tenderness worsens when you move your jaw.
Jaw clicking is common and doesn't always signal a problem. If there's no pain or limitation of movement associated with your jaw clicking, you probably don't have a TMJ disorder.

The cause of some TMJ disorders can be traced to trauma from a severe blow to the jaw, degeneration of the joint, osteoarthritis, rheumatoid arthritis or other forms of inflammation. The causes of many cases of TMJ disorders, however, aren't always clear. Some experts believe that responses to stress or anxiety may be a primary or contributing causal factor.

If you frequently clench your jaw when you're stressed, irritated or concentrating, the muscles of the TMJ are kept in a contracted position, not unlike the discomfort you would probably feel if you flexed your biceps all day. Similarly, you may respond to tension or anxiety by grinding your teeth (bruxism). You may even clench your jaw or grind your teeth in your sleep without realizing it. Other habits that overwork the jaw muscles, such as chewing on a pen or chewing gum, may exacerbate the pain of TMJ disorders.

Poor posture of the head, neck and shoulders may put strain on the muscular and skeletal systems that are closely related to the jaw muscles and joints.

In some cases, the symptoms of a TMJ disorder may go away without treatment. If they persist, your doctor or dentist will most likely recommend one or more conservative, nonsurgical treatments or behavioral interventions to alleviate pain, to correct dental problems that contribute to the disorder, or to change habits that exacerbate symptoms. Your doctor or dentist may suggest the following treatments or interventions:

  • Breaking bad tension-related habits. Your doctor will probably ask you to be aware of daytime habits, such as clenching your jaw, grinding your teeth, or chewing on your lip or on objects. These habits should be replaced with good jaw "posture" — keeping the jaw muscles relaxed with the teeth slightly apart, the tongue lightly touching the roof of your mouth and resting directly behind your upper teeth.

  • Avoiding overuse of jaw muscles. Your doctor or dentist will probably ask you to change diet choices or behaviors that overwork or strain your jaw muscles. Eating soft foods, cutting food into small pieces, avoiding sticky or chewy food, and avoiding gum will minimize muscle use and may help alleviate pain. When yawning, avoid opening your mouth too wide.

  • Stretching and massage. Your doctor or dentist may show you how to do exercises that stretch your jaw muscles and how to massage the muscles yourself. He or she may also show you exercises to improve your head, neck and shoulder posture.

  • Heat or cold. Applying warm, moist heat or ice to the side of your face may help you relax your muscles or alleviate pain.

  • Biteplate. If your TMJ is misaligned, your dentist may recommend a plastic biteplate (splint), worn over your teeth, to help align your upper and lower jaws. A biteplate may also reduce pressure in the joint structure.

  • Night guard appliance. If you grind your teeth in your sleep, a night guard appliance, which is a soft or firm device inserted over your teeth, can help prevent grinding and excessive wear of your teeth.

Coping skills
Because stress can contribute to TMJ disorders, stress-relieving relaxation techniques may reduce jaw clenching or teeth grinding and may help alleviate TMJ symptoms. Beneficial techniques include:

  • Deep breathing. Unlike children, most adults breathe with their chests. Each time you breathe in, your chest expands, and each time you breathe out, it contracts. Children generally breathe from their diaphragms, the muscle that separates the chest from the abdomen. Deep breathing with your diaphragm, a technique that you can relearn, can be relaxing. To practice deep breathing, sit comfortably with your feet flat on the floor. Breathe in through your nose, and allow your abdomen to expand as you breathe in. Pause for a second, and then exhale through your mouth, gently pushing in your abdomen with your hand.

  • Progressive muscle relaxation. This involves relaxing a series of muscles one at a time. First increase the tension level in a group of muscles, such as a leg or an arm, by tightening the muscles and then relaxing them. Then move on to the next muscle group. It may also help to apply warm, moist heat.

    Meditation. Meditation is a way to calm your mind and body. During meditation you sit quietly and focus on nothing or on a mantra — a simple sound repeated over and over. This causes you to enter a deeply restful state that reduces your body's stress response. Your breathing slows, your muscles relax and your brain wave activity indicates a state of relaxation.

  • Yoga. Yoga incorporates proper breathing, movement and posture. It involves completing a series of postures, during which you pay special attention to your breathing — inhaling during certain movements and exhaling with others.

Chiropractic Care and TMJ Problems a Case Study

In the January 2002 edition of the peer reviewed scientific journal, the Journal of Manipulative and Physiological Therapeutics, (JMPT) appeared a case study on a 41-year-old woman who sought chiropractic care with complaints of pain at the TMJ on both sides, ear pain, ringing in the ears, vertigo, decreased hearing ability, and a sensation of pressure or fullness in both ears. She also reported that movements of her jaw while talking or chewing provoked pain at the TMJ.
Before seeking chiropractic care she was treated for her TMJ by two medical doctors. She was also referred to an eye, ear, nose, and throat specialist, who diagnosed her with TMJ syndrome. Additionally, she was referred to a dentist for the problem. Medical recommendations were to apply heat to the area, reduce talking and yelling, and change her diet to a soft diet. Even with all this medical and dental care her symptoms steadily continued to get worse.


Eventually she sought the care of a chiropractor. After an examination it was determined by the chiropractor that the patient had an Atlas subluxation, (first bone in the neck). Care was begun by a series of adjustments. After only a few visits the patient reported significant improvement in her symptoms. After two and a half months she reported complete relief from the TMJ symptoms. She also reported a decrease in the frequency and severity of her headaches. Prior to starting chiropractic care, she was experiencing 1 to 2 migraine headache attacks per month. The effects of the chiropractic care were long term as shown at her 1-year follow-up where she had not experienced any headache symptoms for a period of 9 months and her TMJ complaints had completely resolved.