Temporomandibular Joints

TMJ (Temporomandibular Joints) disorders are a family of problems related to your complex jaw joint. If you have had symptomatic pain or a clicking sound, you will be glad to know that this problem is more easily diagnosed and treated then it was in the past. No one treatment can solve TMJ disorders completely, and treatment takes time to be effective. But with the help of your dentist and physical therapist you are likely to have a healthier and more comfortable TMJ.
To Help You Recognize TMJ Disorders:

  • Grinding or clicking your teeth. Awaking with sore, stiff muscles around your jaw.
  • Frequent headaches or neck aches. Pain increases when you clench your teeth.
  • Stress increases your clenching and pain.
  • Teeth that are sensitive, loose, broken or worn.
  • Bite problems, Teeth that do not touch even when you bite.
  • Missing teeth.
  • Teeth that meet differently occasionally.
  • Difficulty chewing your foot.
  • Jaw clicking, popping or grating when you open your mouth.
  • Trouble opening your mouth (eating or yawning).
  • Neck, head or jaw injury.
  • Problems with other joints (arthritis).
  • Pain behind your eyes.
  • Eyes sensitive to sunlight.
  • Sensation of foreign object in your throat.
  • Voice irregularities or changes.
  • Hissing, buzzing or ringing sound in your ears.
  • Ear pain, ear ache with no infection.

The more times that “yes” is the answer the more likely it is that TMJ is the disorder.

Physical Therapy plays a very important role in controlling the acute and chronic TMJ disorders. It is very difficult in this brief answer to explain in depth the relationship between temporomandibular, head, and cranio vertebrae joints, which are making the physical therapy vital in the treatment approach of TMJ.

The physical findings of temporomandibular disorders are:

Disc derangement, myofascial pain, capsular adhension (hypomobility) and ligament laxity (hypermobility)

Due to disc derangement, there is a displacement state in which the patient starts to lose the normal smooth opening and closing pattern of mouth. In these cases, the patient requires splinting therapy with manipulation exercises to help place the disc properly and restore the normal smooth mouth opening pattern.

In myofascial pain cases, due to an inflammatory process caused by clinching habits or other causes, ultrasound and myomatic stimulation have the greatest effect in the physiological adjustment to the muscles and body cells. The pain will be killed by restoring the blood supply which enhances the accumulation of neurotransmitters (endorphins) which inhibit the perception of pain. Very specific mouth exercises are also demonstrated to help improve blood circulation and increase muscle endurance for better tolerable function.

In capsular adhesion, caused by trauma or chronic uneven bit problems, splinting therapy in addition to the above modalities may have to be applied to prepare the joint for the mobilization approach. Ultrasound and manual mobilization are the most important elements to break down the adhesion.

The ligamentum laxity, or hypermobility cases, are very common problems and are the highest percentage of the TMJ syndrome. These cases have to be carefully evaluated to be differentiated from the disc derangement problems because both cases have a click sound and 80% of the signs and symptoms are the same. Ultrasound and/or myomatic stimulation should be used to improve pain. But most important are the therapeutic exercises which are specifically designed to tighten up the joint and limit the irritation caused by the condo displacement every time the patient opens his/her mouth.

The head and neck area are in strong relationship with the function of the temporomandibular joint. When a patient does not treat the jaw malfunction properly, they will start to suffer headaches due to spasms of the head muscles which are caused by the spasm of the TMJ muscles. When these problems last long enough, the spasm will continue to spread to the neck region. Within several weeks, a structural imbalance in the cranio vertebral region will occur. The C1 will be displaces forward, the space between the occiput and C1 will de diminished and the space between the C0 and C2 will be severely diminished due to the C1 anterior displacement.

If only the TMJ were treated, ignoring the cranio vertebral disorders, it would always be hard to achieve satisfactory recovery, as again, the disalignment in the cranio vertebral region could cause recurrent imbalance in the temporomandibular region. This is why we require that all three areas (TMJ, head, neck) be treated simultaneously.

Mechanical or manual traction may have to be used for cranio vertebral adjustment. Specific, therapeutic exercises would be demonstrated to help spinal adjustment around the clock until the body posture has been satisfactorily changed.

The main key in handling the temporomandibular joint is:

How can we restore the physiological resting state to the TMJ in relation to the head and neck areas?

When this is achieved we are able to stop the chronic pain and headaches which, with some cases, persisted over ten years.