Our two TMJ’s (temporomandibular joints) – one on each side of our head in front of the ears allow the jaw to open and close, move side to side, forward and backward. Unlike any other joints of the body, these joints generally move at the same time. When one or both aren’t functioning properly, it is referred to as “dysfunction”. This is commonly caused by the displacement of the cartilage (disc).
Temporomandibular joint and muscle disorders (TMDs) refer to a complex set of conditions that can cause pain in the area of the jaw joint and associated muscles and/or problems using the jaw. Both or just one of the TM joints may be affected.
TMDs can affect a person’s ability to speak, eat, chew swallow, make facial expressions and even breathe. When untreated, it can cause other parts of the face, head and neck to hurt, even though the tissues are intact and do not have a problem themselves.
Causes of TMD
Not all causes are known for TMD. The most common cause is bruxism (grinding), or clenching of the teeth in our sleep. There is new evidence showing a relationship with bruxism as a ‘protective mechanism’ to keep our airway open while we sleep and prevent us from stopping breathing;
Other factors include dental procedures, Arthritis, injuries, genetics, hormones, low-level infections, autoimmune diseases, and even stretching of the jaw that occurs with inserting a breathing tube before surgery.
TMD Patient Statistics
t’s been estimated that up to 30% of adults will experience TMD at some point in their lives.
Recent research indicates that more women seek medical care for a TMJ problem than men. Physiologically Women process pain in a completely different way to men using different pain signal mechanisms. This may explain why more women suffer from TMJ conditions than men.
Children also suffer from TMD- to find out more about how please Click Here.
How TMJ Disorder is diagnosed
TMJ & Sleep Therapy Centre philosophy is consistent with the scientific literature documenting the co-existence of TMJ disorders and headaches with airway obstruction and sleep disordered breathing. Our initial clinical examination always includes:
- Oral exam with airway evaluation
- Medical, trauma, and drug history
- Nutritional analysis
- Mandibular and cervical ranges of motion
- Postural, skeletal evaluation
- Muscle, tendon and ligament palpations
- Motor Nerve Reflex Testing
This all helps us arrive at an accurate diagnosis. We usually see patients that have already been to see multiple health professionals before they walk through our doors. Due to the thorough nature of our record taking and diagnosis we can usually help you find the answers you are looking for right from the outset.
Treatment for TMD
We at the TMJ and sleep therapy Centre of London provide an individualized treatment plan for each of our patients. This may include day and/or night appliances, Chiropractic referral, ENT referral, Nutritional advice or Orthodontics or physical therapies using lasers or medications to correct acute pain.
Diagnosis is key. It is for this reason our initial appointment takes between 1-2 hours so that all parameters are evaluated.
We look very closely at the trigeminal nerve system, which is the main sensory nerve system running through your head and accounts for 90% of all the sensory input into the entire nervous system. This may explain why TMD can sometimes become debilitating for its sufferers. Many patients seek treatment for craniofacial pain due to recurrent migraines, however 90% of headaches are caused by disorders in the facial muscles and nerves. Jaw asymmetry affects the muscles, nerves, tendons, ligaments, bones, and connective tissue in the jaw. Patients are often diagnosed with atypical facial pain or trigeminal neuralgia. We find patients with a sliding scale of different symptoms from dull ache to a sharp stabbing pain in the muscles from everyday activities like chewing.
There are very important nerves that supply the jaw joint, and when they are inflamed, they can cause anything that those nerves supply to hurt, even though there is no damage to that area!
This is called Central Sensitization, and the reason why chronic pain is so challenging to eliminate. The inflamed nerves aren’t addressed at an acute stage so when the pain transitions to a chronic state any nerve that related to the Trigeminal System can now hurt. This is why TMJ is often labeled the Great Impostor.
Clicking or Popping in Jaw Joints
This is the most common symptom of TMD. Usually the cause of the popping jaw is a displaced disc in the jaw joint. These joints are ball and socket joints, just like the shoulder joint. During proper function the ball and socket have a cushion in the form of a thin disc of cartilage located between them. This disc of cartilage is held in place and by muscle and ligaments to make sure there is no bone- on bone contact.
There may or may not be pain in the jaw when the clicking or popping sound is heard. Sometimes the sounds may even be so loud that it is audible to others when chewing or having a conversation.
Incorrect biting patterns or trauma can result in damaged tissues causing the joint to be pulled out of alignment, and the disc is typically pulled forward or the attachments to it impaired. The bones now are rubbing against each other and pressing on nerves, causing pain in the jaw and joint sounds. The strain often causes added pain in the jaw and face as well as in the head, neck, back and shoulders.
Limitations in Jaw Movement /Lock Jaw
Limited jaw movement or locking jaw may feel like the lower jaw is “catching” when the jaw is opened. In some cases a person with a locked jaw must move the jaw to one side or the other in order to open the mouth wide. A person might also have to open the mouth until a popping sound is heard and felt, at which point their jaw unlocks. This is most commonly felt in the mornings, but is not mandatory. A subluxated TMJ can result in locking jaw, clicking or popping in the jaw, and eventually, headaches, ear pain, tinnitus, tooth pain and etc.
Anxiety and Depression
Due to a lot of misdiagnosis or outright dismissal with no physical cause detected, unfortunately, many people that suffer with TMD also suffer from depression. Scientific evidence that shows that patients with chronic pain which is a symptom nearly all TMD patients have, have chemical changes in the brain as a result of the pain. These chemicals can cause depression. Because TMJ is a multifaceted disorder, many patients need to work with more than one specialist to return to optimal health. (similar to original look up wording)
The posture and bite are intimately related. Picture a postural chain with the feet at one end and the teeth at the other. When the upper and lower teeth are closed together, each tooth actually forms a skeletal relationship with its opposing tooth. In turn, this bite determines and position of your jaw and the position of your head on your spine. Poor posture places unnecessary wear and tear on the joints. It can also cause the muscles to suffer. Symptoms that are specific to a poorly postured bite include:
- One shoulder being higher than the other
- Altered gait
When your posture is incorrect, you may notice pant legs that must be hemmed to different lengths or shoe heels that wear unevenly. The majority of people carry their head too far forward. This places tremendous strain on the muscles of the shoulders, back, neck and head. Because the average human head weighs 15 pounds, with each inch the head is held forward it adds 15 more pounds.
Further, the shoulders roll forward and the jaw is pulled back. Treatment for poor posture is normally treated with physical therapy. Therapists stretch muscles which have become shortened over time. When your bite is involved with a postural problem the dentist must correct with a properly fabricated orthotic so muscles, bones and teeth can function without strain and tension.
Numbness or Tingling in Hands / Arms
What most people don’t know is the common link between subluxations in the cervical spine (the top end of the spine that connects with the base of your skull) and TMD. During our diagnosis we can determine which one came first. When the cervical spine is subluxated (out of position), it compresses the nerves that supply the muscles of the neck and arms. The group of nerves that affect he arms and down into the hands are a branch off what we call the brachial plexis. This can result in a numb or tingling sensation in the affected area.
Mystery Tooth Pain
Teeth may become sensitive because of clenching or grinding. However there can also be pain due to inflamed muscles. These can ‘refer’ pain to the teeth, and treating the cause can relieve the tooth pain. Unfortunately, when seeking relief from this tooth pain many patients are misdiagnosed and some common treatments include having the nerve from the tooth removed with root canals or even having the tooth extracted. This may not relieve the pain, and can actually make it worse!
We now know that patients with sleep disorders also have muscle spasms in their airway. One entrance to your airway is through your mouth. If this is the case it can also result in what feels like jaw pain or tooth pain as the area in which we have muscle spasms correlate directly with the area the pain is felt. This again emphasizes the need for a correct diagnosis from the outset.
Scalloping of the tongue
This is very common in suffers with a jaw joint issue as they use their tongue as a water bed to brace their jaw. This creates the marks on the side of their tongue known as “scalloping”.
Ringing in the Ears
This is shown to be 70% predictive of Tinnitus. In many cases ringing in the ears is due to dislocated or ‘clicking’ or ‘locking’ jaw joint. The ligaments that connect the jaw joint with the malleus of the ear are put under extra tension and this pull can cause all sorts of different sounds in the ears from feeling like your ears are blocked to ringing. This is not detectable by an audiologist and therefore many are misdiagnosed or left untreated. Clinical studies have confirmed the efficacy in treating the jaw alleviating these symptoms.
Clenching/Grinding of Teeth/Stress/Sleep – The Link
Clenching or Grinding in our sleep (Bruxism) is now classified as a neurologic sleep movement disorder. This disorder is very damaging to the teeth and the Jaw Joints, and also causes fatigue and pain to the facial muscles. For years the theory that we are brushing too hard and wearing our teeth away or that we are stressed was the most common diagnosis for Bruxism. The fact that our teeth are one of the strongest bones in our bodies was dismissed and we were convinced that a toothbrush could cause this amount of destruction. Stress still remains a contributing factor, however research has shown with the aid of sleep studies, extremely strong muscle activity right before or during Sleep Apnoea events. It is thought that this is a protective mechanism in order to maintain an airway and allow us to continue breathing.
We obviously feel stress when this occurs as our bodies are fighting to keep breathing- it’s a fight for survival. If this activity continues day after day and night are night we can cause changes to our nervous system, which in turn can cause us to feel “stressed”. This remains until we address the issue and allow the body to heal and therefore bring back our nervous systems to normal function and restore the balance. Our bodies are not very good at determining emotional vs. structural stresses and traditionally we build teeth up to restore the structure. But without addressing the issue it just masks the problem for a short while and can often make it worse.