TMD or Temporomandibular Joint Dysfunction, according to the TMJ Association affects nearly 12% 0f the population or 35 million people a year. For many of us, it is no more than an annoying “click” or “pop” that one can get with yawning, speaking or chewing. For others, however it can be rather debilitating leading not only to jaw pain, but neck pain and even headaches. Here is a little test that you can do as a little quick screen:
So, let’s get started….
You can either be sitting or standing. First, are your lips open or are they touching? Next, how about your teeth. Are they touching? Now think about where your tongue is sitting. By this I mean is it pressed against the roof of your mouth, lying on the floor or is it pressed against your teeth?
The answers: Your lips should be touching, however your teeth should not be. As for your tongue, the correct position is resting on the ridge behind your upper front teeth. What!? Do this…say the name Norman. Where your tongue rests after the second syllable is the proper place of the tongue.
Now open your moth…
Can you put your second and third knuckle in your mouth? If you can, that is functional (and a neat party trick!). However normal would require putting 3 knuckles in your mouth. Do you hear and audible “pop” or “click”? If you are in front of a mirror, when you open your mouth does your jaw shift to one side?
The temporomandibular joint is used more frequently than any other joint in the body. It moves with talking, swallowing and chewing. It is capable of producing great forces. TMD is multi-factorial, it can be affected by posture, stress, trauma and or sleeping position.
The Temporomandibular Joint
The Temporomandibular Joint is the jaw joint. You have two of them that work in tandem located in front of the ear. As the name implies, the temporomandibular joint is formed by the temporal bone of the skull and mandible or lower jaw bone. The muscles that are associated with the joint allow for three general types of motion, up and down, side to side and forward and back.
But Why Does My Jaw “Click”?
To explain this, we need to delve into anatomy a little bit. Something that is rather unique about the TM joint is that it contains a disc which is made up of some of the same components as those between the vertebra. The disc, which looks similar to the shape of a bow tie, acts as a shock absorber to blunt the trauma of chewing or talking. When you open your mouth, ideally the condyle will rotate and glide back as the mouth closes. The “click” that you hear is when the condyle and disc have lost their normal relationship. With clicking during opening of the jaw, the condyle may start in proper relationship to the disc, however when the mouth opens it slips over the back portion of the disc producing the sound. If the clicking happens with closing of the jaw then the condyle has slipped past the back portion of the disc.
Symptoms Of TMD
TMD can cause a wide range of symptoms. The most commons symptoms that I see for TMD are jaw pain, neck pain, headaches, upper back pain, “clicking” or “popping”. Other symptoms such as ear fullness, ringing in the ears (tinnitus) and dizziness can also be associated with TMD.
Causes of TMD
- Dental Work
- Autoimmune Diseases
The two that I want to discuss primarily are stress and posture. Anytime I have a patient whose chief complaint is headaches located either at the temples or the back of the head (occipital) the one question that may seem a little atypical is the following:
“If something is upsetting or bothering you, do you…..A. Express it, vent, get it off your chest, etc or B. Internalize it?” What do you think is the most common answer? If you said B, you are correct. So the way people manifest internalizing stress is by clenching their jaw and tensing their shoulders. Try this, put your hands on the base of your skull and clench your jaw. You may feel muscle tighten when you do this. These are grouped as the suboccipital muscles. Nerves that innervate the back of our head are located in close proximity to these muscles, so when they get irritated their pain distribution is to the back of the head.
What about posture and how does that play a role? The average adult sits 9-10 hours per day. Although this sounds like something a chiropractor would say, Dynamic Dental states that “The body functions optimally when all of the joints, bones, and muscles are properly aligned. If you routinely slouch in your chair or spend your days hunched over a computer, you are retraining your body to hold itself in a less-than-ideal position.”
Look at the photo and see the effects of what poor posture can have on your neck and upper back. As the head shifts forward, the muscles that are required to hold our head up are placed under constant strain. This leads to over-sensitization and pain in these areas.If you look at the illustration with the head that reads 40lbs, you can visualize how the sub occipital muscles at the back of the head are getting squeezed and may lead to headaches. And this posture is not only present in adults, just look at the posture of our children while they text or play video games. Does the photo below look familiar?
Treatment of TMD
Writing this from the chiropractic perspective, the first thing you want to do is decrease the patient’s symptoms. Chiropractic manipulation to the neck and upper back has been shown to relieve pain in these area and to reduce or eliminate headaches. Another effective modality is dry needling which uses acupuncture needles that can be inserted into muscles. Our advanced training allows us to needle, not only the cervical musculature, but also the SCM (an under-diagnosed contributor of headaches), sub occipital muscles and even the muscles of the jaw itself. Dr. Infanti has specialized training to perform intraoral massage to relax taut or tense muscles and also joint mobilization to increase joint extensibility.
As a patient’s symptoms begin to alleviate, care should shift to corrective exercise. Examples of exercises that focus on reversing the effects of poor posture include chin-tuck exercises, scapular-stabilization exercises and stretching muscles that become shortened such as the pectoral muscles. Foam-rolling the upper back is helpful in mobilizing the joints of the thoracic spine.
Take a look at your ergonomic set-up at work. Have a friend or coworker take a picture of you from the side and see if there are things that can be improved. Is the monitor at eye level? Are you looking straight-on at the screen or is it off-centered? Does the office chair slide under your desk or do the arm rests prevent this from happening? Versa desk and Varidesk have become popular recently because they allow you to convert from sitting to standing. If you do not have the budget for one of these options, set a timer for every 30-60 minutes and get up and move around.
A Word About Night guards….
The most recent research regarding night guards is that they should be thin, rigid and provide complete coverage. Soft night guards, although effective in protecting the teeth, can actually cause more clenching. Also if the guard does not provide full coverage it can lead to teeth becoming malformed.
Have a question….give Chiro 1st Chiropractic and Physical Therapy of Annapolis a call.
Chiro 1st Chiropractic and Physical Therapy of Annapolis is the only office that offers collaboration of chiropractors, physical therapists, massage therapists, acupuncturists and registered dietitians all at one location!
Until next time….Stay healthy!
Dr. Raymond Infanti