TMJ Dysfunction
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Temporomandibular Joint Dysfunction or TMJ dysfunction or TMJD, are conditions that affect the jawbones, surrounding muscles, and ligaments. It occurs in the synovial joints where the jaws are connected to the skull. TMJ allows you to perform several activities such as yawning, talking, eating, or kissing. Any kind of issue in this joint will result in serious discomfort in the region and hinder the performance of such activities.
The region may be injured due to several reasons such as accidents, arthritis, or even improper chewing. Read on to learn more about the causes, symptoms, and various treatment plans for Temporomandibular joint type dysfunction.
There can be several causes of the Temporomandibular joint pain, such as an old injury or trauma that has left an impact on the jaw. This can be a result of physical injuries that occur while playing, accident-related, or any types of falls or collisions that injure it. Some other causes are inflammation in the region, slipped discs of the facial bones, and immobilization of the jaws due to several reasons.
Reasons such as emotional tension, and muscle spasms in the facial muscles can also result in TMJ. Excessive stress on the joints as a result of improper chewing and biting can impact the joints and cause dysfunction. Since it occurs in the jaw region, dental problems can also reduce the mobility of the jaw and its muscles.
Signs and symptoms of TMJ disorders may include:
Pain or tenderness of your jaw
Pain in one or both of the temporomandibular joints
Aching pain in and around your ear
Difficulty chewing or pain while chewing
Aching facial pain
Locking of the joint, making it difficult to open or close your mouth
TMJ disorders can also cause a clicking sound or grating sensation when you open your mouth or chew. But if there's no pain or limitation of movement associated with your jaw clicking, you probably don't need treatment for a TMJ disorder.
Seek medical attention if you have persistent pain or tenderness in your jaw, or if you can't open or close your jaw completely. Your doctor, your dentist or a TMJ specialist can discuss possible causes and treatments for your problem.
Physiotherapy is advised after initial acute phase to reduce swelling, increase joint range of movement, break down any scar tissue and improve muscle strength.
A physiotherapy assessment will commence with a thorough subjective interview. Posture will be assessed including neck posture, jaw and tongue position, palpation of the TMJ looking for any possible swelling, joint hypomobility or hypermobility, range of movement of the jaw and neck. If symptoms are inflammatory in nature, then pain is likely to be irritable and care should be taken not to aggravate symptoms during assessment or treatment.
Treatment should address any issues identified during the assessment. For inflammatory dysfunction, anti-inflammatories and avoidance of aggravating activities should be the initial course of action. For those who have difficulty chewing, they may require a modified diet including softer food while pain improves or using a straw instead of opening the mouth to drink. Patients should avoid resting their chin on their hand, avoid chewing gum and any other chewy foods as well as food that requires a large mouth opening such as taking a bite from an apple or a large hamburger.
Soft tissue work can be very effective at releasing tight muscles in the jaw, base of skull and surrounding areas. Treatment of the neck muscles and joints can be especially helpful in resolving TMJ pain including joint mobilisation of any stiff joints found on assessment as well as making any postural corrections.
Botulinum toxin- A has emerged as a sought after treatment option for muscular TMJ disorders including bruxism and hyperactive muscles of mastication. Botulinum toxin is a natural poisonous by-product of a bacterium. FDA approved, this neurotoxin acts by inhibiting the release of acetylcholine, disabling muscle function at the neuromuscular junction. Botox A is injected into the active target muscle under the guidance of electromyograph. Effects will start to take effect at 2-7 days and can last between 8 and 12 weeks. Systematic reviews and meta analysis compared Botox A to Physiotherapy techniques such as myofascial manipulation and dry needling without clinically significant differences in pain scores. Another review compared pain scores at 6 weeks post Botox or dry needling actually supported dry needling.
There is limited evidence for exercise therapy for bruxism or muscular related jaw pain or following head and neck cancer. Exercise therapy is a non-invasive intervention that in certain populations can reduce the intensity and severity of pain. The Rocabado exercises are 6 exercises that are completed 6 times per day. These exercises aim to improve head and jaw posture.
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