by Dr. Eric L. Mitz, DC
Temporomandibular Joint Syndrome (a.k.a.: TMJ, TMJ Disorder, Temporomandibular Disorder, TMD) is a collection of (mostly painful) symptoms that are created or perpetuated by a dysfunctional temporomandibular joint.
The TMJ is one of the most complex joints in the body. It also happens to be one of the most used joints as well. Two of the most important human activities: eating and talking, are both impaired by TMJ syndrome.
TMJ Syndrome Symptoms
- Pain. Jaw pain is present in virtually every patient with TMJ Syndrome. Headache and earache are the most common additional complaints TMJ patients report. Most patients report having headaches around their temples or around the base of the skull, though I have seen virtually every conceivable headache pattern in TMJ patients. TMJ Syndrome Patients usually have other areas exhibiting pain as well, most commonly effected are the teeth, face, neck, and shoulders. The pain may radiate (travel or shoot) down the arm, down the jaw, across or up the face and even down their backs.
- Popping or clicking in the jaw seen when the patient opens and closes their mouth. This symptom can often be the first clue to the patient that the cause of their headache or neck pain could be coming from their jaw as they may actually not have any significant jaw pain.
- Locking or limited mobility of the temporomandibular joint. Patients report that their jaws will lock in place or even refuse to close or open. The patient’s forward excursion of their jaw (the distance their jaw travels from fully closed to fully open) is usually limited, sometimes severely so, compared to the normal.
- Bite changes. Patients often report that they do not feel as though their teeth are coming together. Often times this may involve only one side of their jaw, the other side’s bite feeling relatively normal. This bite alteration can often make eating difficult.
- Dizziness or vertigo, difficulty hearing or a feeling of fullness in their ear, and difficulty swallowing are reported less frequently, but do occur in many TMJ Syndrome cases.
- Low Progesterone. There is recent evidence that low progesterone levels are linked with TMJ. See my blog post on this topic: TMJ Syndrome and Low Progesterone?
What Causes TMJ Syndrome?
The actual causes of TMJ Syndrome are divided into four categories, from most commonly seen to least commonly seen:
- Muscle Dysfunction. Most often, the muscles that move the jaw become dysfunctional and spastic. In particular, the medial pterygoid, lateral pterygoid, masseter, and the temporalis muscles become targets for my therapy. [note: I would argue that TMJ Syndrome, distilled down, is largely a myofascial pain syndrome.]
- Slipped Disc. There is a cartilaginous disc that cushions the temporomandibular joint. It is connected and it influences several other structures integral to proper TMJ function. Any derangement or displacement of this disc will have significant impact on the TMJ’s overall function. The jaw popping noise often heard in TMJ Syndrome is in fact the condyle snapping over and back across the displaced disc in those patients. The gentle adjustments I perform are targeted at reducing this displacement and resetting the TMJ properly. [note: notice the relationship of the ear canal to the TMJ? This will help you understand why some patients exhibit significant ear complaints. See my case study below.]
- Arthritis. Specifically, osteoarthritis or degenerative joint disease of the TMJ itself. This is the common wear-and-tear form of arthritis wherein the joint surfaces begin to degrade and remodel. Less frequently, other arthritic diseases can affect the TMJ, such as rheumatoid arthritis.
- Temporal Arteritis. A rare condition, but one that any competent clinician must rule out when presented with a patient exhibiting TMJ Syndrome complaints.
Though not technically directly related to the TMJ, research has shown, and my experience strongly agrees, that a significant number of TMJ Syndrome patients suffer from excessive stress or even untreated anxiety disorder. Either of these frequently lead to clenching and grinding of the jaw, especially at night while sleeping. This is often the trigger for the TMJ Syndrome.
Who Treats TMJ Syndrome?
Historically, this condition has been managed by oral surgeons, orthodontists and dentists as well as various medical specialties including pain management and rheumatology. Since the three most common causes of TMJ Syndrome involve the muscles and joints, it was only natural that chiropractors would begin to take a more active role in helping these patients. This makes even more sense when you consider the overlapping neck pain and headache that are seen in TMJ Syndrome patients; both of these conditions respond very well to chiropractic care.
If a TMJ Syndrome patient’s dentist is comfortable treating TMJ, we can work together to develop a comprehensive and unique treatment strategy that addresses all of the patient’s TMJ Syndrome complaints. I humbly tell you that my methods for treating temporomandibular disorder (TMD) are quite successful. In fact, I am unaware of any of my patients that have completed our treatment program that required TMJ surgery.
What to do for TMJ Pain?
- DO eat soft foods like soups and stewed vegetables. Meal replacement shakes can also be helpful during an acute flareup to ensure that you are getting adequate nutrition while not working your TMJ.
- DO NOT eat hard foods or foods that require a great deal of hard chewing.
- DO use ice over your jaw. Heat may feel good, but it is likely only temporary.
- DO NOT open your mouth to its limits (e.g., yawning).
- DO use over-the-counter or prescription pain medicines as they may provide relief.
- DO NOT use over-the-counter or prescription pain medicines longer than a few days. Pain is like a fire alarm and the medications simply turn off the alarm while doing nothing about the fire.
- DO call us if you require pain medication for longer than 72 hours, you need to get those flames put out and we have the fire extinguisher!
- DO NOT chew gum or taffy and avoid all other repetitive jaw movements.
- DO perform TMJ exercises, but…
- DO NOT perform TMJ exercises if your TMJ Syndrome gets worse from doing them.
Unless and until you have tried working with a TMJ chiropractor and failed to reap benefits, you should avoid therapies that permanently change your bite or jaw structure. This includes crown and bridge work, bite altering orthodontia, permanently altering your bite by grinding down teeth, or bite-repositioning splints. These should only be done as a last resort.
DO NOT have TMJ surgery unless you have truly exhausted every other clinical resource. Unfortunately, no research has been performed to prove the safety and long term effectiveness of these risky and invasive procedures.
TMJ Syndrome Case Study
I recall a patient of mine that I was actively treating for neck and back pain. Unaware that chiropractors work in this area, she casually mentioned that she had seen several Otolaryngologists (Ear, Nose Throat Specialists) for earaches and stuffiness in her ear. The patient also had a history of intermittent dizziness which was blamed on the fluid in their ear. Several rounds of antibiotics did nothing to resolve her complaints and meclazine, a medication used to treat dizziness, was not at all helpful for her dizziness but did accentuate her daily headaches. She eventually had tubes surgically placed in her ears as a last ditch effort to resolve her earaches and stuffiness. She did not report having jaw pain, though her jaws clicked routinely.
Examination of the patient showed very clear evidence of TMJ Syndrome and a tailored treatment plan was initiated. The patient is now symptom free: no headaches, no earaches, no stuffiness, no dizziness, a near resolution of her neck discomfort and only occasional jaw clicking and popping. To say she is happy would be an understatement. She says getting accurately diagnosed and properly treated for her TMJ Syndrome was “life changing.”
[note: I elected to use the phrase 'TMJ Syndrome" almost exclusively in this article even though TMD or Temporomadibular Disorder has become more commonly used in modern medicine. This is for the sake of clarity as most patients still refer to this condition by the historical "TMJ Syndrome" or simply "TMJ".]
- Dr. Eric Mitz is a chiropractor in Evansville, IN. He has a particular interest in working with TMJ disorders and welcomes referrals from Dentists and other medical professionals seeking consultation on their challenging TMD patients.