The Temporo Mandibular Joint (TMJ) is the joint which allows us to open and close our mouth. Situated right in front of the ear we become aware of it just when it starts to “pop” or after a visit to the dentist.
Conditions such as migraine and headaches, earaches, pain in the face, sinuses and eyes, neck pain, loss of sensation, pins and needles in the arms tinnitus, dry unproductive cough or swallowing difficulties and of course locking of the jaw can be related to a Temporomandibular Disorder (TMD). TMD are classified in two groups: In the first group the cause of the problem is mainly muscular (MPDS = Myofascial Pain Dysfunction Syndrome). In the second group the problem is in the joint.
What causes a TMD?
The causes are multiple and there is still much controversy regarding the extent to which possible causes may influence the outcome. The following list shows some causes but it is still unclear which are actual causes and which are risk factors or merely coincidental. The more factors involved the more difficult it is to make this distinction.
- Trauma, directly or indirectly to TMJ or to the spine
- Work habits, Posture , Symmetry
- Disease (osteoarthritis, immune disorders, viral, tumour)
- Gender (male to female ratio 1:4)
- Para functional habits (mouth breathing, wide yawning, nail, lip or cheek biting)
- Malocclusion (bad bite)
- Brux (grinding the teeth together)/Clench/Brace BCB
- Intubation during surgical procedures
- Psychological stress
The best results are achieved through a holistic approach with a team of physiotherapist, dentist and orthodontist.
The physiotherapist will assess the condition and movement of the joint, the muscles of mastication and the neck, the posture and working habits. The treatment will involve mobilisation of the soft tissue as well as manual therapy on the TMJ joint and of the neck (if needed), correction of posture and exercises to re – learn the correct movement of the TMJ (Mariano Rocabado). Dentist and Orthodontist will provide the dental work and bracing as appropriate.
Who to contact first
This depends on your situation. If you are suffering from headaches and/or sinus pain and tense neck muscles you might want to see a physiotherapist first. You can then be referred to a dentist or orthodontist when the tension of the muscle is balanced and the joint movement can’t be improved any further.
If you are already seeing your dentist he will possibly refer you to a physiotherapist for treatment and/or orthodontist for bracing.