Dayton Chiropractor Explains TMJ
A special thanks to Robert Goodwin, D.C., a Dayton, OH Chiropractor, for providing this article.
Did you know that jaw pain (TMJ syndrome) is the second most common musculoskeletal complaint only to low back pain? This pain syndrome can affect not just the jaw, but give you pain in the teeth, ear, mouth, pharynx and cause headaches.
The most common cause of TMJ syndrome is grinding of the teeth, called bruxism, usually when sleeping or when overly stressed out. Most people must be told they are grinding their teeth at night by their spouse or significant other. Dentists often suspect it by inspecting your teeth for signs of worn and cracked teeth.
Dentists will usually prescribe a mouth guard that has to be worn at night and this is good, however, for best results the joints and muscles that allows us to move our jaw must also be addressed. Most Dentists are not trained in treating muscle dysfunction and this is where Chiropractic and Massage Therapy come into play.
There are four major muscles that move the jaw;
- Temporalis is the muscle located above each ear and attaches your skull to your jawbone (mandible). It acts to close your mouth by elevating and retracting the mandible.
- Masseter is the muscle located in front of each ear and attaches your cheek bone to your jawbone. It acts to close your mouth by elevating the mandible. The Masseter is a very strong muscles and is likely the main culprit in wearing teeth down when grinding your teeth.
- Lateral Pterygoid crosses your mouth by the jaw joint (TMJ) in a horizontal orientation and acts to protrude your jaw, moving your lower teeth forward ahead of your upper teeth, as well as to open your mouth.
- Medial Pterygoid also crosses but is located inside your mouth in a diagonal orientation and acts to assist the lateral pterygoid.
Every muscle in the body can become dysfunctional if it is overworked, as what happens when grinding your teeth. Focal areas of spasm, called trigger points can develop and it is these trigger points that cause pain to radiate into your ear, teeth, jaw, throat and/or head. Larger muscles, such as the upper trapezius that attaches the upper back and neck to the shoulders, form large trigger points that are commonly referred as muscle knots that we all experience. These trigger points cause soreness and respond well to massage and heat. The same is true in the smaller muscle we use to chew, the trigger points are much smaller, so we do not usually associate them as muscle knots.
The TMJ joint is considered a “hinge joint” that connects the jawbone to the part of the skull called the temporal bone. However, this is no simple hinge as chewing requires the jaw to move sideways, forward and back while also moving up and down. To achieve this grinding action, the TMJ has a disc in it, much like the discs in our spine. The disc essentially acts to split the TMJ into two spaces, one space for opening and closing and the other space for moving the jaw forward and back. The Pterygoid muscles must perform an intricate dance, alternating contractions left and right to cause the jaw to move side to side.
Just like the discs in our spine, the TMJ disc acts as a shock absorber, protecting the bones from the high impact of chewing.
Unlike the discs in our spine, the TMJ disc has a muscle (lateral pterygoid) that connects to it assisting with its motion. Prolonged spasm of the lateral pterygoid can displace the disc. Displaced TMJ disc can be a serious condition that leads to surgery. Catching the problem early is the key to avoiding such drastic medical intervention.
A thorough evaluation of the TMJ joint and the muscles that move the joint is essential to prevent serious TMJ problems.
The TMJ evaluations is three part:
- Visual inspection for signs of worn, broken or loose teeth, this is done with the mouth open and with the mouth closed.
- Evaluation of the function of the joint. Is there pain and restrictions during jaw motion? Does the jaw bone move side to side during opening and closing? Is there any clicking, popping or other noises during opening and closing?
- Palpation or touching of the four muscles for pain, spasm and/or trigger points.
The treatment plan is formed out of this evaluation. Reducing spasm and trigger points is achieved with massage techniques and each muscle differs in the approach. For example, if the medial pterygoids are involved, massage can only be performed by a trained professional with a gloved hand entering the open mouth to reach the muscle. As the muscle is forward in the mouth, this rarely activates the gag reflex and does not cause much discomfort. Massage of the other muscles are performed outside the mouth and knowledge of the direction of the fibers is essential for good results. Stretching exercises to be performed at home will be provided. Chiropractic adjustments may be needed if the joint function is compromised. Often neck adjustments are also needed to improve function. Working with a Dentist for a good fitting custom mouth guard may be needed depending on how long the problem has been allowed to advance, and how bad you grind your teeth.
If you or a loved one is experiencing jaw pain and/or popping, or if you notice grinding of teeth, schedule an evaluation with Dr. Goodwin. The sooner we determine the cause of the problem, the better we are at avoiding medical intervention, including surgery.
By Dr. Robert Goodwin, D.C.