You open your mouth to say hello to a friend, and suddenly there is a loud click in your jaw. You try to brush it off, but over time the clicking continues. One day you wake up and realize it never went away. And worse still, the clicking is now accompanied by pain.
Temporomandibular joint disorders, often abbreviated as TMD, are characterized by continual disturbances of the TMJ joint located just in front of the ear. They affect an estimated 10 million people in the U.S.[I] One study suggests it could be even more common than that, as it often goes undiagnosed with no obvious symptoms.[II] As we get older, though, the chances that these imbalances manifest as TMD increase dramatically.
Despite the prevalence of the issue, countless people suffer chronic TMJ pain and cannot find true relief. Most of this can be attributed to the complex nature of the joint itself, as well as a lack of knowledge about what causes TMD in the first place.
Joint Function and Structure
The temporomandibular joint connects the lower jaw to the skull. It is also arguably one of the most complex joints in the body, with more moving parts and connective tissues than the simple hinge joints that make up our elbows and knees.
The TMJ is a complex ball and socket joint with added adaptations that allow for both hinge and sliding motions. This lets us to apply up and down forces to crush tough foods as well as shift our jaw side to side for grinding, chewing and speaking. Variety of types of pain may be present dull ache, searing pain possible difficulty opening their mouth.
The lower jaw itself has rounded ends that glides in and out of the upper joint socket. The joint is protected by both cartilage and a feature unique to the TMJ, a fibrous bit of connective tissue known as the articular disc.
The entire facial structure relies on the position and movement of this joint. It, in turn, is affected by other localized structures, including the tongue and teeth. With a structure as delicate and complex as this, it does not take much to knock it out of balance.
It’s the little habits which can create big problems: propping your head up on your hand, or resting your head’s weight on your jaw while sleeping are common culprits most people never think twice about.
Common Symptoms of TMJ
There is a long list of symptoms associated with temporomandibular joint disorders. The pain itself may be short-lived, but if left untreated, the symptoms can turn into degenerative problems. The longer TMJ is allowed to persist, the more difficult it becomes to treat.
- Clicking, popping, or grating sound in the joint when opening the mouth
- Limited mouth mobility and difficulty chewing
- Swelling or pain in the face or around the ears
- Dull, densely located toothaches
- Headaches (migraines)
- Neck or ear pain
- Chewing imbalances (favoring chewing on one side or another)
- Uneven occlusion
- Open bites (where the teeth do not meet during biting or chewing)
- Locked jaw
- Shifting teeth, even after orthodontic treatment
Not everyone will experience the above symptoms, and even those who do may have other issues as a root cause. Trickier still, both adults and children may be impacted. For these and other reasons, a thorough evaluation and an accurate diagnostic plan is vital to treating TMJ.
While definitive root causes are mostly unknown, TMJ trouble may stem from:
- Falling on your face
- Being hit in the head by an object
- As a side effect of a broken jaw
- Chronic teeth grinding or clenching (Bruxism)
- Untreated airway issues
- Head propping
- Irregular occlusions
A Difficult Diagnosis
Many temporomandibular joint disorders (TMD) go undiagnosed for years. Other patients receive a diagnosis based on incomplete information, providing limited relief from the symptoms but failing to correct the underlying disorder.
The most common diagnostic tools for TMD include dental x-rays and MRI scans. These provide insight into the jaw’s location at rest and can indicate imbalances in the surrounding tissues. They are generally only effective for advanced stage TMJ disorders, however.
What many diagnostic routines fail to account for is the variety of other factors that can cause TMJ disorders. This includes chronic teeth clenching, damage to TMJ cartilage, allergies and breathing problems, a misaligned jaw, and habits such as nail biting.
The tongue also plays a role in the proper functioning of the temporomandibular joint. Where the tongue sits at rest affects how the jaw closes, and its position while chewing and swallowing directly influences the shape of the oral cavity. If the tongue’s movement or resting position are incorrect, the TMJ will shift as a result. Over time this can create imbalances in the joint’s delicate structure, building to many of the symptoms listed above.
Issues that develop as a result of tongue placement or soft tissue imbalances are often overlooked during the TMJ diagnostic process. This is one of the reasons why a consultation with a Certified Orofacial Myologist (COMTM) is crucial for properly assessing the cause of TMDs as well as outlining a safe and effective wellness plan.
Temporal Mandibular joint disorders are not curable but treatable. Non-invasive therapy are treatments that reduce discomfort, reduce symptoms, while preventing damage and pain.
There is no one-size-fits-all treatment for TMJ disorders. Unfortunately, many sufferers look for a quick fix to ease their pain, leading to a hasty diagnosis and treatment plans that only focus on the symptoms, not the cause.
Surgery for TMD
Surgery is often the first recommendation made by doctors, but it is unfortunately a drastic and invasive one. While successful alleviation of TMJ symptoms can indeed result from surgery, there are a few factors to consider before agreeing to go under the knife.
First, relief from surgeries targeting specific symptoms are often quite temporary, as the underlying cause of TMJ may remain undiagnosed or untreated. Second, while many advances in surgical practice have and continue to be made, surgery is by nature invasive and traumatic, leading to prolonged recovery times and a reduced ability to cope with aforementioned reemergence of TMJ symptoms.
Uncovering the “Why”
When seeking treatment for chronic painful conditions like TMJ, it’s vital to build an understanding of the entire constellation of contributing factors underlying the problem. That characteristic “click” may occur where bone meets bone, but consider that muscles control the movement of the bone. A clicking jaw is not necessarily caused by worn cartilage. It could be related to airway difficulties, tongue positioning, and dozens of other factors. Determining why TMJ is occurring is far more critical than merely treating its symptoms as they arise.
TMJ and Myofunctional Therapy
A Certified Orofacial Myologist (COMTM) can assist patients to bring their muscles in harmony with the jaw. The tongue (colloquially known as the “CEO of the body”) has tremendous ability to reshape the craniofacial complex through its movement patterns and resting position.
To gain perspective over the tongue’s power, consider that with every swallow, the tongue exerts 6-8 lbs. of pressure on the teeth and jaw. What’s more, a healthy human swallows between 900 and 1200 times per day. That’s a lot of constant force to withstand! Some of the most visible manifestations of tongue imbalances include a crooked smile or the shifted jaw often associated with TMJ.
Regular application of Orofacial Myofunctional Therapy will retrain facial muscles to keep the jaw where it needs to be, rather than where aberrant tongue pressure has placed it. By working with a certified orofacial myologist along with an orthodontist, TMJ sufferers can fully realize the source of their discomfort and find a safe and effective path to balanced health. Myofunctional therapy provides additional insights into the jaw’s movement and factors contributing to TMJ, bringing a more complete and customized patient profile to the table.
Working with a COMTM can help ease TMJ pain and discomfort by eliminating the cause of the imbalance. In some cases, this can even prevent the need for surgery, braces, or other expensive treatment options. The core difference is that Orofacial Myofunctional Therapy seeks to discover the “why” behind TMD. Armed with this deeper understanding of the underlying issues, healthcare professionals can coordinate their expertise to affect more effective and less invasive treatments.
Working Towards Wellness
Myofunctional therapy along with orthodontic treatments can be an effective means to resolving TMJ disorders and related pain. It all comes down to a proper multi-modality diagnosis and ongoing treatment to allow the joint to function as intended.
If you think you could be suffering from a temporomandibular joint disorder, don’t wait until it’s too painful to bear. Call me today and we can discuss options for getting rid of that clicking sound once and for all!
Patricia Pine RDH, COM