Jill Murphy, DPT, LAT, CSCS
Frequent clicking in your jaw, clunking when biting down into a piece of hard candy, or cracking when you open your mouth wide when yawning or for a dental cleaning are some of the more common symptoms of TMJ (tempermandibular joint) dysfunction. Other signs and symptoms of TMJ dysfunction are pain and soreness in the TMJ joint located in front of the ear, or pain along the jaw line, locking with the mouth open or closed, and associated pain in the upper neck with or without tension headaches. Problems like these give you reason to avoid your favorite foods, give up chewing gum, and make you dread a trip to the dentist just due to the discomfort you feel when opening your mouth.
According to the National Institute of Dental and Craniofacial Research, a conservative estimate is that ten million Americans suffer from TMJ dysfunction with more women than men reporting TMJ symptoms. The causes of TMJ are unknown, but are believed to develop over time, in bouts of pain that come and go. One important symptom of TMJ dysfunction is bite misalignment of the maxilla (roof of mouth) over the mandible (jaw bone). An uneven bite increases wear on one side of the teeth, which stresses the TMJ further and can create a hypomobile (not moving) side and a hypermobile joint on the other side that moves too much. Excess sliding and shifting within the joint create stress on joint surfaces not intended to withstand routine loading from chewing, biting down on something hard, and extended bouts of repetitive oral movements such as biting a pen cap or biting the nails. This process results in early joint degeneration.
There are three possible syndromes that are blamed for TMJ pain, including myofascial pain from muscle imbalance or tightness around one or both joints, a disc problem within the joint, and arthritis or degenerative changes within the joint. A dental care provider, primary physician, or physical therapist can help assess TMJ dysfunction and develop a treatment plan to address your symptoms. Providers will work together as a team to determine the best treatment approach to reduce your pain and symptoms. A dental provider can make an oral device, bite guard, or splint to address bite deviations and nocturnal habits such as clenching and grinding the teeth. A physical therapist will assess joint movement and deviations in bite and mouth opening, and determine which muscles are affected in the head, neck and TMJ. Using joint mobilization, soft tissue work, and exercises, patients can regain mouth opening, reduce and eliminate their pain, and learn to avoid stressful oral habits.
If you don’t have a dentist or doctor’s appointment coming up, you can start addressing your TMJ pain by making some simple changes. First, find and maintain your resting mouth position, which relaxes the jaw and keeps the teeth apart throughout the day. Resting mouth position is a relaxed jaw, teeth apart, lips together, and tongue gently placed behind the front two teeth resting flat in the front one third of the roof of your mouth.
Later on, you can progress this exercise by practicing opening your mouth just 1-2 cm while maintaining your tongue on the roof of your mouth. Next, make a habit of avoiding the following poor oral habits that can aggravate your TMJ pain:
- Chewy and crunchy foods: choose cooked versus raw veggies, and cut whole fruit into pieces instead of eating them whole.
- Full mouth opening: control your mouth opening with yawning, talking, and singing; if at the dentist, let them know that you have symptoms, so they can give you as many breaks as possible with your mouth closed.
- Repetitive oral habits: biting nails, chewing pen caps, chewing on ice, chewing on hard candy, chewing gum, and smoking.
TMJ dysfunction is a very common disorder for which many people do not seek help, but rather live with the pain silently. While the originating source of TMJ problems can be difficult to identify, there are many conservative treatments that can make a huge difference in the intensity and frequency of pain flares, that don’t require extensive jaw reconstruction surgery. Don’t live with this pain any longer. Talk to your dentist, primary physician, or one of our physical therapists at MotionWorks who specialize in the treatment of TMJ dysfunction today to begin your journey to finding pain relief.