What is TMJ and where is it located?

The temporomandibular joint (TMJ) is located on either side of your head, just in front of your ears. These joints connect your mandible (jawbone) to your temporal bone (skull). It is estimated that between 50% to 70% of the population will at some point in their life exhibit some sign of a TMD. This may be subclinical, and patient may not relate them to jaw problems. The TMJ is a synovial diarthodial joint, which means that the joint is lubricated by synovial fluid and the joint space is divided into two separate compartments by means of an intra articular disc. The movements that take place in the compartments are predominately a sliding movement in the upper joint space and the rotational movements in the lower joint space. Pain in the jaw can be the very uncomfortable when you bite, chew, or talk. The pain occurs due to the inflammation in the joint which is called Temperomandibular joint (TMJ). Patients with jaw pain usually present with pain on one or both sides of the joint. This can sometimes be mistaken as middle ear infection, due to its proximity with the ear. Sometimes you also feel clicking or locking sensation along with the pain. This is due the jerky movement of the disc called as articular disc in the joint, where the jawbone moves during opening and closing the jaw. It is also called as TMJ dysfunction.

What are the common Causes of TMJ Pain?

Did you know, the most common cause of jaw pain is grinding your teeth(bruxism) during sleep, which goes unnoticed in most of the patients and head or neck muscle tension may make TMD symptoms worse. Factors consistently associated with TMD include other pain conditions (e.g., chronic headaches), fibromyalgia, autoimmune disorders, sleep apnea, and psychiatric illness.

• Smoking is associated with an increased risk of TMD in females younger than 30 years. (Sanders AE, Maixner W, Nackley AG, et al. Excess risk of temporomandibular disorder associated with cigarette smoking in young adults. J Pain. 2012;13(1):21–31.)

• Other causes of would be chewing only on one side, arthritis, clenching teeth, and bad posture.

• Bad posture like forward head posture has also shown to contribute to the pain due to tightening of the muscles around back of neck and laxity of muscles of the front of the neck.

• Stress is also a possible factor.

• Partial or full dentures that are not the right fit and certain habits such as fingernail biting, and pen or pencil biting can also cause TMD issues.

• Temporomandibular joint hypermobility like Dislocation, Joint laxity, Subluxation

• Trauma like contusion, Fracture, Intracapsular Hemorrhage

How is it investigated or diagnosed?

Physical examination findings that support the diagnosis of TMD in Physiotherapy assessment may include—but are not limited to—abnormal mandibular movement, decreased range of motion, tenderness of masticatory muscles, pain with dynamic loading, signs of bruxism, and neck or shoulder muscle tenderness.  

The Physiotherapist usually assess based on a single click during opening of the mouth may be associated with an anterior disk displacement. A second click during closure of the mouth results in recapture of the displaced disk; this condition is referred to as disk displacement with reduction. When disk displacement progresses and the patient is unable to fully open the mouth (i.e., the disk is blocking translation of the condyle), this condition is referred to as closed lock.

Crepitus is related to articular surface disruption, which often occurs in patients with osteoarthritis. Tenderness of the masseter, temporalis, and surrounding neck muscles may distinguish myalgia, myofascial trigger points, or referred pain syndrome. Deviation of the mandible toward the affected side during mouth opening may indicate anterior articular disk displacement.

Ultrasonography and MRI can be done to diagnose internal derangement of the TMJ. 

 What are the Symptoms/Signs of TMJ pain or dysfunction?

1. Locking of the joint

2. Clicking /snapping sensation in the joint

3. Pain on one or both sides of the Jaw

4. Inability to chew on painful side.

5. Rarely patients also present with deviation of jaw to one side.

6. Problems when you try to open your mouth wide.

7. A tired feeling in your face

8. Swelling on the side of your face

9. Pain or tenderness in your face, jaw joint area, neck, and shoulders

10. You may also have toothaches, headaches, neck aches, dizziness, earaches, hearing problems, upper shoulder pain, and ringing in the ears.

How can I treat TMD at home?

Use moist heat. 

Eat soft foods!

Avoid extreme jaw movements.

Practice good posture to reduce neck and facial pain.

Implement relaxation techniques to help loosen up your jaw.

How can Physiotherapy treatment help in Jaw pain at Curezone physiotherapy Mississauga?

Our physiotherapist at Curezone physiotherapy try to make sure you experience better results and full satisfaction. The aim of rehabilitation in our Physiotherapy clinic Mississauga is to plan patient oriented exercise program that is progressed gradually by our physiotherapists. Our licensed physiotherapist customizes an exercise and prevention program based on your individual needs.

Manual therapy

The manual techniques included intra-oral myofascial release and external massage therapy on masticatory muscles, atlanto-occipital joint thrust manipulation, and upper cervical spine mobilization. Techniques may be active or passive mobilization with the goal of improving muscle strength, coordination, relaxation, and range of motion. Other options such as ultrasound, electrotherapy, or low-level laser therapy have been used in the management of TMD.

Active Exercises

Postural correction, relaxation and breathing exercises.

Stretching and strengthening exercises of the jaw, head and neck

Acupuncture is used increasingly in the treatment of myofascial TMD. Following your assessment, your Physiotherapist will put you on a specific, individualized exercise program.

Give us a call at Curezone Physiotherapy, Mississauga to schedule a consultation today!  Make sure you book your appointment today and get assessed by our physiotherapist now.