TMJ / TMJD: Jaw Pain

The acronym T.M.J. stands for Temporo Mandibular Joint and the "D" stands for "Disorder," hence Temporo Mandibular Joint Disorder. This painful jaw disorder has many causes and contributory factors and it has prompted a multitude of very expensive and invasive surgeries, some of which largely unnecessary.

TMJD Has Many Different Symptoms

  • Difficulty biting or chewing.

  • Clicking, popping, or snapping sounds when opening or closing the mouth.

  • A dull, aching, pain in the face and temple region of the head on one or both sides.

  • Jaw pain with and/or without movement.

  • Pain in the joint itself.

  • Headache or migraine (particularly in the morning or late in the work day).

  • Neck and upper shoulder pain.

  • Hearing loss, ringing in the ear, or loss of equilibrium.

  • Reduced ability to open or close the mouth.

If you put your fingers in your ears and press forwards toward your eyes, you will feel the TMJ. Now very slowly, open your mouth and now close your mouth. You should be able to feel the Mandible or jaw bone articulating or moving away and downward from (opening the mouth) and moving toward and upward (closing the mouth) the area of the skull near the Temple (Temporal Bone). Thus, the Temporo Mandibular Joint.

Here are a few of the most common causes of TMJD:

  • Mensicus dislocation

  • Clenching or grinding the teeth (while asleep and/or the day, particularly during episodes of stress)

  • Trauma (auto injuries, spousal abuse, bar fights, boxing, etc)

  • Misalignment of the teeth (chronic grinding causing neurological pathways of habit, dental work, etc.)

  • Excessive gum chewing or nail biting

  • Vertebral subluxations (vertebral altered instantaneous axis of rotation, aka AIAR)

  • Myofascial pain syndrome and/or degenerative arthritis

There are four muscles that are chiefly responsible for chewing. These four are referred to as, “The Muscles of Mastication” and include the Masseter and Temporalis Muscles and the Internal and External Pterygoid Muscles The External Pterygoid is easily accessed but the Internal Pterygoid can only be accessed with the mouth open.

We will first focus on the Temporalis and Masseter muscles and note the broad and very strong muscles, tendinous sheaths and fascia. The picture on the left demonstrates a jaw cut away to expose the Internal Pterygoid Muscle.

For more than 23 years I have treated patients suffering from TMJD and the approach is multifocal. It is important to carefully evaluate the patient to make sure that any patient that suffers from TMJD is in the right place and the doctor is not going to do further harm to the patient's TMJ and the doctor is not just wasting their patient's time and money. For this reason a complete history and exam is necessary along with motion palpation of the joint watching for mandibular deviation, vertical opening and closing as well as forward (anterior) and backward (posterior) gliding, carbon bites for malocclusion, listening for clicks, pops or any locking. Assessing coping mechanisms to stress at home and in the workplace. Occasionally dental co-management is necessary. Treatment is varied and dependent on objective examination findings and should only be treated if the doctor is absolutely sure that he or she is accurate in their diagnosis and treatment approach. If you suffer from TMJD give us a call before contemplating invasive surgical or corticosteroid options. It is always the prudent thing to do, to first approach treatment of your condition by conservative means first and foremost. Give us a call.