Temporomandibular joint disorder
The temporomandibular joint (TMJ) seems to be an area that is often overlooked. Most of us deal with the odd clicking in our jaw, which by itself is not an issue, until it is!
The most common cause of acute (sudden) pain in the jaw is often due to trauma to the jaw. However, another acute mechanism may be from a car accident due to whiplash. How can this be? This is particularly true if you have been hit from behind or rear-ended. No one ever thinks about it, but often times, the mouth is open during a whiplash mechanism which can put some sensitive structures on stretch (ligaments and muscles) in the jaw.
Friedman et al. 2000 examined 300 patients all involved in a motor vehicle accident and that the most clinical findings were jaw pain, neck pain, headache, jaw fatigue and jaw crepitus and clicking. In this study, the most common dysfunctions were the masseter muscle trigger point, closing jaw muscles (temporalis, infrahyoids, pterygoids etc) hyperactivity and disc derangement.
Chronic causes of TMJ pain may be related to your occupation, sport or activity. Clenching, previous dental work, even seasonal allergies can create unequal pressure on the TMJ. Have poor eyesight or difficulty hearing in one ear? This too can create uneven pressures in the jaw by creating a head tilt or chin protrusion which puts more strain on the TMJ.
According to statistics, muscle dysfunction accounts for 85% of all pain syndromes which includes craniofacial pain, headaches, atypical face pain and cervical pain. Patients presenting with head, neck and jaw pain are sometimes challenging to assess and treat as there can be multiple areas to examine. There have been many scientific and clinical publications pointing to myofascial trigger points as the central cause or significant contributor to painful syndromes seen in neck, face and head pain (Fricton, 1999, Mackley, 1999, Alverez et al., 2002).
What are some common symptoms of TMJ dysfunction?
- clicking, popping, grating with opening or closing
- Limited jaw movement
- Pain or tenderness in the face, jaw, neck
- Pain with chewing or speaking on one side of the mouth
So what should you do about it? The solution is a comprehensive approach to rehabilitation. This may require a dental referral, medications, soft tissue rehabilitation (Kalmir et al. 2012) and self care exercises. If the injury has been a long term injury, a full body approach examining posture and biomechanics would also be beneficial.
Some articles to examine if you are interested in further reading! If you have TMJ issues, best to get it checked out sooner than later to avoid long term pain and injury.
Fricton JR. Masticatory myofascial pain: an explanatory model integrating clinical, epidemiological and basic science research. Bull Group Int Rech Sci Stomatol Odontol., 1999. Jan-Feb; 41 (1): 14-25.
Alverez DJ, Rockwell PG. Trigger Points: diagnosis and management. Am Fam Physician, 2002. Feb 15; 65(4):653-660.
Mackley RJ. Role of trigger points in the management of head, neck and face pain. Funct Orthod., 1990. Sept-Oct; 7(5):4-14.
Intraoral manipulation and jaw exercises shown to benefit temporomandibular joint disorder http://jaoa.org/article.aspx?articleid=2094255
Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized control trial. http://www.sciencedirect.com/science/article/pii/S0161475411002223