Your Health : Chiropractic
Temporomandibular Joint Disorder
Does it hurt when you chew, open
wide to yawn or use your jaws? Do you have pain or soreness in front
of the ear, in the jaw muscle, cheek, the teeth or the temples? Do
you have pain or soreness in your teeth? Do your jaws make noises loud
enough to bother you or others? Do you find it difficult to open your
mouth wide? Does your jaw ever get stuck/locked as you open it?
If you answered “yes” to some of these questions, you
may have a temporomandibular joint disorder, or TMD. TMD is a group
of conditions, often painful, that affect the jaw joint.
Signs may include:
- Radiating pain in the face, neck, or shoulders;
- Limited movement or locking of the jaw;
- Painful clicking or grating when opening or closing the mouth;
- A significant change in the way the upper and lower teeth fit together;
- Headaches, earaches, dizziness, hearing problems and difficulty
For most people, pain or discomfort in the jaw muscles or joints is
temporary, often occurs in cycles, and resolves once you stop moving
the area. Some people with TMD pain, however, can develop chronic symptoms.
Your doctor of chiropractic can help you establish whether your pain
is due to TMD and can provide conservative treatment if needed.
What Causes TMD?
Researchers agree that TMD falls into three categories:
- Myofascial pain—discomfort or pain in the muscles of the
jaw, neck, and shoulders;
- A dislocated jaw or displaced disc;
- Degenerative joint disease—rheumatoid arthritis or osteoarthritis
in the jaw joint.
Severe injury to the jaw is a leading cause of TMD. For example, anything
from a hit in the jaw during a sporting activity to overuse syndromes,
such as chewing gum excessively or chewing on one side of the mouth
too frequently, may cause TMD.
Both physical and emotional stress can lead to TMD, as well. The once-common
practice of sitting in a dentist's chair for several hours with the
mouth wide open may have contributed to TMD in the past. Now, most
dentists are aware that this is harmful to the jaw. In addition to
taking breaks while they do dental work, today’s dentists also
screen patients for any weaknesses in the jaw structure that would
make physical injury likely if they keep their mouths open very long.
In that case, they may use medications during the procedure to minimize
the injury potential, or they may send the patient to physical therapy
immediately after treatment. In less severe cases, they instruct
patients in exercises they can do at home to loosen up the joint after
While emotional stress itself is not usually a cause of TMD, the way
stress shows up in the body can be. When people are under psychological
stress, they may clench their teeth, which can be a major factor in
Some conditions once accepted as causes of TMD have been dismissed—moderate
gum chewing, non-painful jaw clicking, orthodontic treatment (when
it does not involve the prolonged opening of the mouth, as mentioned
above), and upper and lower jaws that have never fit together well.
Popular theory now holds that while these may be triggers, they are
Women experience TMD four times as often as men. Several factors may
contribute to this higher ratio, posture and higher heels.
TMD Diagnosis and Treatment
To help diagnose or rule out TMD, your doctor of chiropractic (DC)
may ask you to put three fingers in your mouth and bite down on them.
You may also be asked to open and close your mouth and chew repeatedly
while the doctor monitors the dimensions of the jaw joint and the
balance of the muscles. If you have no problems while doing these
things, then the problem is not likely to be TMD. Your DC can then
look for signs of inflammation and abnormalities. Sometimes special
imaging, an x-ray or an MRI may be needed to help confirm the diagnosis.
If you have TMD, your doctor may recommend chiropractic manipulation,
massage, applying heat/ice and special exercises. In most cases, your
doctor’s first goal is to relieve symptoms, particularly pain.
If your doctor of chiropractic feels that you need special appliances
or splints (with the exception of the “waterpack” and other
guards against teeth grinding), he or she will refer you to a dentist
or orthodontist for co-management.
In addition to treatment, your doctor of chiropractic can teach you
- Apply heat and ice to lessen the pain. Ice is
recommended shortly after the injury or after your pain has started.
In the later stages of healing, you need to switch to heat, especially
if you are still experiencing discomfort.
- Avoid harmful joint movements. For example, chomping
into a hard apple is just as bad as crunching into hard candy (some
hard candies are even called “jawbreakers”—for
good reason). And giant sandwiches can cause the mouth to open too
wide and have a destabilizing effect on the jaw.
- Perform TMD-specific exercises. Depending on your
condition, your DC may recommend stretching or strengthening exercises.
Stretching helps to loosen tight muscles and strengthening helps
to tighten muscles that have become loose. Special feedback sensors
in the jaw can be retrained, as well, if needed.