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
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 swallowing.
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.
Dr. Conboy can help you establish whether your pain is
due to TMD and can provide conservative treatment if
What Causes TMD?
Researchers agree that TMD falls into three
- 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 the visit.
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 their TMD.
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 not causes.
Women experience TMD four times as often as men. Several
factors may contribute to this higher ratio, posture and
TMD Diagnosis and Treatment
To help diagnose or rule out TMD, Dr. Conboy 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 Dr. Conboy 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. Dr.
Conboy 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, Dr. Conboy may recommend chiropractic
manipulation, massage, applying heat/ice and special
exercises. In most cases, Dr. Conboy's first goal is to
relieve symptoms, particularly pain. If Dr. Conboy feels
that you need special appliances or splints (with the
exception of the “waterpack” and other guards against
teeth grinding), he will refer you to a dentist or
orthodontist for co-management.
In addition to treatment, Dr. Conboy can teach you how
- 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, Dr. Conboy 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
Source: The American Chiropractic