I n this article I would like to address a problem that many of us experience during our lives.This problem can cause facial pain, pain in the jaw joint area and around the ear, and pain when we chew or try to bite an apple or a bagel. It also can cause headaches, toothaches, neck pain, dizziness and even ringing in the ears.These symptoms can come from a dysfunction of the temporomandibular joint (TMJ) — a hinge joint that connects the temporal bone of our skull (our temple) and the mandible (our lower jaw).The proper name of this condition is temporomandibular disorder, or TMD. I have seen many patients who complain of neck pain and headaches and are being treated for those symptoms without realizing that they are caused by TMD.
When we evaluate patients with neck pain, upper shoulder pain and headaches, we always check the jaw muscles and the TMJ. More often than not, there is a problem there.
Symptoms
Telltale signs of TMD are:
difficulty opening the mouth very wide clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain) or chewing
pain and tightness when chewing
sudden pain when trying to bite, especially hard food
headache which is usually located around the temples
tight feeling around the temples and the face
tightness in the back of the head where the neck meets the skull
Causes
There are many factors that can contribute to developing TMD.
Some causes are:
uneven bite
gum disease
arthritis of the TMJ
trauma to the head
tightness of the neck and chest muscles
grinding and clenching of the teeth (which itself can be cause by a variety of problems)
Often,TMD-like symptoms can arise from a toothache, sinus problems and problems with breathing, such as mouth breathing from a deviated septum in the nose.
Stress plays a major part in TMD because it causes us to clench our jaw.This creates a spasm in the muscles that help us to chew and open our mouth.These muscles then develop trigger points — tight bands in the muscle that cause pain and inhibit motion.
Not surprisingly, bad posture can contribute to TMD.When our shoulders are slumped we develop what is called a “forward head posture.” Chin is up and upper part of the neck is extended creating undue stress on the neck and jaw muscles.
Treatment
All of the above opens the door to various interventions to bring relief to people suffering from TMD. If you experience the symptoms described above, have your bite and sinuses checked by your dentist and your ear-nose-throat specialist. Check your walking and sleeping postures to avoid stress on your neck muscles.Avoid foods that require extensive biting and chewing, such as tough meat, bagels, apples, nuts, etc.
Physical therapy can help TMD sufferers in many ways. Gentle and very specific soft tissue treatments will relax jaw and neck muscles and get rid of the trigger points. In some cases, therapeutic ultrasound and electrical stimulation can help to relax the muscles and open the door to corrective exercises that include postural correction and strengthening and breathing exercises. There are also exercises that will help you to correct improper jaw movements that you developed trying to adapt to the wrong bite and to decreased mobility of your TMJ.
Your physical therapist, trained in dealing with TMD, will perform a thorough evaluation to determine all factors that contribute to your problem. He or she will design a treatment plan that will include pain relief, corrective exercises and teaching you self-interventions to further reduce the symptoms and improve your well being.
Some extreme and chronic cases of TMD may require surgery. If your problem is not taken care of timely and effectively you can suffer severe scarring and even bone chips in your TMJ. However, surgery for TMD should only be considered after all other treatment options have been unsuccessful. Because surgery is irreversible, it is wise to get a second or even third opinion from several oral surgeons and to exhaust all conservative treatments. Surgery involves general anesthesia and may produce many complications, such as infections.
The bottom line is, if you have neck pain, face pain, difficulty chewing, frequent headaches and other symptoms described above, your TMJ dysfunction might be contributing greatly to these issues. Help is available and possible. Don’t suffer needlessly; you can be helped.
Michael Sheynin, physical therapist, is co-owner of Free Motion Rehabilitation Center, 528 New Friendship Road, Howell. For more information, call 732-901-8844.