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Temporomandibular Joint (TMJ) Dysfunction

Approximately 10 million Americans suffer from a variety of conditions that are seemingly unrelated. But upon further inspection, the headaches, earaches, soreness in the jaw muscles, and dull facial pain all share a common denominator: temporomandibular joint (TMJ) disorders. There really is no clear-cut definition for these conditions. In fact, medical literature features a wide-range of various terminologies, definitions, and treatment methods on it. Such confusion may be responsible for the condition not being treated as it should. There are numerous causes for these disorders, but they are believed to arise from the chewing muscles and jaw joints not functioning together properly.

The temporomandibular joint (TMJ) is a hinged joint that opens and closes the jaw. There are two such joints at either side of the head. The jaw is part of a wider system, the craniosacral system, which extends from the skull to the lowest segment of the spine. Disruption at any level of the craniosacral system can result in TMJ dysfunction.

According to the National Institute of Dental and Craniofacial Research (NIDCR) of the National Institutes of Health (NIH), more than 10 million Americans have TMJ problems. Though the condition doesn’t seem to prefer to strike a particular sex, it does gravitate towards women in their childbearing years.

Causes

The two most common causes of TMJ problems are poor bite and stress. Poor bite may be the result of new dental work that affects tooth alignment. Sometimes braces shift the palate, which affects the jaw.

TMJ dysfunction affects larger numbers of women than men due to stresses brought on by hormonal changes. Dr. Deborah Kleinman, a chiropractor who works with TMJ patients, explains: “There are various stress factors we can talk about that are specific to women. First, we have premenstrual tension. This further weakens an already weakened system. I know women who only have a problem with their jaw 3 days before their period. As soon as their period comes, their pain goes away. This tells me that there is a weakness in the system and that hormones push the body past the point of being able to compensate for it.

Hormonal changes also occur during pregnancy. “Hormones loosen the pelvis so that the woman is more flexible during delivery. And pregnancy creates structural changes through weight gain and the loosening of ligaments. These changes can further aggravate TMJ dysfunction.

“With nursing, postural changes can play a big role. Nursing places stress on the upper back muscles, especially if the woman doesn’t use the proper pillows or if she gets lazy and slumps over while feeding her baby. These upper back muscles insert into the occiput, which is part of this craniosacral system. The occiput is the bone at the bottom of the skull. Tightening or pulling on the occiput can affect the head, neck, and TMJ.”

The hormonal changes that occur during menopause also play a role in TMJ dysfunction.

Symptoms

Pain can be isolated in the joint itself or it can radiate to the face, neck, ear, and shoulder. Headaches may be a part of the picture. There may be a nagging toothache, even though the tooth is healthy. A person with TMJ problems may find it difficult to open the mouth all the way. Inflammation of the muscles around the joint may cause a spasm in those muscles, locking them open. Clicking, grinding, or popping noises may accompany chewing or movement of the joint.

Craniosacral Therapy

Cranio means “skull” and sacral refers to the “sacrum,” which consists of the lowest five vertebrae of the spine. Craniosacral therapy is founded on an understanding of the relationship between these structures and several points in between, including the TMJ. Dr. Kleinman, who uses a specific form of craniosacral therapy called the sacro-occipital technique, explains: “A chiropractor like myself who uses this technique understands that there is a balance between the nervous system and the musculoskeletal system, and a relationship between the pelvis and the sacrum and then the head and the cranium. Between both structures rests the spine, the shoulders, the neck. All of these structures react to shifts in the pelvis and the cranium. The TMJ is part of that.” She adds that a stable pelvis balances the body and works in harmony with the cranium. This allows information to flow to the brain smoothly.

Dr. Kleinman says that with TMJ the first step is to have a doctor perform a series of tests to determine whether structural stresses exist, and, if so, where. Once the structural stresses are identified, treatment can begin. Dr. Kleinman explains: “We place wedges or blocks under the pelvis. The muscles will relax and contract around these levers in an unforced way, based upon what these levers tell the brain. Then we incorporate breathing techniques to assist the brain in making musculoskeletal changes. This reestablishes the proper craniosacral flow.” Sometimes secondary manipulations are necessary to readjust parts of the spine that lie between the pelvis and cranium that get knotted up as a result of compensating for the pelvis and the cranium. Cranial adjustments, made specifically to the temporomandibular joint, also help to reestablish proper balance.

Other Physical Therapies

Isotonic exercise, done regularly, can help some cases of TMJ dysfunction. In addition to jaw exercise, self-treatment for TMJ problems may include jaw awareness, in which the patient tries to notice and avoid clenching and grinding the teeth, as well as biting on gum, ice, or fingernails. Eating soft foods and avoiding resting or sleeping on the stomach can also help, as can learning to rest the jaw and to adopt proper jaw posture. Other potentially helpful techniques include self-massage; relaxed rhythmic opening and closing of the jaw; alternating moist heat (15 minutes) with ice (2 to 3 minutes) to increase circulation; cool sprays and cryotherapy; bite guards; and splints. Surgery should be a last resort when dealing with TMJ problems.

Another physical therapy that can help relieve TMJ problems is Body Rolling, a technique developed by bodyworker Yamuna Zake, author of Body Rolling: An Experiential Approach to Complete Muscle Release. “Many of the muscles that run up the back and insert in the skull, as well as the muscles in the front of the neck, have attachments between the head and the chest. Thus the amount of tension in the muscles of the back, front, and sides of the neck can affect the level of contraction of the sutures (joints) and muscles of the cranium, and specifically the TMJ,” she explains. In Body Rolling, a 6-inch-diameter ball is used to apply traction that lengthens and releases muscles. “The degree of tension in the TMJ is controlled by the tension maintained in the neck. By working the neck muscles with the ball to keep them at maximum length and minimum tension level, you can help reduce the buildup of tension in the TMJ.” Zake has designed specific routines that use the ball to release the front and back of the neck, as well as an around-the-neck routine that helps break the holding pattern of tension that distorts head and neck alignment.

Nutrition

Nutritional supplements may help in treating TMJ problems. Some of the most useful are listed here.

 

GLUCOSAMINE. Whether used alone or in conjunction with chondroitin, glucosamine has shown significant results in treating osteoarthritis. Since osteoarthritis of the TMJ can be a reason for TMJ syndrome, scientists have examined the role this supplement plays in treating the condition. Their hopes were bolstered by the results from a double-blind study comparing glucosamine to ibuprofen in treating 45 patients suffering from TMJ arthritis. Over the span of 12 weeks, glucosamine more than matched the success of the drug.

 

CALCIUM AND MAGNESIUM. These minerals are essential for proper muscular function and have a sedative effect.

 

B-COMPLEX VITAMINS. Take 100 milligrams of B-complex vitamins three times a day. B-complex vitamins are essential for combatting stress.

 

PANTOTHENIC ACID. The appropriate amount of pantothenic acid to take is 100 milligrams, twice daily. B-complex vitamins, like pantothenic acid, are for combatting stress.

 

COENZYME Q10. Coenzyme Q10 is another stress fighter.

 

OTHER SUPPLEMENTS. L-tyrosine and vitamins B₆ and C will improve sleep quality and alleviate anxiety and depression. It is also important to take a multivitamin and mineral complex.

 

Remember, sufferers of TMJ should follow a strict anti-inflammatory diet, which will reduce inflammation throughout the entire body. Such a diet emphasizes avoiding processed foods, eating organic whenever possible, and maintaining a diet that contains heavy amounts of fruits and vegetables. Animal products (meat and dairy) should be avoided because they cause inflammation. And by all means, load up on the omega-3 fatty acids found in fish and flaxseed oil.