The Temporomandibular Joint (TMJ) is the joint that connects the maxilla (upper jaw bone) to the mandible (lower jaw bone). The joint is a sliding ball and socket joint with a disk between. The primary muscles in the area are the massetter and the temporalis which allow the jaw to open, close and to move laterally. This joint is used throughout the day, especially in biting, chewing, talking, and yawning. It is one of the most frequently used joints in the body.
COMMON CAUSES
TMJ syndrome, otherwise known as myofacial pain dysfunction and costen's syndrome, can be a complex condition which can involve inflammation of the muscles, tendons, and ligaments, or structural damage to the bones, disk or joint. Because the muscles and joints work together, a problem with either one can lead to stiffness, headaches, ear pain, bite problems (malocclusion), clicking sounds, or locked jaws. The primary cause of TMJ can be overuse caused by chewing gum, the grinding or clenching of teeth, or stress. Injury to the area or misaligned teeth or jaw can also be the cause of the problem. TMJ is a large a chronic disorder, caused over time, but it can occasionally present as acute, in particular when caused by an accident.
SIGNS AND SYMPTIONS
Common signs and symptoms include headaches, ear pain, dizziness, a full feeling in the ear, sounds similar to grinding, crunching, popping or ringing sounds which may or may not be accompanied by pain
ASSESSMENT / TESTS
A test to help determine if a client is presenting with TMJ is to place one or two fingers against the triangle area of the ear. Move them slightly to the anterior and ask the client to open and close their jaw. If any pain presents, or if there is any accompanying popping, grinding or clicking of the joint, it would be advisable to refer them to a general practitioner or dentist to diagnose the problem. The client will need to be made aware of any clinging or grinding of teeth and stress that they experience. Clients should also be advised to avoid opening their jaw too broadly. Further referral to a psychologist to help with stress management may be helpful.
TREATMENT
Treating TMJ involves passive opening and closing of the jaw, massage of the muscles involved including trigger points, and heat / cold therapy. Ischemic pressure to the area will help to inflame the area and encourage healing. Anti-inflammatory or steroids may be prescribed by a GP, or dental work / surgery may be necessary for structural conditions. Occalal therapy, where a custom made acrylic appliance which fits over the teeth is prescribed for night use, may also be used. Left untreated, TMJ may lead to permanent wearing of the teeth, the disk or the bones. Damage to the bones could also lead to osteoarthritis in the joint, or an inability to open or close the jaw, otherwise known as lockjaw.
MASSAGE
Massage has been shown to be very beneficial in the treatment of TMJ. Techniques such as myofascial release, trigger point therapy , and relaxation massage have all shown positive results. The practitioner should focus his attention on the pectoralis minor, sternocleidomastoid, scallenens, temporalis, and mastoid muscles in particular.
ADDITION ADVICE / REFERRAL
Referral to a general practitioner, dentist, or psychologist would be advantageous. Patients should be advised to utilize heat / cold therapy where applicable and to ovoid clenching their jaws, grinding their teeth, jawing gum, eating hard foods or opening their mouths too wide.