The Beginner’s Guide to the TMJ
Click, Pop, * Pain*
Persistent jaw pain, clicking sounds, or difficulty opening and closing your mouth, might mean that you are experiencing temporomandibular joint (TMJ) dysfunction. People often refer to it as TMJ. Technically, the term “TMJ” is just the name of the joint (temporomandibular joint), but it’s pretty easy to understand what people mean. In the scientific literature, it’s more commonly referred to TMD (temporomandibular dysfunction).
In general, joint dysfunctions are a complicated topic because it relies more heavily on history and physical exam, and not on diagnostic tests like X-rays, MRIs, and blood work. People often self-diagnose with TMJ dysfunction, and they are typically right.
What they often don’t know is why they have it and what to do about it.
Why Is It Important?
I like to start with a “So What” with every teaching point. There is a TON of information out there. It’s how my particular brain works—things stick better if I know why this information matters at the beginning.
The So What with the TMJ is one of the most complex joints in the body and so it is one of the most vulnerable joints in the human body to the brain-body interaction. The joint is located just in front of your ears and it both hinges and slides. It is able to open, close, and move side-to-side. This allows us to chew, bite, speak, and breath.
The Key Players
Without going into Gray’s Anatomy, the anatomy of the joint is that it involves a joint between the temporal bone (in the temple) and the mandible (the jaw bone). All joints have a cartilage disk to cushion it with synovial fluid to lubricate it and a joint capsule to keep it all together as a unit. The joint is controlled by the masseter, temporalis, and pterygoid muscles.
Working Together
The TMJ is fairly unique in that we have a left and right joints, but they need to move in close coordination. If the muscles on the right side are weaker or tighter than the left, or other problems of asymmetry, it can lead to movements that are poorly coordinated and… Click.
It isn’t always painful (That’s a whole other topic of why things hurt). But it’s almost always noticeable.
Most people notice it when they are eating an apple or a sandwich and find that they experience a popping sensation, sometimes followed by pain.
Why do I have it?
Lots of reasons are possible. Here are some of the most common.
Muscle tension or overuse:
Clenching or grinding your teeth (bruxism), often due to stress or sleep disorders, can strain the TMJ muscles.
Joint misalignment:
Structural problems, such as a displaced articular disc, can lead to pain and restricted movement. This is particularly common in people who are hypermobile.
Trauma:
Injuries to the jaw or face can damage the joint or surrounding tissues.
Arthritis:
Inflammatory conditions like osteoarthritis or rheumatoid arthritis can affect the TMJ. This often leads to restriction of one joint and the mouth doesn’t open fully.
Dental issues:
Missing teeth, misaligned bites, or poorly fitting dental work may put additional strain on the TMJ.
Habits and posture:
Poor posture, especially holding your head forward for extended periods, can contribute to TMJ dysfunction.
By far and away the most common causes are the ones easiest to diagnose and least commonly diagnosed by physicians. Bruxism (clenching teeth during sleep), poor posture, joint laxity and muscle imbalances. Dentists do a good job diagnosing it and doing their piece, but even they can struggle when it is from non-dental causes.
Rebalancing the TMJ and rebalancing Life
The treatment is essentially that—rebalance the dysfunction. That means identifying the addressing those common causes. But that’s the rub. If posture is a contributing cause, fixing the TMJ might mean changing your smartphone habits. Tight muscles are often weak muscles, so fixing muscle imbalances means strengthening and stretching the appropriate muscles without injuring the other side. Sometimes, treating it involves understanding why some people clench their jaws involuntarily during sleep. All of us go to sleep stressed these days. But why some people clench their jaw (instead of their toes, for instance) isn’t known. But for those people, sometimes treating their TMD means to develop new sleep routines, supplements, or Cognitive Behavioral Therapy to work through those ongoing stressful experiences.
Sometimes, anti-inflammatories, muscle relaxants, or rubs can be helpful while addressing the underlying issue.
Sometimes, the muscles need to be retrained or weakened while undergoing this process and injectable neuromodulators (like Botox or Xeomin) in the muscles can break the patterns.
TMD isn’t just TMD
One last nuanced topic for further blog posts. TMD isn’t just a jaw, muscle, and joint problem. It also involves the nervous system. It is highly prevalent in people with Chronic Migraine (ie very frequent and longstanding migraines) and the TMJ hurts more in people with migraines.
Understanding the relationship between TMJ dysfunction and migraines is key to effective management. By addressing the jaw’s role in triggering headaches, many individuals find significant relief from both conditions.
I hope you enjoyed this fantastic illustration of the complex brain-body health interaction.
Stay tuned for further blog posts diving further into this topic!
Check out more here:
https://americanmigrainefoundation.org/resource-library/temporomandibular-disorders
