Jaw Pain/Temporomandibular Syndrome

Jaw pain or temporomandibular joint (TMJ) syndrome is a relatively common condition that relates to pain and dysfunction of the temporomandibular joint. In the USA approximately 25% of people will experience symptoms at some point in their lives (1). TMJ syndrome affects females 4 times more than males and is most commonly seen between the ages of 20-40 (1). We have had a number of patients present to George Street Chiropractic with jaw pain or have their TMJ treated as part of the overall treatment plan for other conditions such as neck pain and headaches.

The cause of TMJ syndrome is not completely understood, however it is believed that the cause is multifactorial. The factors contributing to TMJ syndrome include (1,2,3) :

Injury or trauma to the joint
Hypermobile TMJs
Nocturnal jaw clenching/bruxism
Jaw clenching due to psychosocial stress
Overuse due to excessive or vigorous chewing
Orthodontics
Improper alignment of jaw and teeth
Certain conditions may also contribute such as osteoarthritis, rheumatoid arthritis, hereditary conditions and diseases of the articular disc
Smoking may contribute to the development of TMJ issues. A study that looked at 299 females aged 18-60 suggests that compared with non-smokers, female smokers younger than 30 years had a higher risk of developing TMJ syndrome than older adults (2).

There have been three identifiable causes of pain at the TMJ; myofascial pain dysfunction (MPD) syndrome, internal derangement and degenerative joint disease (3). MPD syndrome relates to pain at the TMJ due to increased jaw muscle tension and spasm. This is usually a secondary manifestation as a result of psychosocial stress, jaw clenching and teeth grinding. Internal derangement relates to the primary problem being within the joint itself and commonly the position of the articular disc. Degenerative joint disease (osteoarthritis) is the wear and tear of the joint surfaces and surrounding structures, which alters joint function and mobility.

TMJ syndrome may consist of the following symptoms (1,3):

Dull achy pain in the muscles of the jaw – usually presents one sided
Pain may radiate to the ear and jaw
Pain is typically worse upon chewing
Jaw locking when attempting to open the mouth
Ear clicking and popping – this is usually related to displacement of the articular disc (cartilage)
Headache
Neck, shoulder and upper back pain
Uncomfortable or awkward bite
Bruxism (gnashing, clenching or grinding of teeth)
Decreased range of motion (jaw opening)
Potential swelling surrounding the joint
Tenderness surrounding the joint when touched

There are a number of treatment options available to individuals suffering from jaw pain/TMJ syndrome. Manipulative and multimodal therapy has been shown to produce positive results in the treatment of this condition (4,5) . It is thought that the greatest results in treatment come from a holistic approach that includes a number of interventions. Our treatment at George Street Chiropractic aims to reduce pain as well as normalise and restore proper joint biomechanics to enhance function. Our treatment includes:

Gentle muscle release techniques to reduce TMJ muscle tension and spasm
Gentle joint mobilisation and manipulation to normalise TMJ joint biomechanics and enhance mobility
Postural advice and retraining
TMJ exercise program prescription to address muscle imbalance and dysfunction
Dry needling

Other treatments for TMJ syndrome may include NSAIDs (non-steroidal anti-inflammatory drugs), benzodiazepines (muscle relaxants), moist heat, occlusal appliances and behavioural therapy (1,4,5). Jaw pain/TMJ syndrome is something that we’ve had great success in treating in the past using this form of treatment. To find out more about how we can help to reduce your jaw pain please contact us or make an appointment with one of our chiropractors.

References:

Tsai V, Emedicine. Temporomandibular Joint Syndrome (internet). New York NY: 2012. Available from; http://emedicine.medscape.com/article/809598-overview#a4
Sanders AE, Maixner W, Nackley AG, Diatchenko L, By K, Miller VE, et al. Excess risk of temporomandibular disorder associated with cigarette smoking in young adults. J Pain. 2012 Jan. 13(1):21-31.
Uyanik JM, Murphy E. Evaluation and management of TMDs, Part 1. History, epidemiology, classification, anatomy, and patient evaluation. Dent Today. 2003 Oct. 22(10):140-5
Brantingham, James W. et al. Manipulative and Multimodal Therapy for Upper Extremity and Temporomandibular Disorders: A Systematic Review. Journal of Manipulative & Physiological Therapeutics. 2013 Apr. 36(3):143 – 201.
List T, Axelsson S. Management of TMD: Evidence from Systematic Reviews and Meta-analyses. J Oral Rehabil. 2010 May. 37(6):430-451.