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TMJ: Temporal - Mandibular - Joint

Let's See What it is and How Chiropractic Can Help:

Definition: TMJ (termporal-mandibular-joint) is so named due to its anatomical situation: The temporal part refers to the Temporal bone in the skull. This is a bone on the side of the skull. Mandibular refers to the mandible, which is the lower jaw. Joint simply means that this TMJ is a joint. In this case, a simple hinge joint. See the pictures below:

    This graphic gives us a close-in snap shot of the actual TM joint: the mandible (lower jaw) has a "condyle" that fits into the joint located in the Temporal bone of the skull. Note also; there is a disc in this joint cushioning the TM joint. Now, add in some muscles:

 Note in this graphic the sizeable temporal muscle as well as the ligaments surrounding the actual "joint" aspect of the structure.

Definition Continued: TMJ may be classified as either intracapsuler or extracapsuler. Intracapsuler disorders include issues such as Rheumatoid Arthitis (RA), Osteoarthritis (DJD-degenerative joint disease) and articular disc displacements. The Extracapsular disorders are far more common and are collectively known as the "Myofascial Pain" of the masticatory (eating) muscles. More common names include TMJ Myofascial Pain Syndrome, TMJ Dysfunction Syndrome, or simply TMJ Syndrome.

TMJ Symptoms: Are characterized by chronic or acute musculoskeletal pain with dysfunction of the masticatory muscles; the muscles that move our jaw to eat food. It, the TMJ, is aggravated by movements of the jaw but should not be confused with dental disease. The myofascial pain comes from persistent, unconscious in some cases, repetitive use of the involved muscles.

TMJ Etiology: TMJ may arise due to stress, jaw malocclusion, jaw clenching, bruxism, other musculoskeletal issues such as DJD of the TM joints themselves, after-effects of a car crash or fall, cervical traction, dental errors. In fact, a surprising number of TMJ episodes arise from Dental mistakes such as too much filling, in a fillng such that the tooth is totally offset from resting properly when the jaw is closed. Most patients with TMJ have nocturnal bruxism (psychogenic grinding of the teeth) or unconscious jaw clenching. One study directly measured nocturnal tooth contact in patient with TMJ and control subjects. (Trenouth MJ, "The Relationship between Bruxism and TMJ Dysfunction as shown by Computer Analysis of Nocturnal Tooth Contact Patterns," J Oral Rehab, 6:81, 1979.) Evidence of tooth grinding was found in 78% of the patients. Tooth contact occurred an average of 360 times per night in 10 control subjects, compared to 1325 times in nine patients with TMJ and known bruxism and 999 times in six patients with TMJ without confirmed Bruxism. Occasionally, a patient may be allergic to a certain kind of tooth filling that will start a TMJ Syndrome.

Self-rated oral habits including teeth clenching, lip biting, and mouth biting occurs commonly in those people with TMJ and almost never in those patients without facial pain. (Moss RA, Lombardo TW,, "Oral habits and TMJ Dysfunction in Facial Pain and non-pain Subjects," J Oral Rehab 22:79, 1995.)

Jaw malocclusion may be a cause for, or may result from chronic muscle tension compressing the joint. This then can often actually be caused by dentists. (Velly AM, Gornitsky M, Phillippe P, "Contributing Factors to Chronic Myofascial Pain: A Case Controlled Study," Pain, 104:491, 2003.)

TMJ occurs more commonly in patieant with articular disc displacement. One study found MRI evidence of TMJ displacement in 84% of patients with symptomatic TMJ versus 33% of asymptomatic subjects. (Tallents RH, Katzberg RW, Murphy W, et. al., "MRI Findings in Asymptomatic Volunteers and Symptomatic Patients with TMJ Disorders," J Prosthet Dent 75:529, 1996.

Other musculoskeletal problems may predispose to the developement of TMJ such as joint laxity, body asymmetry, increased cervical and lumbar lordosis, scoliosis, poor postural positioning of the head and shoulders, tongue problems. (Friction JR, "Clincial Care for Myofascial Pain," Dent Clin N Americ 35:1, 1991.)  One study found significantly higher joint mobility scores in 26 patients WITH TMJ compared to 28 matched controls. (Khan FA, Pedlar J, "Generalized Joint Hypermobility as a Factor in Clicking of the TMJ," Int. J Oral Maxillofac Surg, 25:101, 1996.)

CLINICAL:  Most patients are young woman in the second to fourth decade of life and is second only to headaches as a cause of facial pain. Presenting symptoms besides TMJ pain is clicking in the joint, pain in the ear, jaw and posterior cervical spine region. It is usually made worse by chewing. It is often made worse by stress. In my experience, car accidents often have associated TMJ pain. Noted also is headache pain, jaw tension, clicking in the TMJ itself, uneven bite and pain when chewing.

CHIROPRACTIC HELP: Chiropractic care is growing as a non-invasive approach to TMJ Syndrome treatment. Chiropractic manipulation can occasionally relieve some cases of TMJ. What chiropractic can do is manually "adjust" or manipulate the TMJ joint itself. At Boston Spine Clinics, we occasionally perform this service. This often brings eventual relief, provided that the jaw itself is NOT mal-occluded in the first place. Barring dental or anatomical irregularities, manipulation to the TMJ as well as trigger point therapy on the muscles of mastication can relieve some TMJ pain. Noted further is the interesting phenomena of cervical spine adjusting: as we learned, spinal problems can lead to TMJ pain. Conversely, correction of the spine through chiropractic manipulation can often lead to a frank reduction in TMJ pain without ever touching the TMJ itself; again barring mal-occlusions or an anatomical variant.

Consider this new and highly interesting article: Fischer MJ, Riedlinger K,, "Influence of the TMJ on Range of Motion of the Hip Joint in Patients with Complex Regional Pain Syndrome," JMPT, Vol. 32 (5), June 2009. Upshot: TMJ dysfunction apparently plays a sizeable role in the restriction of hip motion experienced by patients with Complex Regional Pain Syndrome (CRPS).

The literature of chiropractors reducing TMJ syndrome issues is growing.


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