TMJ Dysfunction

Mandible tense or sore? Tinnitus without apparent reason?

Do you frequently grind or clench your teeth?

These are just some of the many signs of a Temporomandibular Joint Dysfunction (TMJ Dysfunction), also known as TMD.

The temporomandibular joint is located at the front of the ear (bilaterally) and is largely responsible for the opening and closing of your jaw.

When this joint shifts or becomes immobile in any way, it can lead to a painful and debilitating problem.

Do you experience any of the following signs of TMJ dysfunction?

1. Headaches: These are usually linked to various causes or present as a recurring symptom, one of which is temporomandibular dysfunction. Headaches associated with TMD often radiate from the base of the skull and are referred to as tension headaches. In some cases, patients may also experience migraines for years before discovering that TMJ dysfunction was one of the primary contributors to the headaches.
2. Frequent headaches should not be ignored, and it is important to ensure that there are no underlying neurological problems causing these headaches.
3. Pain in the face and neck: Temporomandibular dysfunctions are sometimes responsible for pain that may be localized in the joint itself or radiate across the face or neck. Over time, this pain may become intense and disabling.
4. Bruxism (teeth grinding/clenching): Millions of people grind their teeth without realizing it. Many patients suffering from TMD report facial muscle tension caused by constant pressure between the upper and lower teeth. In addition to teeth clenching when awake, a more common issue is teeth grinding that occurs during sleep. The most common symptom of nighttime bruxism is waking up with a headache almost every morning, along with a feeling of muscle tension in the facial muscles.
5. Clicks or crepitation: It is not normal to hear joint sounds during mouth opening or closing. These sounds are often associated with degeneration of the temporomandibular joint and can be one of the signs of dysfunction in the joint.
6. Tinnitus: For those suffering from TMD, tinnitus may not have an identifiable cause, but when combined with other symptoms, it may be associated with this region. It will, however, be necessary to consult an Ear, Nose, and Throat (ENT) specialist to rule out other causes.
7. Limited mouth opening: In certain situations, during eating or yawning, the articular disc may slip and cause joint locking, leading to an inability to open or close the mouth fully.

Headaches and facial muscle pain? It could be a consequence of anxiety.

The temporomandibular joint (TMJ), although not well known, is essential because it would not be possible to open or close the mouth without it.

It is one of the most interesting joints in the body, as it allows the lower jaw to move backward, forward, and sideways.

Many people come to us after developing a TMJ dysfunction, which is usually responsible for the most common pain in the jaw or near the ears.

Although discomfort may disappear on its own, in pandemic times with all the changes in anxiety and stress levels, some TMJ exercises can help alleviate pain and maintain functionality.

Here are some of them:

Exercise 1: Opening and closing the mouth

• Sit in a chair with back support to maintain an upright and comfortable posture;

• Place your tongue on the roof of your mouth;

• Then, try to open your mouth while keeping your tongue in the same position;

• While doing this, breathe in slowly for a few seconds and exhale gradually;

• Close your mouth and, if you do not feel pain, repeat the exercise 10 times.

Exercise 2: Lateral movements

• Sit in a chair with back support to maintain an upright and comfortable posture;

• Place your tongue on the roof of your mouth;

• Then, try to open your mouth while keeping your tongue in the same position;

• Place your index finger between your upper and lower teeth;

• Slide your jaw from side to side in a controlled manner, within a comfortable range, without going to the maximum;

• If you do not feel pain, repeat the exercise 10 times.

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How is TMJ dysfunction diagnosed?

TMJ dysfunction (Temporomandibular Joint Disorder) can be diagnosed by a physiotherapist specializing in mandibular dysfunction, dentist, and/or maxillofacial surgeon. TMD (Temporomandibular Dysfunction) is a clinical diagnosis of movement dysfunction. Complementary diagnostic tests such as X-rays (RX), computed tomography (CT), or magnetic resonance imaging (MRI) may be recommended for a more complete diagnosis.

After the evaluation, the physiotherapist will begin treatment, if appropriate. It is an intervention that is typically very successful in treating TMJ disorders, largely because it is a movement disorder affected by muscular and/or joint motor control.

Field (2012) found that with conservative physiotherapy treatment for TMJ, 75% of patients with TMD resolved their condition within 3 months, which is consistent with our clinical results. The vast majority improve within a few weeks after starting TMJ treatment, compared to slower resolution when not intervened by physiotherapy, as studied by Rammelsberg in 2003, who found that spontaneous resolution occurs in 33% of TMD sufferers over a 5-year period.

We present the case of a female patient, 35 years old, with a history of right TMJ surgery in 2014. She presented with intense pain in the left TMJ during opening, with a limitation of 30 mm. She felt fearful during this movement, with limitations in eating, headaches in the frontal and occipital regions, tinnitus, as well as photophobia and hyperacusis (excessive sensitivity to certain sounds). She had pain on palpation in the temporal and facial regions, bilaterally, as well as the sub-occipital region, reporting that this was “the origin of her headaches.”

She started physiotherapy treatment and, after 3 weeks of progress, she was already able to open her mouth 40 mm without any pain, along with a greater willingness to perform a movement that had previously caused her fear. She was free of headaches, tinnitus, and sensitivity to sound and light.

It is another case heading towards success, the result of a multidisciplinary team, focused and guided by the patient!

Written by Sérgio Neto