TMJ & CHRONIC PAIN

The jaw joints, called the temporomandibular joints (TMJs), are two joints attached to one bone, the mandible. The TMJs should function in exactly the same way, at exactly the same time. If they don’t, there can be problems. They need to sit in the right place in the sockets. This is especially important when the teeth come together. If one or both of the TMJs are positioned back and/or up in the sockets, they will compress the articular disc that sits within the joint.

 

Compression of the discs when the teeth come together creates a pressure that may cause the discs to slip out of place, which results in a clicking sound. With the discs slipping in and out of place, the joints are unstable. It is possible for the discs to slip out of place and stay out of place, causing the mandible to be locked in an open or closed position. This can be scary and painful, and requires gentle manipulation back into place. 

 

It is possible to have a problem perceived in only one joint, however, both joints are always affected. If symptoms are worse in one joint, it may be due to trauma, or a twist in the skull, called a cranial strain. Cranial strains are related to a twist in the sphenoid bone in the center of the skull, which can be addressed with craniosacral therapy and a functional orthodontic appliance using a unilateral bite block. 

 

Teeth clenching and grinding, called bruxism, which can occur day and/or night, can damage the TMJs. This extra pressure on the joints can cause changes in the bone and inflammation in the joints themselves, as well as in the soft tissue and muscles involved in jaw movements. Pain and dysfunction in this system is called temporomandibular joint disorder (TMD). Bruxism and related TMD symptoms can be caused by stress, psychological disorders, breathing disorders, medications, stimulant drugs, and epigenetic factors.

 

TMJs that are compressed can cause the head to posture forward to relieve the pressure in the joints that are positioned up and back. When the head is chronically cantilevered forward, it adds extra weight to the neck muscles, back muscles, and spine. This also causes the pelvis to compensate by tilting forward and the feet to flare out laterally for balance. This misalignment commonly causes chronic back, neck, and head pain. 

 

In order to resolve TMD and chronic pain, we must determine the root causes. Jaws that are too small cause the TMJs to be back and up in the sockets, so jaw development with a functional orthodontic appliance and/or orthognathic surgery may be the solution. However, temporary relief can come from using an oral orthotic to stabilize the TMJs. This is called TMJ decompression therapy because it takes the pressure off the joints by holding them precisely in the right position to allow adequate space for the articular disc and therefore for healing to occur. In order to pursue a permanent solution that addresses the root cause, typically initial TMJ stability must be achieved using an oral orthotic to prevent exasperation of TMD symptoms. Many people find relief from craniofacial pain by using adjunct therapies in addition to oral orthotic therapy.

Such therapies can include:

• photobiomodulation

• prolotherapy

• platelet-rich fibrin (PRF) injections

• anti-inflammatory soft diet

• chiropractics

• jaw exercises

• ensuring nasal breathing

• orofacial myofunctional therapy

• a gentle SPG nerve block through the nose

 

It is important to consider tongue posture when thinking about jaw joint position and neck posture. The tongue must rest on the roof of the mouth so that the neck, and therefore the rest of the spine, can be in proper alignment, which allows the pelvis to be in the right position. With the tongue postured properly on the palate, the jaw can hang in a relaxed state with the teeth slightly apart. If the teeth are touching, they send a signal to the brain as if we are chewing. This creates tension in the system and involves activating muscles that should be relaxing. Overactivated muscles of chewing creates inflammation in these muscles, which can result in muscle spasms and chronic pain. 

 

Chronic pain comes from inflammation in some structure. It is essential to reduce inflammation at all costs.

This means eating an anti-inflammatory diet, avoiding drugs and alcohol, reducing mental and emotional stress, using lasers and red light therapies, and addressing the root causes creating the inflammation.