Does it hurt when you chew, open wide to yawn or use your
jaws? Do you have pain or soreness in front of the ear, in the jaw muscle,
cheek, the teeth or the temples? Do you have pain or soreness in your teeth? Do
your jaws make noises loud enough to bother you or others? Do you find it
difficult to open your mouth wide? Does your jaw ever get stuck/locked as you
open it?
If you answered “yes” to some of these questions, you may
have a temporomandibular joint disorder, or TMD. TMD is a group of conditions,
often painful, that affect the jaw joint.
Signs may include:
- Radiating
pain in the face, neck, or shoulders;
- Limited
movement or locking of the jaw;
- Painful
clicking or grating when opening or closing the mouth;
- A
significant change in the way the upper and lower teeth fit together;
- Headaches,
earaches, dizziness, hearing problems and difficulty swallowing.
For most people, pain or discomfort in the jaw muscles or
joints is temporary, often occurs in cycles, and resolves once you stop moving
the area. Some people with TMD pain, however, can develop chronic symptoms.
Your doctor of chiropractic can help you establish whether your pain is due to
TMD and can provide conservative treatment if needed.
What Causes TMD?
Researchers agree that TMD falls into three categories:
- Myofascial
pain—discomfort or pain in the muscles of the jaw, neck, and shoulders;
- A
dislocated jaw or displaced disc;
- Degenerative
joint disease—rheumatoid arthritis or osteoarthritis in the jaw joint.
Severe injury to the jaw is a leading cause of TMD. For
example, anything from a hit in the jaw during a sporting activity to overuse
syndromes, such as chewing gum excessively or chewing on one side of the mouth
too frequently, may cause TMD.
Both physical and emotional stress can lead to TMD, as well.
The once-common practice of sitting in a dentist's chair for several hours with
the mouth wide open may have contributed to TMD in the past. Now, most dentists
are aware that this is harmful to the jaw. In addition to taking breaks while
they do dental work, today’s dentists also screen patients for any weaknesses
in the jaw structure that would make physical injury likely if they keep their
mouths open very long. In that case, they may use medications during the
procedure to minimize the injury potential, or they may send the patient to
physical therapy immediately after treatment.
In less severe cases, they instruct patients in exercises they can do at
home to loosen up the joint after the visit.
While emotional stress itself is not usually a cause of TMD,
the way stress shows up in the body can be. When people are under psychological
stress, they may clench their teeth, which can be a major factor in their TMD.
Some conditions once accepted as causes of TMD have been
dismissed—moderate gum chewing, non-painful jaw clicking, orthodontic treatment
(when it does not involve the prolonged opening of the mouth, as mentioned
above), and upper and lower jaws that have never fit together well. Popular
theory now holds that while these may be triggers, they are not causes.
Women experience TMD four times as often as men. Several
factors may contribute to this higher ratio, posture and higher heels.
TMD Diagnosis and Treatment
To help diagnose or rule out TMD, your doctor of
chiropractic (DC) may ask you to put three fingers in your mouth and bite down
on them. You may also be asked to open and close your mouth and chew repeatedly
while the doctor monitors the dimensions of the jaw joint and the balance of
the muscles. If you have no problems while doing these things, then the problem
is not likely to be TMD. Your DC can then look for signs of inflammation and
abnormalities. Sometimes special imaging, an x-ray or an MRI may be needed to
help confirm the diagnosis.
If you have TMD, your doctor may recommend chiropractic
manipulation, massage, applying heat/ice and special exercises. In most cases,
your doctor’s first goal is to relieve symptoms, particularly pain. If your
doctor of chiropractic feels that you need special appliances or splints (with
the exception of the “water pack” and other guards against teeth grinding), he
or she will refer you to a dentist or orthodontist for co-management.
In addition to treatment, your doctor of chiropractic can
teach you how to:
- Apply
heat and ice to lessen the pain. Ice is recommended shortly after the
injury or after your pain has started. In the later stages of healing, you
need to switch to heat, especially if you are still experiencing
discomfort.
- Avoid
harmful joint movements. For example, chomping into a hard apple is
just as bad as crunching into hard candy (some hard candies are even
called “jawbreakers”—for good reason). And giant sandwiches can cause the
mouth to open too wide and have a destabilizing effect on the jaw.
- Perform
TMD-specific exercises. Depending on your condition, your DC may
recommend stretching or strengthening exercises. Stretching helps to
loosen tight muscles and strengthening helps to tighten muscles that have
become loose. Special feedback sensors in the jaw can be retrained, as
well, if needed.
VIA: www.acatoday.org
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