by Duncan Cameron Mitchell (Osteopath) – following a course he attended on Temporomandibular Disorders (TMJ/Jaw problems).
It’s slightly ironic that an organisation who’s aim is to help those with Orofacial pain choose such a mouthful. That said, the weekend spent studying management of Temporomandibular disorders (TMD from now on) was hugely beneficial to my practice.
It has become more and more commonplace for patients to present with a range of neck and head symptoms which on examination can be traced back to the jaw. I believe that now we as a society are making it hard for our brains to slow down . Even in the evening we sit down at the dinner table with our phones beside us, flick through the Ipad whilst the TV is on and check emails before bed.
A significant number of my patient base are admitting to clenching or grinding the teeth at night (Bruxism). Research now tells us that about 30% of the population will suffer from TMD at some point in their lives. Consequently it is possible to reassure oneself if you are suffering that you are not alone and what you have is commonplace.
What are the most common triggers for TMD?
- Trauma: Head injuries, surgery.
- Daytime habits: Nail biting, chewing gum, sitting with chin on hands.
- Emotions: Stress, anxiety.
- Posture: Head held forward sat for extended periods.
- Bruxism: Night time clenching.
Movement and Muscles
If we think about our mouth movement we assume the jaw simply opens and closes. However the TMJ (the temporomandibular joint/jaw) has a movement that is a little more complicated. Firstly there is a rotation of the condyle within the fossa.
This is followed by a sliding of the condyle and jaw forwards. This sliding is facilitated by a articular disc which sits under the bony condyle allowing this movement.
The muscles used to open the mouth include Geniohyoid and Digastric which form the floor of the mouth . These pull the chin down and backwards ( see Gordon Brown for illustrative purposes).
Temporalis ( the side of the head) Masseter (cheeks) and Medial Pterygoid (inside of your jaw) elevate your jaw, thereby closing the mouth.
So what can go wrong?
1. Mastication muscle disorders.
These are usually associated with guarding, emotional tension, nail biting for instance. Pain tends to be reproduced on activity and through palpating the area in question. Sometimes earache and headaches can be associated with the problem.
2. Temporomandibular joint disorders are subdivided
A) These can be related to issues with the articular disc which can slide forwards and then suddenly retract with an audible noise or even refuse to slide back creating limited mouth opening for a number of weeks afterwards.
B) Degenerative joint disease which is the result of years of usage.
C) Subluxation/luxation which is dislocation and sometimes relocation of the joint.
What can be done to help?
Initially effective diagnosis of the cause of the pain is the first step. A skillful practitioner must rule out any red flags of serious pathology.
Once this is done a case history must consider physical influencing factors such as postures, unhelpful daily habits, jaw movement patterns.
The questioning should also go some way to reveal cognitive factors, psychological and social factors which may be contributing to the dysfunction in the jaw.
Without these being identified successful management going forward is impossible.
Treatment will be a combination of techniques to reduce muscle tightness if necessary and exercises to improve range and control of the jaw.
As an adjunct to this treatment it may be necessary for the patient to use splints for the Bruxism and possibly medication to assist.
Finally on a personal note, I would like Burtons the makers of Wagon Wheel biscuits for reducing the size of a Wagon Wheel. Many fifty year olds now have TMD because nobody believed that you could fit one into your mouth in one go. Today’s children are safeguarded against such risks thankfully.
See an Osteopath
If you are suffering from head , jaw or neck ache then one or two visits to an Osteopath with experience in treating TMD could make all the difference.
To book an appointment with Duncan Cameron Mitchell, please ring our friendly receptionists on 01865 558561, or book online here.