As osteopaths we are often asked are TMJ and TMD the same, what the symptoms of TMJ/TMD are and how do osteopaths treat it, so here is a blog to answer all your questions.
The short answer is no. TMJ is the name of the joint and TMD is the name of what goes wrong with the joint. That being said, many patients simply get told they have “TMJ” when technically it should be “TMD.” Either way it can hurt, so keep reading to find out how it all works and what you can do to fix the problem.
The TMJ or temporomandibular joint refers to the main joint in your jaw. It is one of the most used joints in your body. It is involved in everyday activities such as chewing, talking and yawning. In fact, every time you move your mouth you are using your TMJ.
Temporomandibular dysfunction (TMD) is a term used to describe the conditions that affect the jaw and surrounding muscles. TMD can be an unexpected and painful ailment and it can be a huge problem for sufferers as there is little opportunity to rest your jaw, even if it hurts. This is because we use our jaw for so many important functions, all day long.
What are the symptoms of TMD?
The most common symptoms of TMD include: Clicking and popping sounds when moving your jaw Locking of the jaw Difficulty chewing and yawning Pain in front or in the ear Neck pain Face pain Headaches
Anatomy of the TMJ
The TMJ is a small joint that is found on either side of the face in front of the ears and it is formed by the boney condyle of your lower jaw bone and the temporal bone of the skull (imaged below). Between these two bones is an articular disc, designed to cushion and support movements. The disc becomes an important structure in TMD as it is involved in most TMJ problems.
Source: https://sharedentalcare.com/tmj/
What is causing my TMJ symptoms?
There can be multiple factors causing your TMJ pain or other symptoms. Your TMJ symptoms may be related to one or more of these common causes:
- Trauma
- Bad habits (e.g. clenching teeth, nail biting)
- Inflammatory conditions (e.g. arthritis)
- Psychological stress
- Muscle spasm
- Poor posture
Why does my jaw click and lock?
A frequent complaint of TMD is difficulty to open or close the mouth, accompanied with varying degrees of pain, clicking, popping and locking. These symptoms are experienced when there is abnormal positioning of the articular disc within the joint.
There are two main stages of mouth opening; initially the mouth opens around 2-3cm with little joint movement. During this stage, the jaw and the disc stay within the socket. However, to open the mouth fully, the jaw and disc need to move forward and slightly out of the joint.
Occasionally, the disc can form an obstacle, acting as a hurdle for the jaw to move forward. As a result, this hurdling can produce an audible clicking or popping sound on opening. When closing the mouth, the jaw needs to glide back over the disc to return to its socket, again producing a click or pop. This presentation is known as disc displacement with reduction; the disc is not moving properly and considered displaced, but the jaw can move in and out of its socket.
Problems can also arise if the disc is acting like a roadblock, not allowing movement either in or out of the socket. In this situation patients report an inability to open their mouth fully or describe a locked sensation. This is commonly known as lockjaw and clinically referred to as disc displacement without reduction
Source: https://link.springer.com/article/10.1007/s12663-012-0447-6
The above image demonstrates the condyle (part of the jaw that forms the joint) and the articular disc (light pink) on normal and abnormal mouth opening.
Osteopathy and TMD
Your osteopath is trained in diagnosing, treating and managing your TMD. As a condition with many contributing factors, your osteopath may recruit the help of other health professionals such as a dentist, GP and/or psychologist. This approach is well rounded and provides you with the best management plan for your problem.
Treatment should aim to reduce pain and improve the function of the jaw. Currently, conservative therapy is considered the most effective and preferred approach. This type of treatment includes:
- Manual therapy (osteopathy)
- Occlusal splints (night guard)
- Medication
- Self-management strategies
- Psychological support
Osteopathic treatment for TMD
Osteopathic manual therapy aims to alleviate pain, reduce inflammation and restore function. This type of treatment for TMD should be administered as soon as symptoms arise as the earliest form of intervention. Osteopaths are known to apply a holistic approach to examination and treatment. As TMD is rarely an isolated issue, your jaw, neck, head, shoulders and upper may need to be examined and treated as they can contribute to your symptoms of TMD.
Treatment may involve a combination of techniques that include but are not limited to:
- Intra-oral techniques (treatment inside the mouth)
- Massage
- Joint manipulation
- Stretching
- Joint mobilization
- Cranial and other indirect osteopathic techniques
Rehabilitation exercises such as stretching and/or strengthening are often indicated. You may also be given a self-management plan including exercises and minor changes to lifestyle habits that may be responsible for TMD progression such as posture.
When TMD involves grinding or clenching of teeth (bruxism), provision of an occlusal splint (night guard) by the dentist can be very useful, not only to relieve muscle tension, but to protect teeth from wearing down and breaking. Anti-inflammatories, muscle relaxants and pain relief may also be prescribed by your doctor alongside other treatment options.
References:
- Porto De Toledo, I., Stefani, F. M., Poporatti, A. L., Peres, A. M., Flores-Mir, C., & De Luca Canto, G. (2016). Prevalence of otologic signs and symptoms in patients with temporomandibular disorders: a systematic review and meta-analysis.
- Hanna, k., Nair, R., Armfield, J. M., & Brennan, D. S. (2020). Temporomandibular dysfunction among working Australian adults and association with workplace effort-reward imbalance
- Theroux, J., Stomski, N., Cope, V., Mortimer-Jones, S., & Maurice, L. (2019). A cross-sectional study of the association between anxiety and temporomandibular disorder in Australian chiropractic students.
- Ryan, J., Akhter, R., Hassan, N., Hilton, G., Wickham, J., & Ibaragi, S. (2019). Epidemiology of Temporomandibular Disorder in the General Population: a systematic review.
- Melo, R. A., Machado de Resende, C, M, B., Renata de Figueirêdo Rêgo, C., de Sousa Leite Bispo, A., Barbosa, G. A. S., & Oliveira de Almeida, E. (2020). Conservative therapies to treat pain and anxiety associated with temporomandibular disorders: a randomized clinical trial.
- Mehndiratta, A., Kumar, J., Manchanda, A., Singh, I., Mohanty, S., Seth, N., & Gautam, R. (2019). Painful clicking jaw: a pictorial review of internal derangement of the temporomandibular joint.
- Gil-Martínez, A., Paris-Alemany, A., López-de-Uralde-Villanueva, I., & La Touche, R. (2018). Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions.
- Poluha, R. L., De La Torre Canales, G., Costa, Y. M., Grossmann, E., Bonjardim, L. R., & Conti, P. C. R. (2019). Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation.
