What is TMD? TMD stands for temporal mandibular dysfunction. Temporal mandibular dysfunction is when the temporal mandibular joint (TMJ), or the joints on either side of your jaw, are not functioning properly. This disfunction of the TMJ can cause a spectrum of issues from light cracking to debilitating pain. TMD can also lead to a wide range of problems that go well beyond jaw pain. TMD can cause pain in the ears, neck, shoulders, or headache pain. It can disturb sleep. It can lead to an inability to open the mouth and cause problems with eating and even intimacy.
If you’ve ever had any kind of tooth, mouth or ear pain, you know how awful these symptoms are and how much it affects your ability to move on with your day. Imagine having that type of pain indefinitely and now knowing what to do about it.
The Epidemic of TMD
Valesan et al. (2021) discovered during a systematic review of the literature relevant to Temporal Mandibular Joint Dysfunction, the prevalence of TMD in the United States is as follows:
• 31% of adults/elderly (approximately 80 million).
• 11% in children/adolescents (approximately 8 million).
Temporal Mandibular Joint Dysfunction affects women 1.5 to 2 times more than men and 80% of those treated for TMD are women (Warren & Fried, 2001). These statistics are staggering, and people need help.
The Causes of TMD
The cause is often considered multifactorial including biologic, behavioral, environmental, social, emotional, and cognitive components (Kaban, 2009).
- Stress or anxiety
- Muscle strain
- Injury from car accidents or other trauma
- Posture
- Head forward position
- Cervical Issues
- Spinal Curves, lordosis
- Pelvic distortions
- Hip mobility issues
- Myofascial tension
- Habits
- Medical Conditions
Stress
How does stress cause TMD? We all have places we hold stress in our bodies. For me it is often my shoulders, my abdomen, or my thighs (odd, I know). Many people hold stress in their jaws by clenching their teeth. This may happen during sleep, during the day, or both. It is often an unconscious clenching process just like holding stress anywhere else in the body.
Posture
How does posture play a role? Our body is meant to have a specific geometry to function best. Just like a car functions best when everything is in good alignment, we do too. My dealership has a device that measures my wheel alignment when I drive into the shop. Alignment is very important in keeping your car healthy. Even though we are not machines, we need our bodies aligned well to keep all our tissues and systems healthy. When one part of our body is out of alignment, it can affect everything else in the body and how each joint functions.
The Progression of TMD
TMD can start with a mild sense of tension in your jaw. This can progress to sensations of catches or clicking happening in your jaw. The clicking may or may not be painful. Some people feel a sense of relief in the tension when they click their jaw. This can irritate the tissues and actually make the problem worse.
Over time, the tension can build and place pressure on the tissues in this area. Blood flow can be reduced and restrictions in the myofascial tissues can develop. In addition, the structures of the joint can actually get stuck out of alignment making it difficult to open and close the jaw. The more tension that builds, the more pressure is placed on surrounding nerves and circulatory structures. As a result, less nutrition is able to get to the tissues and keep them healthy. All this can result in a lot of discomfort and even severe pain that can spread away from the jaw into the ear, temples, head, neck or shoulders.
What can you do?
There is not typically a single answer but here are some things we know from our latest scan of the literature.
Start Early
As soon as you recognize any tension or clicking, do something about it. Do not let it persist. The longer the problem persists, the worse the symptoms can get. Early conservative intervention gets the best results according to Aggarwal et al., (2019).
Check Your Habits
If you have a habit of clicking your jaw to reduce the tension, do your best to stop. Clicking can affect the joint over time and cause more inflammation. Notice when you are clenching your jaw when you are awake and try to stop. If that is difficult, try to replace the habit with something else. Try making a fist then let it go instead of clenching your jaw.
Manage Stress
Stress is a huge factor in TMD. Please do not discount it. Identifying your sources of stress and reducing them as much as you are able is a huge first step. However, we can’t always eliminate our sources of stress, so what can we do? Learn to respond to them differently. Get help from a professional if your stresses are many and you have no idea where to start. Others may benefit from simply learning how to meditate which can help us become more aware of our thought patterns and how we respond to stressful stimuli.
Check Your Teeth
I’m not a dentist but clenching at night can cause lots of problems with your teeth. I had a client who was a dentist and he mentioned that during covid, there was so much stress that people were clenching and grinding their teeth so hard at night, they were cracking teeth. Even people in their 20’s were having this problem. A bite guard can help protect the teeth. However, a bite guard is NOT a fix for TMD. If you continue to clench down on the guard, the problem will persist. When your jaw is relaxed your teeth should not touch.
Check Your Whole-Body Posture and Tension
There are some professionals who believe posture has nothing to do with our health. I wholeheartedly disagree and the literature does too when it comes to TMD. Forward head posture especially changes the geometry of the muscles in the shoulders, neck and jaw. This affects the joint. If you want a joint to behave as it should, your posture should support it. End of story. See my post on turtle neck.
You must also consider the posture of your entire body, not just your neck. Everything really is connected. If one joint can’t function normally due to problems with posture or tension, another must pick up the slack when doing normal daily activities. Learn more about posture and removing tension with myofascial self-treatment in my on-demand courses.
Get Good Sleep
Sleep is vital for healing. Practice good sleep hygiene. Allow yourself to wind down before bedtime. Create a bedtime ritual or routine that relaxes you. If you are a person whose head starts spinning with all the stresses of the day, refer back to the stress section and learn some meditation. I love Yoga Nidra for bedtime. It is a method that engages your brain with your body making it hard to focus on your stressors. Try my Yoga Nidra recording for free. Enter FREENIDRA at checkout. Find the 15-minute recording here.
Body Work
Not all therapists are open to working in the mouth. But working around the shoulders, neck and face can be helpful to relieve the symptoms. When I have a client with TMD, I glove up and get into the mouth (with permission of course). Working in the mouth with a gentle myofascial approach makes an immediate difference in symptoms and ability to move the jaw. This softening of the tissues allows for better blood flow and saliva production which lets the healing begin. This softening of the fascia also allows better movement which means it is easier to eat.
I have worked with many clients who were surprised that I could help them with TMJ issues. Yes, there is fascia everywhere, even in the mouth. Taking a myofascial approach to TMD makes a huge difference. It is common to see clients be able to open their mouths twice as wide or more after just one treatment. It is common to see the clicking reduce significantly in just one treatment. Clients have reported a reduction in tinnitus and of course a reduction in pain. Don’t expect miracles, but even I am continually surprised by the results. You must be a team member in the process and address your posture, stress, etc. or the jaw tension will return.
If you or someone you know has TMD, please let them know there is more that can be done besides bite guards, injections and surgical interventions. Too many people are offered theses invasive and sometime irreversible interventions before conservative treatment.
Barnes style myofascial release is gentle. This doesn’t mean it may not be uncomfortable, but any discomfort should feel therapeutic. Discomfort beyond this is counterproductive to healing.
If you are in or near the Omaha area, please let us help. Make an appointment here.
References
Aggarwal, V. R., Fu, Y., Main, C. J., & Wu, J. (2019). The effectiveness of self-management interventions in adults with chronic orofacial pain: A systematic review, meta-analysis and meta-regression. European journal of pain (London, England), 23(5), 849–865. https://doi.org/10.1002/ejp.1358
Empowering you with the truth. The TMJ Association. (2022, December 2). Retrieved February 16, 2023, from https://tmj.org/
Lee, Y. H., Auh, Q. S., An, J. S., & Kim, T. (2022). Poorer sleep quality in patients with chronic temporomandibular disorders compared to healthy controls. BMC musculoskeletal disorders, 23(1), 246. https://doi.org/10.1186/s12891-022-05195-y
Valesan, L. F., Da-Cas, C. D., Réus, J. C., Denardin, A. C. S., Garanhani, R. R., Bonotto, D., Januzzi, E., & de Souza, B. D. M. (2021). Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clinical oral investigations, 25(2), 441–453. https://doi.org/10.1007/s00784-020-03710-w
Warren, M. P., & Fried, J. L. (2001). Temporomandibular disorders and hormones in women. Cells, tissues, organs, 169(3), 187–192. https://doi.org/10.1159/000047881
