Your jaw joints, in front of your ears, are called the Temporomandibular Joints (TMJ). It is the joint that connects your lower jaw to your head.
Temporomandibular Joint Disorder (TMJD) is a common condition which affects the joint, disc, muscles and/or ligaments of the TMJ. The symptoms include:
- Difficulty opening your mouth
- Popping, clicking or grating of your jaw point
- Pain from the jaw area, or generalized discomfort or jaw ache
- Headaches and pain of your jaw muscles
- Earache and Tinnitus - ears may feel ‘full’
This information sheet will concisely summarize the best advice to care for your TMJ. The advice here is part of ‘ conservative care ’ - all these measures are powerful and 80% of patients with TMD will recover with conservative measures alone.
Conservative jaw therapy should be exhausted before proceeding to a non-conservative, irreversible treatment like bite modifications or TMJ surgery.
1) Eliminate Bad Habits
The following habits should be minimized as they place strain on your TMJ
- Yawning too wide - push against your chin while yawning to help
- Opening wide to eat large foods such as burgers or large sandwiches
- Eating and chewing hard, crunchy, chewy and tough foods
- Resting your hands on your face/chin
- Nail Biting
- Playing around and rubbing your jaw joint excessively
- Cradling the phone between your ear and shoulder
- Biting the skin of your lips
- Pen chewing
- Playing wind instruments or singing if this hurts your jaw
- Forward head posture while on your mobile phone
- Using your teeth to carry things/using your teeth as a tool
- Teeth Grinding - although this may be out of our control if it is happening in your sleep
- Remember that apart from eating, your teeth should be apart
The last point may be the most difficult to do as many people subconsciously rest their teeth together. This is a destructive habit. Our teeth should only touch for less than 20 minutes per day.
The mantra is: ‘Lips together. Teeth apart’
If you are having long dental procedures, ask your Dentist for a ‘mouth prop’ to prevent muscle fatigue from your mouth staying open. After a long dental procedure, consider self-massage of the jaw and muscles and read the section below on heat application to the muscles.
2) Stress reduction, Sleep Quality and Mindfulness
The connection between stress/anxiety and TMJD is well established. This is why many patients may benefit from cognitive behavioral therapy (a type of psychological treatment that develops your personal coping strategies).
Those that suffer from poor sleep quality and insomnia are also more likely to suffer with TMJD.
The following is recommended to reduce stress and help improve your sleep quality:
- Avoid caffeine as this is a stimulant and likely to increase stress and cause muscle tension
- Avoid alcohol
- Practice deep diaphragmatic breathing (belly breathing or abdominal breathing) - you can search for tutorials online eg. YouTube
- Modern smartphones have a ‘Blue Light Filter’ which will filter the blue light emitted from your phone screen - switch this ‘On’. Otherwise, the blue light makes your brain think it is day-time and can affect your sleep. There are also Apps for this.
- Use Mindfulness and Meditation techniques and Apps such as ‘Calm’ and ‘Headspace’
- Many patients have found that ‘self-hypnosis’ in the form of instructing yourself before you sleep that ‘I will stay relaxed. My jaw muscles will relax. My joint will heal’.
Some patients may benefit from Hypnotherapy/Hypnosis. Stress is a leading cause of Teeth Grinding (Bruxism), so learning Self-hypnosis can not only help you to relax regularly, it can also help you to develop more positive strategies for coping and conquering your daily stress.
3) Orthotic Appliances / Night Guards
Teeth grinding and clenching can place immense strains on the TMJ and muscles. Whilst a specialized night-guard will not stop you from grinding, it will protect your teeth. Certain types of guards/orthotic appliances will ensure that whilst you grind, you minimize the damage to your joints and muscles. The jaw opening and closing muscles are able to relax. Your Dentist will listen to you and assess your condition and bite to decide which is the best orthotic appliance for you.
Many patients will find that their headaches and jaw strain improves. If you have lots of dental work in your mouth, a protective night guard is sensible for teeth grinders to protect your teeth and dental work from wear, chipping and fracture.
With certain orthotic appliances, they can be colored in to check if grinding activity is taking place, and to what extent.
A physiotherapist that is trained to treat the TMJ will use exercises, manual therapy (massage, stretching, manipulation), acupuncture and laser therapy to improve mouth opening and comfort. They are an important part of conservative care for TMJD sufferers.
Patients with muscular ache in their jaw area often also have aches in their shoulder and neck - a physiotherapist can help with this as well as advising on a more ergonomic set up in for their work environment.
Your Dentist may recommend a TMJ Specialist Physiotherapist they work closely with, or you may find one from the following website:
5) Heat application, Cold therapy and Home Exercises
Whilst Physiotherapists will give condition specific exercises and is strongly recommended for TMJD, below are some generic physiotherapy techniques and exercises that patients will find helpful.
The use of moist heat or ice is described below, typically applied to the Masseter (below) or Temporalis (side of the head) muscles.
Applying moist heat is useful to increase blood flow to affected areas, it is recommended before TMJ exercises described below.
A warm, moist flannel wrapped around a warm hot water bottle will provide moist heat. Apply for 15 minutes, twice daily to the affected muscles. This is also beneficial just before the TMJ exercises.
Ice can help to reduce swelling or if jaw feels tender and warmer then usual (or feels like ear ache) - likely at the start of symptoms or after an injury. It can be applied to the affected muscles wrapped in a damp tea towel, placed on to the skin overlying the affected muscle for 5-10 minutes until muscle feels frozen and numb.
Heat and Ice Contrast
In cases of muscle spasm (and a painful change in your bite), switching between hot and cold can be helpful.
Use heat for 4 minutes, then ice for 1 minute. Keep switching from hot to cold for 20-30 minutes and finish with heat for 10 minutes.Home Exercises
Isometric Tension Exercises
Put your thumb under your chin - try and open your mouth, but at the same time push up with your fist to provide gentle resistance. Hold your opening against resistance for 5 seconds (one set). Complete 5 sets up to four times a day. (Diagram)
Practice opening in a straight line in front of the mirror. You can use a hand lightly on either side of your face to gently guide you to straight opening if you keep moving to one side. Do this slowly in a controlled manner for 5 seconds (one set). Complete 5 sets up to four times a day.
Jaw Retrusion Exercise
Open normally and curl your tongue to the very top and back of your palate. Your lower jaw will move back with your tongue. While you keep your tongue against the back, slowly close together until your teeth gently touch. One open-close cycle is one set. Complete 5 sets up to four times a day.
You can use over the counter medicines like Paracetamol and Ibuprofen.
You can also use an Ibuprofen gel applied over the jaw joint and master area (see above photo) if it is flaring up with tenderness and if you feel swelling.
Physiotherapists and Dentists should be considered first line for assessment.
Patients are also welcome to try Chiropractors and Osteopaths, especially if you have had success with these practitioners before.
TMJD can be a complex condition to treat. It is not as simple as joint damage that heals after some time. Actual jaw joint damage does not correlate to pain and severity of problems.
Joint mobility, anatomy, genetics, hormones, stress, teeth grinding, habits and injuries all play a role on TMJD. This is why the conservative care pathway outlined above is so exhaustive.
Thankfully most patients will get better with conservative care that is non-invasive.
Whilst your symptoms will improve, you may experience flare-ups and bad patches from time-to-time that should be managed with pain killers, night-guard use and exercises as described above.
If you have tried all the avenues above, and are still suffering, speak to your Dentist about referral to an Oral and Maxillofacial Surgery department that will consider patients who have tried Conservative care first.