Temporal Mandibular Dysfunction

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When it hurts to eat

Your mouth is the most important part of your body.  If you have ever injured your jaw or had dental work you’ll recall the agony trying to eat during the healing process.  

The ability to chew and swallow involves a complex series of events which start with a bite of food.  In order to chew, you need muscle coordination of the jaw and tongue so that you effectively and effortlessly masticate your food and swallow.   When there is muscle imbalance or joint pain it is common to favor one side of the mouth.   If pain is a problem, you may also find that you have to limit certain foods that require more effort to chew.   Maintaining a healthy jaw will help you to avoid discomfort so you can eat, chew and be merry.  

The TMJ

The joint that forms our jaw is called the Temporal Mandibular Joint (TMJ). The temporal bone (part of the head) fits together with mandible (the moving part of the jaw) separated by a disc.   The disc sits on the condyle (end) of the mandible and moves with this bone as you open and close your mouth.  It is held in place by the capsule, ligaments and fascial extensions of the muscles of the jaw.  Any strain to these structures or to the muscles that move the jaw may also affect the position of the disc.  If the disc translates forward, you may notice clicking as the condyle of the mandible rolls over the disc during mouth opening.  A less common scenario occurs when you open your mouth and then cannot close it because the disc blocks movement.  This is not an attractive position (think drool) and is quite painful.    Any dysfunction of the TMJ  and surrounding structures is called TMD (temporal mandibular dysfunction).

What causes TMD?

Poor postural habits such as sitting with your head forward can be a major contributor to TMD.   Prolonged sitting, poor ergonomics, genetics and/or psychosocial components such as anxiety and depression can promote poor posture despite your efforts to avoid it.  Impact from a fall or blow to the jaw may lead to TMD if not immediately, down the road.  Headaches, earaches, face pain or neck pain are often symptoms of TMD, but sometimes there is dysfunction without pain.  Clicking and asymmetrical mouth opening indicate joint dysfunction.   The jaw has a joint on both sides, so what happens on one side affects the other.   

The main muscles of mastication

Mastication means to grind, crush and chew.  It is a critical step for proper digestion.  The muscles that close the jaw and pulverize your food are quite powerful.  When they become chronically tense and tight from clenching or grinding your teeth or for other reasons like jaw alignment, the pressure through the joint increases.  Two of the muscles that contribute to jaw movement have fascial attachments to the disc (lateral pterygoid and masseter).   If you have an issue with joint function, inevitably the muscles of mastication will be involved.  

More about muscles

The jaw is part of your head-neck complex.  The position of your head on your body will affect the length-tension relationship of the muscles that attach to the jaw.  Poor posture, specifically a forward head posture, can affect the coordination and efficiency of opening and closing your mouth.  There are things you can do to improve jaw alignment and reduce unnecessary joint and disc compression.  

Conservative management for TMD

Making efforts throughout the day to avoid habits that contribute to TMD will help to keep your TMJ healthy.    Below are a few suggestions:

  1. Make sure you have a good ergonomic set up at work.  There are many links available online like this with instruction on how to adjust your workstation to encourage good posture.  Start there.
  2. Make a conscious effort to breathe diaphragmatically during the day.  Shallow breathing, or chest breathing requires more work from the neck muscles and is a common occurrence with computer workers.  For guidance on how to breathe diaphragmatically visit our blog.
  3. Limit or eliminate habits such as clenching, nail biting, gum chewing and leaning on the jaw.  These activities strain the TMJ.
  4. Instead of clenching, try “Lips together, teeth apart and tongue to roof of mouth”.  Clenching causes stress to the muscles that close the jaw.  
  5. Seek help from a professional if you have pain rather than adopt compensations that may cause further imbalance.  Your issue may be stress more than poor posture but undesired muscle tension is the result of either.