temporomandibular joint disorders (TMD) and Orofacial Pain

The most common cause of facial pain is Temporomandibular Joint Disorder, known as TMD. It is caused by dysfunction of the masticatory (chewing) muscles, and derangement within the temporomandibular joint.

Problems within the Temporomandibular Joint (TMJ) present as:

  • Clicking/Popping of the jaw

  • Locking of the jaw (either open or closed)

  • Catching of the jaw

  • Snapping in the joint

Common signs and symptoms of TMD

  • Pain on chewing

  • Pain on opening

  • Facial pain

  • Tingling in the face

  • Chronic headaches

  • Sleep concerns

  • Neck/shoulder pain

  • Diziness

  • Tinnitus (ringing in the ears)

  • It may present as ear pain, stuffy ears or reduction in hearing

  • It may present as tooth pain

Common causes of TMD

  • Bruxism (habitual involuntary tooth grinding)

  • Clenching of the teeth (both clenching and grinding can be caused by various medications)

  • Tongue-tie

  • Trauma to the jaw, head or neck (whiplash/heavy blow)

  • Incorrect chewing patterns

  • Oral habits (nail biting/lip chewing/biting on objects)

  • Habits like resting your chin on your hand, or holding your phone to your ear with your shoulder, or sleeping on your stomach

  • Autoimmune conditions such as arthritis or other inflammatory conditions

  • Postural issues

  • Stress

  • Sleep disorders

  • Genetics

  • Age related degeneration

  • Poorly aligned occlusion (where your teeth don’t bite correctly together)

Pain can range from mild to extremely severe and debilitating, and onset can be slow over time or sudden.

TMD is most common in the 20-40 age range, with women four times more likely to suffer than men.

Whilst its possible to get temporary relief from TMD by using simple treatment such as massage, heat/ice, and over the counter non-steroidal-anti-inflammatory medications (NSAIDS) unless you deal with the root cause of the problem there is potential for your condition to worsen over time, becoming chronic.

How can Orofacial Myofunctional Therapy help TMD suffers?

This study from Brazil shows that orofacial myofunctional therapy can make a significant different to TMD as it restores correct function of the orofacial muscles enabling the TMJ to function correctly, therefore reducing pain.

This study indicated that Orofacial Myofunctional Therapy can reduce pain levels, increase the mandibular range of motion, and reduce the frequency and severity of the signs and symptoms of TMD

Effective treatment of TMD involves starting at the start, rather than looking at the symptoms. Because TMD is caused by dysfunction of the masticatory (chewing) muscles it is important to address how these muscles are functioning, with the aim of restoring correct oral resting postures, with the goal to eliminate the pain and discomfort associated with TMD.

We work in conjunction with airway centric Dentists, Physiotherapists, Chiropractors, Maxillofacial specialists, and in some cases Orthodontists because TMD is usually a multifactorial condition.

bruxism/tooth grinding

Bruxism is the involuntary clenching, grinding and gnashing of the teeth. Sleep bruxism is considered a sleep-related movement disorder, and can be associated with other sleep disorders, such as Sleep Disordered Breathing and Obstructive Sleep Apnoea. It is often multifactorial.

The forces exerted on the teeth are much higher during clenching and grinding than with chewing, and cause a tightening of the muscles of mastication. This muscle tightening is often responsible for facial, head and neck pain which can be misdiagnosed by health professionals.

It is important to note that bruxism is a symptom, not a diagnosis.

Risk Factors for Bruxism

  • Airway/Breathing issues

  • Sleep Disordered Breathing

  • Low Iron

  • Reflux

  • Tongue Tie

  • Psychological

  • Occlusive issues (where the teeth don’t bite correctly together)

  • Some medications

Signs and Symptoms of Bruxism

  • Headaches

  • Ear pain

  • Pain in the jaw joint

  • Clicking/Popping/Catching/Locking of the jaw

  • Tooth wear/cracked teeth/broken restorations (fillings)

  • Sensitive teeth

  • Exotoses of the jaw bones (bony lumps)

  • Facial/head/neck pain/stiffness

  • Aching or stiffness of the jaws when chewing/sore jaw muscles

how Orofacial Myofunctional Therapy (OMT) can benefit bruxism sufferers

Bruxism during the day (clenching and/or grinding) can contribute to sleep bruxism. These abnormal daily functions create neural pathways (behavioural patterns) that then can occur during sleep.

OMT works to restore correct oral resting posture and adequate freeway space (back teeth shouldn’t be touching at rest, they should be a few mm apart). It also provides awareness of the habit. Strategies are then implemented to reduce (with the aim to eliminate) bruxism. An orofacial myology assessment will look to the cause of the bruxism (because remember, the bruxism/grinding is a symptom).

If you grind your teeth and have tooth wear, you may have been prescribed a night guard by your Dentist. Its important to note that a night guard is not working to prevent the bruxism, its purely there to protect the teeth from dental wear and cracks. A night guard is a band aid.

Orofacial Myology looks to “Start at the Start”, and delve into the why’s of the symptom (bruxism), with the aim to prevent dental wear, TMJ issues, and head, neck and facial pain. It should not just be about the teeth!