Hello and welcome! We are happy to be returning after a long hiatus from the blog while we worked on other projects. This month we are discussing TMJD (Temporomandibular Joint Disorder).
Temporomandibular joint disorder is an umbrella term that refers to the dysfunction of the temporomandibular joint often accompanied by pain, clicking, and limited range of motion in one or both of the joints and in the muscles that control jaw movement.
The exact causes are difficult to determine. Unless, of course there has been a direct impact to the jaw. TMJD can originate from chronic clenching the jaw muscles often associated with stress and an obstructed airway. There can be arthritic changes in the joint, or there can be dysfunction of the disc that cushions the joint. Other contributing factors can be postural, such as forward head posture that is a common consequence of working on a screen. Forward head posture also occurs when nasal passages are blocked and patients compensate by mouth breathing, awake or asleep.
Incidences of TMJD are higher in women than men, perhaps related to estrogen’s relationship to inflammation and more lax ligaments. If the ligaments that attach to the disc that cushions this joint are lax it may cause the disc to be displaced. The clicking sound upon opening that patients often remark about can be attributed to a displaced disc finding its proper place albeit with a delay upon opening the mouth.
Patients may seek medical attention for complaints such as:
Chronic headaches above the eyes and around the temples upon waking in the morning
Chronic sinusitis that is unresponsive to antibiotics
All of these phenomena can be associated with TMJD, once other more serious pathologies are ruled-out. Other telltale signs of TMJD and chronic clenching are fracturing of teeth, wearing down of teeth, and receding gums which your dentist and hygienist will bring to your attention.
The good news is that TMJD is self-limiting and the joint is extremely adaptive. Unlike other joints in the body, the temporomandibular joint surfaces are covered by connective tissue that resists degeneration and has a greater capacity to regenerate itself. If the postural, muscular, and behavioral conditions that contribute to the mechanical factors that increase joint pressure can be alleviated, the cartilage cells will reproduce a cushioning layer.
Conservative and reversible measures to treat TMJD are the first choice. Among reversible interventions is the use of:
Occlusal splints great for reducing tension and decreasing muscle activity.
Soft food diets
NSAIDS, muscle relaxants
OMT (Osteopathic manipulative therapy)
Oral Myofunctional therapy
Self-care, education, and relaxation training
Biofeedback- Painless sensors are used to measure a particular bodily function
Non-reversible interventions are: occlusal adjustments, orthodontic treatment, prosthetics, and surgery.
Acupuncture and massage therapy can help patients manage stress, and reduce inflammation, pain, and muscular tension around the jaw, neck, and shoulder girdle. Treatment aims to increase awareness and to offer strategies to address behavioral, postural, and occupational habits that contribute to jaw tension.
Self-care strategies for TMJD:
Allow your tongue to gently lift and fill the roof of your mouthany time you are not talking or eating. Be sure not to thrust your tongue against your front teeth. Gently allow your lips to meet and breathe through your nose. This will alleviate mechanical pressure on the temporomandibular joint, increase salivation, and stimulate a relaxation response. (If you have difficulty breathing through your nose, enlist in the help of nasal strips.)
To center your temporomandibular joint, maintain the tongue on the roof of the mouth. Then lower and raise the jaw 5 times. Wait a few minutes and repeat. In the car or in bed on a sleepless night are perfect opportunities for this practice.
James Nestor, author of the book “Breath” goes in to great detail about the consequences of mouth breathing. One of which is clenching. It was a hard sell, but thanks to Nestor I tape my mouth nightly before going to bed. I no longer wake up with a dry mouth, sore jaw, or stiff neck. Like most people once asleep, my jaw drops open and I breath through my mouth. My tongue drops back, partially obstructing my airway. In an effort to breath more fully I throw my head back and my jaw clenches, all while asleep mind you. A simple piece of tape can break this chain reaction.
In our blog we usually include a couple of recipes that we have researched and made in our kitchen. Below are the recipes we chose for this blog. The slow cooker pumpkin soup is a puree soup and the no bake cranberry white chocolate cheesecake is also kind to a TMJD sufferer. Both the pumpkin flavor of the soup and the sweetness of the cranberries are perfect for fall and the upcoming holidays! So TMJD sufferers you don’t have to worry about how you can participate or enjoy the holidays. These recipes will help get you through.
Lazy Slow Cooker Pumpkin Soup
¼ cup brown sugar
1 small onion, diced
2 tablespoon minced garlic
1 teaspoon ground ginger dried
1 scant tsp cumin
½ teaspoon turmeric
4 cups vegetable broth chicken broth works as well
salt and pepper (to taste)
half and half or coconut cream 2 tbsps or so for each individual bowl.
Place slow cooker liner in slow cooker, if using
add pumpkin puree, brown sugar, garlic, onion, ginger, cumin, and turmeric to slow cooker and stir to combine
add stock and mix well to fully combine
cover and cook on low for 6-8 hours (or 3-4 on high)
to serve, add salt or pepper if needed (I don’t generally need any, but it is a personal preference)
when adding pumpkin soup to bowl, add two tablespoon or so half and half (or coconut cream to keep it dairy free) to each bowl.
Nutritional values have been calculated using veggie broth and coconut cream.
If you aren’t a fan of cream or coconut cream, this soup is delicious served without it as well.
This blog is not intended to give or replace medical advice. If you suffer from any of these symptoms, please contact your healthcare provider.
As always, be safe and well.
Cuccia, A. M., Cardonna, C., Annunziata, V., Cardonna, D. (2010). Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular joint disorders: A randomized controlled trial. Journal of Bodywork and Movement Therapies, (14), 179-184. Doi: 10.1016/jbmt.2009.08.002
Cuccia, A. M., Cardonna, C. Cardonna, D. (2011). Manual Therapy of the mandibular accessory ligaments for the management of temporomandibular joint disorders. The Journal of the American Osteopathic Association,
Maixner, W., Diatchenko, L., Dubner, R., Fillingim, R.B., Greenspan, J.D., Knott, C., Orbach, R., Weir, B., Slade, G. (2011). Orofacial pain prospective evaluation and risk management study – the OPPERA study. The Journal of Pain, 12(11), T4-T11.e2.retrieved from the site of the journal: http//www.jpain.org/article/S1526-5900(11)00719X/fulltext
Nicolalis, P., Erdogmus, B., Kopf, A., Djaber-Ansari, A., Pieslinger, E., & FlalkaMoser, V. (2000). Exercise therapy for craniomandibular disorders. Archives of Physical Medicine and Rehabilitation, 81(9), 1137-1142.