6 February 2020

Jaw Pain – Could it be TMD?

Jaw pain, or “temporomandibular joint” pain is usually related to a temporomandibular joint dysfunction, the symptoms of which may present in a number of different ways. As chiropractors we are primarily known for treating back and neck conditions and few people know that we can also help with other MSK (musculoskeletal) problems. If you are uncertain about a pain in your jaw region, or if it is a new pain, you may also want to consult your GP or dentist to obtain a diagnosis. It affects people more often aged 20-40 years of age and further down in this blog we discuss the symptoms and potential causes of this condition.

Anatomy of the temporomandibular joint

The temporomandibular joint is known as a “bi-arthrodial hinge joint” which allows the for a variety of different movements, such as: breathing, eating and articulating words/sounds whilst talking. The Jaw itself consists of your jawbone (mandible), an intra-articular disc and the mandibular fossa (the “cup” that the jawbone sits which is located on the side of the skull). To provide stability to the temporomandibular joint and hold it together, you have a complex variety of soft tissues, which include muscles, tendons and ligaments.

There is also a small disc located within the temporomandibular joint, that is a fibrous extension of the capsule, located between the two surfaces of the joint itself. The disc lies close to the mandibular fossa (the cup of the joint) and the condyle (the end of the bone) of the jawbone beneath it. The disc has two sections, each with its own membrane. The front part of the disc attaches to the joint capsule and the top section of a cranial bone called the “lateral pterygoid”. The back portion of the disc attaches to the mandibular fossa (the cup that the jawbone sits in). The tissues located behind the disc have a blood supply, along with plenty of nerve endings, which make it a sensitive area when irritated; this is also the area most likely to be involved with pain arising from a temporomandibular disorder.

There are several ligaments that passively help to support and keep the TMJ in place and some of these ligaments have connections with the middle ear. It is possible that some cases of tinnitus (a ringing or high pitch sound), may have a correlation with TMD (temporomandibular dysfunction) in certain individuals.

The jaw is supplied by two sets of nerve endings, and originate from nerves called the “trigeminal nerve” and “facial nerve”, whilst both these are derived from a group of twelve nerves, that are called your cranial nerves. The cranial reference means these nerves originate from your cranium, or your skull bone as we would usually refer to it as.

Your Trigeminal nerve is the larger of the two nerves and as the name would suggest, it has three branches to it. The first branch is named the ophthalmic branch, which is involved with providing sensation to the upper face, nose and front/top of the head. The second, named the maxillary branch, provides sensation from around the nose, top row of your teeth and the middle portion of your face, whilst the third branch is called the “mandibular branch” and is different to the other branches. The mandibular branch supplies a combination of both sensation and motor fibres (fibres that control muscle contraction) to the jaw itself. The mandibular nerve provides sensation to the jawbone, the overlying skin of the fleshy part of the cheek, and lower lip. Additionally, there is nerve supply to the muscles involved in chewing and part of the inner ear, that helps to dampen certain sounds, like those produced with chewing for example.

It is important to note, that although a rare (and very painful condition), “trigeminal neuralgia” is a condition involving pain from the trigeminal nerve that can sometimes that can sometimes present similarly to TMD and its symptoms. For more information about this please check out the link to the NHS website. https://www.nhs.uk/conditions/trigeminal-neuralgia/

Some common TMD related symptoms:

Jaw or facial pain
Increased pain in the jaw whilst chewing
Feeling a locking or a catching sensation in the jaw whilst opening and closing the mouth
Reduced motion when opening the mouth, accompanied by a clicking, grinding or popping sensation
Headache, earache and neck pain may accompany the jaw dysfunction
A history of trauma to the jaw or dental problems, that may cause alterations in chewing habits

Multiple potential causes of of TMD (temporomandibular disfunction):

Hypo-mobility of the TMJ where the TMJ moves too little
Hyper-mobility, where the jaw joint moves too much or is unstable
Muscle spasm affecting the muscles involved in chewing
Trauma to the jaw
Psychological stress, this can lead to clenching of the jaw
Bruxism (grinding of teeth), that may be related to stress, or taking stimulants such as coffee and smoking , that may happen at night
Poorly fitting dentures or a range of dental conditions
Underlying deterioration of the articular disc within the joint
Synovitis, or inflammation of the joint or surrounding tissues
Osteoarthritis
Rheumatoid arthritis

With regards to tackling these issues, the first step is to obtain a diagnosis by consulting an appropriate healthcare professional. This may be a chiropractor, GP or dentist, but often health professionals will inter-refer if we feel another opinion is warranted. As chiropractors, we will initially discuss your history and details around your current condition, that is often followed by a physical examination. Often, patients we see with this condition have already seen their dentist, but sometimes an analysis of your bite and dental alignment is indicated.

With certain cases of TMD, chiropractors are able to use a range of manual and rehabilitation techniques to try and help improve the function of the muscles and various tissues around the joint, as well as giving some practical advice. It is important to note that everyone is assessed individually and treatment administered on a case-by-case basis, as evidence for treating these conditions with manual therapy is fairly limited or poor. If we opt for a trial course of therapy, a progress review will be set within a short space of time to determine how well you are responding to the treatment, and there are cases where we may refer back to dentist for a second opinion or, to consider further investigations in the form of X-ray or MRI scanning.

If you would like to consult with one of our chiropractors at Skelian and discuss your jaw complaint with us, please contact the clinic on 01242 254000, or visit our website at www.skelian.co.uk