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Temporomandibular Joint (TMJ) Dysfunction is a disorder of the joint where the jawbone meets the skull or the muscles surrounding that region. People suffering from TMJ Dysfunction complain of popping or locking in the jaw, pain in the face with eating or opening the mouth, and headaches. TMJ Dysfunction can be further classified into joint dysfunction, myalgia, or a combination of dysfunction and myalgia. Myalgia is simply defined as intra-muscular pain. Pure joint dysfunction of the TMJ involves popping in the jaw, pain coming from joint structures (bone, cartilage, disc, ligaments, joint capsule), and a predictable and measureable loss in mouth opening or closing range of motion. Myalgia in the TMJ region relates to inflammation and dysfunction in the muscles surrounding the TMJ. These muscles can cause local facial pain, neck pain, headaches, and changes in how the jaw is actively moved. Combined joint dysfunction/myalgia of the TMJ is the most common presentation and can include all of the elements in the individual disorders previously described.
It is important to explain some the underlying reasons for TMJ dysfunction. The most obvious cause is a serious blow to the face or jaw, disturbing the normal biomechanics of the joint. However, more common causes include chronically poor posture, stress-induced grinding of the teeth or clinching the jaw, malocclusion of the teeth (high or low tooth), and neck pain or trauma to the spine. My experience has been that over 90% of patients that I treat, with the diagnosis of joint dysfunction or myalgia of the TMJ, present with dysfunctions of the neck. These patients require a careful evaluation of the neck and treatment that includes joint mobilization or manipulation, soft tissue massage, and exercise to improve posture and restore pain-free jaw active range of motion.
As with any orthopedic problem, the most important step in treating TMJ Dysfunction is to obtain the proper diagnosis by a specialist. Some physical therapists, dentists, and medical doctors are specialty trained in TMJ Dysfunction. Myalgia is the easiest presentation to resolve and treatment can involve simple self-massage exercises, range of motion exercises, nonprescription anti-inflammatory medication, and ice/heat to the face. Treating joint dysfunction of the TMJ involves exercises to re-educate joint motion and fabrication of an oral appliance (acrylic splint) to fit over the teeth, altering joint motions and forces. I would suggest that only specialist dentist fabricate an oral appliance. These devices are expensive and often have to be remade when a dentist who does not understand the intricacies of TMJ fabricates them. Combined joint dysfunction/myalgia requires the combination of treatment approaches.
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