Help! My Jaw is Killing Me
TMJ PT or TMJ Doctor?
Should You Call the PT or the MD for Jaw Pain?
If you’ve ever suffered from tightness, popping, or pain in your jaw joint known as the temporomandibular joint (TMJ), then you may be familiar with a condition called temporomandibular joint dysfunction (TMD). According to the American Academy of Family Physicians, up to 15% of adults experience TMD with peak incidence occurring between the ages of 20 and 40 years old. In this article we will examine this condition further and discuss how to determine if seeing a TMJ physical therapy practitioner is appropriate or if a visit to a physician is needed.
WHAT AND WHERE IS THE TMJ?
The temporomandibular joint is located in front of the ear on each side of the face. It is the connection between the mandible or jaw bone and the temporal bone of the skull. It works a little like a hinge and a little like a ball-and-socket joint. The two joint surfaces are separated by an articular disc and surrounded by fibrocartilage. Several ligaments stretch between the skull and the jaw bone to stabilize the TMJ. Muscles of the face and neck allow you to protrude and retract your jaw and elevate and depress it to open and close the mouth.
WHAT DOES TMD FEEL LIKE?
Dysfunction of the TMJ can be caused by problems both within and outside the joint. Common symptoms include facial pain, jaw pain or soreness, jaw fatigue, earache or ringing in the ears. Additionally headache, popping of the joint, locking of the jaw, teeth sensitivity without dental issues, limited mouth motions, and changes in the way the teeth fit together can occur. Often these symptoms are more pronounced upon waking up and in the late afternoon.
WHAT IS THE CAUSE OF TMD?
The cause of TMD is often thought to be multifactorial. Biological, environmental, emotional, social, and cognitive triggers for TMD exist. The incidence is higher in persons diagnosed with other conditions such as autoimmune conditions, sleep apnea, mental illness, or fibromyalgia. TMD can be the result of arthritis in the TMJ or from displacement of the articular disc. Jaw or facial fractures and surgery of the face or jaw may lead to TMD in some persons. Also problems with teeth alignment (malocclusion) and frequent jaw clenching (bruxism) can trigger TMD. Even poor posture habits can lead to TMD if repeated frequently.
SHOULD I GO STRAIGHT TO MY PHYSICAL THERAPIST?
Many physical therapists are trained in the assessment and treatment of TMD. Physical therapy has been shown to be effective in reducing pain and restoring motion to the jaw in many cases. It also has the benefit of teaching you how to manage the symptoms on your own if it recurs in the future. In some states you can schedule an evaluation with a physical therapist without a referral from a physician. Outside of those states you will need to see your physician first for a referral.
Since physical therapy is a great option for managing your TMD, let’s take a look at some of the treatments offered by physical therapy to manage TMD symptoms:
Postural re-education: Poor posture including a forward head position and rounded shoulders can contribute to increased stress on the muscles around the jaw and on the TMJ. PT will assess for any postural abnormalities and teach you how to be aware of them and begin to correct them.
Manual Therapy to improve jaw mobility: Restoring the normal motions and mobility of the TMJ and jaw can be done through gentle hands on techniques either outside of the mouth or sometimes from inside the mouth.
Strengthening Exercises: Exercises to strengthen the muscles around the jaw and neck can be very helpful in reducing symptoms of TMD, improving jaw range of motion, and reducing the likelihood of recurrence.
Dry needling, ultrasound, electrical stimulation: Your therapist may choose to apply these modalities to manage your pain and inflammation
WHEN DO I NEED TO SEE MY DOCTOR?
If these symptoms are new to you it is always a good idea to visit your primary care physician or dentist and update them on how you are feeling. While we know that TMD is fairly common, it is not the only condition that can cause jaw pain or discomfort. Here are some other conditions that may mimic TMD but need evaluation and treatment by a physician or dentist:
Cluster headaches: one of the most painful types of headaches, a cluster headache often causes pain around or behind one eye but it can also radiate pain into the jaw.
Sinus infection: infected sinuses can cause pressure on the jaw joint causing discomfort and pain. Unlike TMD, however, sinus infections are often accompanied by congestion, facial pressure or pain, runny nose, throat irritation, fever, or tenderness over the sinuses.
Tooth Pain: Dental abscesses in a nearby tooth can cause pain to radiate into the TMJ and jaw. Sensitivity to chewing or biting, tenderness of the lymph nodes in the neck or jaw, and fever are other symptoms of a tooth abscess.
Trigeminal Neuralgia: pressure or compression on the trigeminal nerve that is responsible for sensation in the upper and lower jaw area can mimic TMD to some degree. Numbness or tingling on one side of the face, pain in front of the ear, one-sided tooth pain, and electric-like shooting pain on one side of the face or jaw is common with this condition.
Heart Attack: The most serious and emergent condition listed here, some people will experience sudden-onset jaw pain during a heart attack. If you are experiencing jaw pain along with other symptoms such as chest pressure or pain, shortness of breath, lightheadedness, cold sweats, nausea or vomiting, or a sense of impending doom, call 911 immediately.
Certain treatments may be prescribed by a physician or dentist that cannot be provided by a physical therapist to treat TMD symptoms. These may be necessary if you are experiencing severe symptoms interfering with eating or physical therapy treatments have not been successful. Here are some examples of these types of treatments:
Medications: anti-inflammatories, muscle relaxants, or low-dose tricyclic antidepressants may be prescribed for pain management
Imaging: Imaging such as X-rays, CT Scans, or MRI may be recommended if a more in depth look at the TMJ is recommended
Oral splints or mouth guards: These devices are typically worn at night to minimize teeth grinding and bruxism which may be causing increased muscle tension and jaw pain.
Surgical intervention: Various surgical options exist to address different causes of TMD. These may be recommended if conservative care has failed to successfully treat your symptoms.
Corticosteroid joint injections: used to reduce local inflammation
THERE IS HELP OUT THERE FOR YOU
After reading this article we hope you have a better understanding of how doctors, dentists, and physical therapists can treat your TMD symptoms. If you haven’t had the opportunity to try physical therapy, it is a great option to improve your symptoms and educate you on how you can manage your TMD symptoms in the future. If you have been suffering with symptoms of TMD, the physical therapists at Evolve are ready to help restore better jaw movement, provide symptom relief, and give you something to smile about.
Click here for more information about TMJ/TMD treatments or if you are in need of immediate need of physical therapy for TMJ/TMD
About EvolveNY-
Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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