Temporomandibular disorder is a problem with the jaw joint that may be caused by a number of issues.
Our jaw joints are just in front of the ears and they allow our lower jaw to move as we talk, eat, breath and smile. Like any joint system, the jaw can develop problems including joint sounds, clicking and cracking, pain and limited movements.
We’re going to talk about the big picture of these issues, but first let’s talk a bit about the anatomy.
You have two jaw joints, one on each side and they allow the lower jaw to swing open as well as moving forward and from side to side. You can think of each of your jaw joint as a ball and socket joint, with an additional part between the ball and socket – a disc of tissue called… the disc.
This disk of tissue works to make each simple joint into a more complex system of really two joints on either side. With normal jaw joints, the disc stays between the ball and socket as the jaw moves around – and there’s no sound with a completely normal jaw joint. This disc is held into position by having a normal shape that fits the ball and socket and the disc is attached with ligaments and tissues to keep it in place as well.
Problems with the position and the movement of the disc come from changes in the shape of the disc and stretching and even tearing of the tissues that help to keep the disc in its normal position during those jaw movements.
When the disc doesn’t stay in its normal position between the ball and socket of the joint you can get joint sounds – clicking and cracking and in some cases the disc can get stuck in the forward position and the disc stops the jaw from opening all the way.
Depending on the position of the disc, you might be limited to a very small jaw opening, or one that’s almost normal.
So how can this happen to the disc? It's trauma to the lower jaw which distorts the disc and the supporting tissues.
There are two types of trauma – big trauma and little trauma. Big trauma is a blow to the jaw that tears and stretches the disc and the supporting tissues. This could be a sports injury, being hit in the lower jaw with your baby’s head, a wide yawn or many other things. Now we’re not so delicate that every blow to the jaw is going to do this, but the potential’s there.
Small trauma is the normal wear and tear of our lives – magnified. Clenching and grinding are not normal activities that your jaw joints are designed for and over time, they can lead to changes in the disc and jaw joint that lead to a less stable disc – clicking and locking.
Gum chewing and other habits are also part of this little trauma that can cause problems. Our jaw joints are designed to move throughout the day, but they’re not designed for chewing movements and pressure for hours on end. This overwork leads to problems.
Our bodies are designed to heal themselves and the TMJ is no exception. But once a jaw is clicking due to a disc that’s out of position, it’s common for that clicking to remain. The good news is that a clicking jaw joint can be annoying but it doesn’t necessarily lead to any more problems. One or both of your jaw joints can click for many, many years with normal movements and comfort.
And it’s not unusual for a clicking jaw joint to come and go – often coming on when you’re under some stress and clenching more than usual – such as at exam time – and then going away when you’re more relaxed.
Clicking is usually not painful, but it can be annoying – especially when it starts, when it tends to be louder. Clicking from big trauma tends to be louder and more annoying. But clicking jaw joints tend to soften and get quieter over time.
Clicking happens when the disc is ahead of its normal position and there’s a click as the ball clicks back onto the disc – its normal position as you open your jaw. And then there’s a second click – usually quieter – as the ball moves back off the disc, as you close again. So you get click, click, click, click.
Locking or sticking happens when the ball gets stuck on the disc and can’t slide back onto it – no click and you can only open part way. This is usually uncomfortable or painful as the disc is being stretched.
Now it can happen that you have occasional locking that comes and goes. If you clench a lot at night you may have more locking and sticking early in the day, which gets better later in the day. This locking can be momentary – lasting a few seconds, a few hours or days.
Many TMJ problems include pain and discomfort, which are related to the muscles that move the lower jaw, but also other muscles in the head and the neck. The neck is a very common source of problems. Tension in neck muscles can lead to headaches, tension in the jaw muscles and problems moving the jaw.
Tension in the jaw muscles can lead to tension and problems in the neck. Everything in the body is related and connected. Problems and tension in one area can lead to wider effects.
Finally the teeth or fit of your upper and lower teeth – the bite – can also play a role in TMJ problems. A poor fit of your teeth can lead to more stress on your jaw joints and muscles. And your brain can be uncomfortable with that fit of your teeth and this can lead to your brain starting more grinding and clenching as a reaction to that.
But there is a no direct relationship between the bite of your teeth and TMJ problems. You can have perfectly straight teeth and have TMJ problems and you can have a poor fit of your teeth with a healthy working jaw joint and muscles. However, there’s no question that some poor bites can stress the joints and muscles more and make problems more likely in the future. No one can predict that future for you.
Another normal factor is aging. What doesn’t bother you in your teens and twenties may overwork the muscles and joints when you’re older.
So what’s the take-away from all this? And what can you do to avoid and heal TMJ problems? The biggest factor for many people is small trauma – grinding and clenching of your teeth – which we call parafunction. This is jaw activity that isn’t necessary for life and health. Chewing is the most stressful thing for your jaw joints, but normally only happens maybe 30 or 60 minutes spread out over the day – time spent actually chewing.
Grinding and clenching your teeth, including gum chewing and other habits, can be the biggest factor by far in TMJ problems. I’ve seen people who have major discomfort, with pain and clicking that goes away when they stop the gum chewing or cut back. Chewing smaller and softer pieces of gum for shorter periods is much better for your jaws than chewing a big wad of bubble gum for hours.
A night guard from your dentist can also help a lot if you’re grinding and clenching at night. Eating softer food and smaller pieces, requiring less chewing, will help your joints and muscles recover and heal.
Physiotherapy is an excellent treatment for TMJ problems because physios are experts in joint and muscles and these problems so often involve the neck and more distant parts of your body.
Physiotherapists can also help you with habits in your jaw and head posture.
Chiropractors are another resource that can help with these problems.
Your body is designed to heal itself and with some rest and reducing the stresses on your TMJs and muscles, it’s common to see a real improvement. And often back to normal or very close.
We’re all under stress at various times in our life and the TMJs can be a focal point of that stress in some people. Stress reduction and relaxation can be an important part of the healing process.
Problems can develop in the TMJs and often in the muscles around it. But conservative management can promote the natural healing to bring back your comfort.
Braces and straightening your teeth can be a part of this. But reducing habits, which stress the TM joint and muscles are the biggest part of encouraging this healing.
Your dentist is the best overall guide to TMJ problems as well. Orthodontics can play a role as well, but it’s not the first thing to consider if your primary problem is TMJ issues or TMD.
I’m happy to give you my opinion, but braces are not the primary way to heal these issues. When braces make sense, we’re here for that.