Have you ever experienced clicking in the jaw when eating, pain around the ears, headaches or difficulty fully opening your mouth? You might notice that your jaw is stiff in the mornings or that you clench your teeth unconsciously in times of stress.
These symptoms may be related to a condition known as temporomandibular disorder (TMD), which affects the temporomandibular joint (TMJ) and the muscles responsible for controlling the movement of the jaw.
What is the temporomandibular joint (TMJ)?
The temporomandibular joint (TMJ) is the joint that connects the lower jaw (mandible or lower maxilla) to the skull and is located just in front of each ear. We have two temporomandibular joints, one on each side of the face.
These joints are essential for performing everyday activities such as:
-> Eating and chewing.
-> Speaking.
-> Yawning.
-> Swallowing.
-> Opening and closing the mouth.
What are the most common symptoms of temporomandibular disorders?
Temporomandibular disorders can manifest differently in each person. Some people experience mild discomfort, while others develop persistent pain that interferes with their daily activities.
The most common symptoms include:
- Jaw pain: Pain around the jaw joint, cheeks, or temples, which sometimes increases when chewing or talking.
- Facial and cervical pain: Tension and sensitivity in the jaw muscles may occur along with discomfort in the neck and surrounding areas.
- Clicks or cracks: Some people hear clicks or cracks when opening or closing their mouth.
- Difficulty in opening the mouth: You may feel stiffness in the jaw or notice that you cannot open your mouth as wide as usual.
- Headaches: Pain around the temples or forehead may accompany temporomandibular disorders, especially when the muscles responsible for jaw movement are sensitive.
- Ear-related symptoms: Some people experience pain around the ears, a feeling of pressure, or tinnitus (ringing in the ears).
What are the causes of temporomandibular disorders?
There is rarely a single explanation for temporomandibular disorders. In many cases, various biological, physical, and psychological factors may contribute to the onset or persistence of symptoms.
Some of the factors that may contribute are:
- Grinding and clenching teeth: Repetitive or sustained muscle activity can contribute to fatigue of the jaw muscles, as well as sensitivity and discomfort in some people.
- Stress and muscle tension: Stress and emotional tension can influence muscle activity and sensitivity to pain. Some people notice that they clench their jaw more frequently when they are focused, working or going through stressful situations.
- Joint and disc disorders: Changes in the joint or in the articular disc can contribute to the onset of certain temporomandibular disorders.
- Trauma or previous injuries: An injury affecting the jaw, face or neck can contribute to the development of temporomandibular symptoms.
- Cervical and postural factors: The jaw, head and neck are functionally connected. Some people with temporomandibular disorders also experience cervical pain, decreased neck mobility or increased muscle sensitivity.
How can physiotherapy help with temporomandibular disorders?
Physiotherapy can play an important role in the conservative treatment of many patients with painful temporomandibular disorders, especially when symptoms affect the jaw muscles, there are movement limitations or associated cervical pain is present.
The main objectives of physiotherapy are to reduce pain, improve jaw mobility, restore normal function and help patients manage their symptoms independently.
Different techniques used during the physiotherapy treatment
1. Manual therapy
It consists of manual techniques that can be used to treat pain, sensitivity, and restrictions in movement.
- Gentle soft tissue techniques aimed at the jaw muscles.
- Massage of the masseter and temporal muscles.
- Appropriate joint mobilisation techniques.
- Techniques aimed at treating associated cervical discomfort.
2. Therapeutic exercises
Specific exercises to improve mobility, coordination, and functioning of the jaw.
3. Patient education and muscle awareness
Helping the patient recognise and control jaw tension habits, such as unconsciously clenching their teeth, and learning strategies to relax the jaw muscles.
References:
- Schiffman E, Ohrbach R, Truelove E, et al. (2014). Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. Journal of Oral & Facial Pain and Headache, 28(1), 6–27.
- Busse JW, Casassus R, Carrasco-Labra A, et al. (2023). Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline. BMJ, 383, e076227.
- Armijo-Olivo S, Pitance L, Singh V, Neto F, Thie N, Michelotti A. (2016). Effectiveness of manual therapy and therapeutic exercise for temporomandibular disorders: systematic review and meta-analysis. Physical Therapy, 96(1), 9–25.
- List T, Jensen RH. (2017). Temporomandibular disorders: Old ideas and new concepts. Cephalalgia, 37(7), 692–704.
- Ohrbach R, Dworkin SF. (2016). The evolution of TMD diagnosis: past, present, future. Journal of Dental Research, 95(10), 1093–1101.
