What Is TMJ Syndrome ?
TMJ actually stands for Temporo-mandibular-joint. Temporo = The temporal bone of your skull that receives your lower jaw bone. Mandibular = Lower jaw bone that fits into the Temporal bone. Joint = The connective tissue (ligaments, disc, muscles) that connect the mandible and temporal bones. Technically you have two TMJ's, one on each side of the face.
What most people are thinking of when they ask the question "Do I have TMJ ?" is do they have a problem with their jaw joint. Pain and problems arising from the TMJ are actually termed TMD. TMD stands for Temporo-mandibular-disorder. I know this seems like a pretty small point, but it can be confusing, especially if you start doing web-searches for painful conditions of the your TMJ.
There are several painful conditions that can refer pain to the jaw area even though the pain is not actually coming from the TMJ . The most serious one is emerging heart attack pain from compromised arteries in and about the heart. Another example of pain in and about the TMJ that is not actually coming from it would be a tooth infection. We will talk more about self tests and how to determine if you have TMD / TMJ in the next newsletter.
TMJ pain / TMD typically is divided into three categories:
Arthrogenic = Pain emanating from the bony connection of the joint. This is things like arthritis, and joint restriction / dysfunction (the same thing occurs commonly in the spine, and is often why a chiropractor adjusts your back).
Myogenic = Pain emanating from the muscles responsible for moving your jaw up down and sideways, as well as the muscles that stabilize your tongue for swallowing. This is things like Trigger Points (focal areas of tightness in a muscle) or spasm (when the entire muscle contracts and locks down) or something called inhibition (when a muscle shuts down and stops working).
Neurogenic = Pain emanating from the main nerve to the face, the Trigeminal Nerve. This one is actually involved in the first two (after all nerves go to muscles and joints !) as well. However Neurogenic pain coming from the jaw usually is related to compression or friction on the Trigeminal Nerve as it exits your skull right behind your mandible (lower jaw).
What's The Bid Deal With TMD / TMJ ?
If you aren't currently experiencing pain or limitation in your jaw or face, there is a good chance you don't have anything to worry about. If you are dealing with a problem in your TMJ joint (TMD) then you may have one or more of the following: Pain at the TMJ (usually described as just in front of the ear) Pain along the jaw line Limited and or painful opening of the mouth Clicking or popping of the mouth when talking or chewing "Tracking" issues when opening the mouth (jaw shifts to one side)
Other problems that can arise from a TMD (but may not be exclusive to it) are things like: headaches, crackling in the ears, fullness in the ears, snoring, neck pain, balance issues, pain in and about the face other than the jaw line, Trigeminal Neuralgia (very intense pain along the course of a nerve in the face), grinding the teeth at night and stress and anxiety.
TMD can on occasion come on suddenly (usually with a trauma) but more often gradually occurs over time. Stress, excessive gum chewing, tooth malposition, erupting wisdom teeth and developmental issues from birth have have all been implicated as causes. Usually these are quickly ruled in or out by a good history and examination. More often than not, it is not possible to identify a single cause for this condition.
How Does Technology Syndrome Impact My TMD / TMJ ?
If you look at the gentleman in the picture above (no it actually isn't me) you can note several things. First, normal posture would be the head balanced directly over the shoulders, the phone shifts the skull mass (head) forward. Second, in order to look down at his screen, the skull mass (head) is angled down, this is easy to tell by comparing the arm of his glasses to the horizontal. Finally, in order to balance the head going forward, the upper back is forced to push back and this ends up rounding his shoulders. This is commonly termed Forward Head Posture (FHP), and has been related in the literature to neck pain, carpal tunnel and headaches. In addition FHP can cause stress and strain on the muscles in and about the head and neck, and start to pull the jaw back into its socket, compressing the sensitive nerve (Trigeminal Nerve) that sits right behind it. Over time this can irritate the muscles around the jaw, as well as the ligaments and disc that make up the Jaw joint. This causes inflammation, spasm and eventually can lead to arthritic changes. In a recent article (2020) from the Journal of Dental and Medical Sciences the authors have related FHP to Neck and TMD issues. They conclude:
"On the basis of findings of present study, we can conclude significant relationships between temporomandibular dysfunction, forward head posture and self reported severity of neck pain in patients with neck pain and TMJ dysfunction. "
Translation: When your head is bent forward looking at your phone or computer, your neck and jaw are probably not going to be happy, and eventually will start to let you know! In summary: You have two TMJ's, one on each side of your face. They are made up of the bones of your skull (Temporal Bone), your jaw bone (Mandible) and the disc's ligaments and muscles that connect the two and allow movement. When you lose the ability to open and close your mouth smoothly it can irritate the muscles, discs and nerves in your jaw leading to pain and limitation of movement as well as a variety of other symptoms collectively called Temporal Mandibular Disorder (TMD). While there are a lot of different causes for TMD an emerging one is related to the postures we end up in (sometimes for hours at a time) secondary to the technology we use (phones, computers, etc.).
Next week we will cover some quick self tests you can do to determine if you have TMD.
Yours in Health,