Temporomandibular disorder or TMD is a broad term referring to problems with the jaws and their functioning. It is commonly referred to as "TMJ". This system is very complex and problems are caused by a variety of factors.

Therapy is one of only a few ways of treating TMJ disorder. It must be noted that this is a treatment to relieve symptoms, not a cure for the cause of the disorder. The problem is that there is not an instant cure for TMJ syndrome. Treatment takes time and dedication for it to work. Physical therapy is often used in conjunction with other TMD treatments in order to get the best possible results in the shortest amount of time.

The temporomandibular system consists of three basic components:

TMJ:  This is the term often used to describe TMD, but it specifically refers to the joints that work your lower jaw, or mandible. These two joints are found just in front of the ears. Their close proximity to the ear is why some patients experience ear symptoms and can often hear the joint pop. These two joints never act alone, that is, when your jaw functions, both joints will be working. There is a small cartilage disc between your lower jaw and skull in the joint. Some TMD problems are caused by dysfunction of this disk. When healthy it acts as a sort of "shock absorber" for the joint.

Teeth:  The teeth are like the third leg of a tripod, the TMJs being the other two legs. The alignment of your bite and the functioning of the TMJs are intimately connected. Problems in any of the three areas may affect the other two.

Neuromuscular:  This system is the nerves and muscles which work the temporomandibular system. It is important to realize that only the lower jaw, or mandible, moves during jaw function. The upper jaw, or maxilla, does not move; it is firmly attached to the skull. Therefore, the nerves and muscles are involved in moving the lower jaw only. The nerves transmit the messages for the muscles to move the jaw. They also transmit pain signals to the brain causing you to feel discomfort. The muscles are fairly large and are found from the side of your head down to your neck. Other related muscles that do not specifically work the jaw, but are sometimes symptomatic are found in the neck, face, and upper back.

• Jaw pain and/or stiffness
• Headaches, usually at the temples and side of head
• Vague tooth soreness or toothaches which often move around the mouth
• Sensitive teeth
• Painful or tender jaw joint
• Difficulty opening your jaw
• Pain and fatigue when eating hard or chewy foods
• Clicks, pops, or grinding sound in jaw joint
• Ear pain
• Cervical neck tension and pain
• Tooth wear
• Awareness of grinding/clenching teeth while sleeping or awake (Bruxism)
• A pattern of breaking or cracking teeth with no cause (i.e. tooth decay or trauma)
• A history of medically diagnosed migraine headaches (common incidence of concurrent TMD)

Treatment plans for TMD are as varied as the patients that present with it. Each patient must be treated differently depending on the uniqueness of their problems and the contributing factors.

It is very important to realize that the goal of TMD treatment is to minimize pain and establish a return to function. TMD conditions are not "cured" but are managed instead. The basic goal is to allow the muscles and joints to heal through rest and care. Often damage to the joint itself can not be reversed, but the body can often heal it enough to return to function without pain. We also want to teach you to recognize the symptoms early and manage them yourself once we give you the tools to do so. This condition can often recur later on but early care can minimize the severity.

Physical therapy can help relax the muscles, increase joint flexibility, and align the jaw. We can perform both simple stretching as well as some more involved therapy at our clinic. The following treatment modalities may be used in each case:

Rest:  You must rest your jaw for it to heal. A splint will help somewhat but other steps should be taken. You should not chew gum at all, bite your nails, clench your teeth together while awake, or any other non functional jaw habits (pencil chewing, etc.). Your diet should be fairly soft, avoid chewy and crunchy foods during treatment.

Moist Heat:  Moist heat is very helpful for the sore muscles of TMD. The penetrating moist heat promotes blood flow into the muscle which aids in healing and relaxation of the muscle as well. This increased blood flow also helps analgesic/ anti inflammatory medications into the muscles. A wet washcloth with a hot water bottle will do, or you can purchase moist heating pads if you wish.

Exercises:  Some simple jaw and neck exercises, which will help the muscles stretch. A good time to do some of these is in the warm, moist environment of the shower or bath, particularly in the morning and/or before bedtime. These exercises will help relax the muscles and increase mobility in the jaw joints. These can be done when symptoms are mild or non-existent. Do not do these when pain is moderate to severe, instead the jaw should be rested as much as possible during these more painful episodes.

Splints:  Also called a night guard, it is designed to protect the teeth from further wear. These also will reduce the severity of grinding at night and allow the muscles to rest. In more severe cases it needs to be worn all day as well to allow the TMJs and muscles to rest.

Our Approach:

• Don’t look for a “cure” for TMJ, but rather the most naturally correct position for the jaw joint, muscles and teeth to work together.
• If a person truly has a TMJ problem, the answer will be corrected physiologically. In other words, the solution will fit directly into how the joint, muscles and teeth should work together in the most naturally stable position. This position is not artificially created; it is simply where that person’s joint operates most efficiently with the least trauma being passed to the joint by the teeth and muscles.
• The solution will follow sound orthopedic principles (such as all joints within your body want to be in socket) and sound dental principles.
• The treatment will focus on addressing the cause…not merely treating the symptoms.

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