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  • Jun 09, 2020

Temporomandibular Joint (TMJ) Dysfunction
Anatomy and Conservative Treatment Options
Raymond M. Ruszkowski, D.C., C.P.T.

In twenty years of practice as chiropractic physician, I have treated many patients with jaw related pain, ear pain, headaches, and neck pain which have originated from TMJ dysfunction. TMJ is the shortened name for temporomandibular joint disorders. It describes a group of disorders in which the connecting point between the jaw and the skull becomes painful and swollen. The cause of the disorder can vary widely, and in some instances, no known cause is ever discovered.
The temporomandibular joint is a diarthrosis or freely moveable joint. The TMJ is composed of a synovial cavity, articular cartilage, and a capsule that covers the same joint. This joint is the union of the temporal bone cavity with the mandibular condyle.

Symptoms of TMJ, which I have seen in practice, are widely varied. Person to person differentiation in symptoms are not unlike other musculoskeletal maladies but some of the more typical problems are fairly common among most sufferers. These symptoms might include pain in the jaw, trouble chewing or talking, headaches, and neck pain. In some cases, the patient may also experience a bit of dizziness. Since other ailments can cause similar problems, it’s important to be seen by a professional in order to accurately diagnose your symptoms and find a treatment plan which works best for you.

Anatomy of the TMJ
The anatomy of this joint is interesting but complex. I’ll delve into the anatomy sufficiently enough in order to create a mental image for the reader as this article progresses.
The TMJ is the main connection between the skull and the lower jaw. The joint is comprised of
• The participating area of the temporal bone.
• The articular disc within the joint capsule.
• The head of mandible.
• The surrounding ligaments.

The joint is separated into a superior and an inferior compartment by the articular disc. The superior compartment is bordered superiorly (above) by the mandibular fossa of the temporal bone and inferiorly (below) by the articular disc itself. It contains approximately 1.2 mL of synovial fluid and is responsible for the translational movement of the joint. The inferior compartment has the articular disc as a superior border and the condyle of the mandible as an inferior border. It is slightly smaller with an average synovial fluid volume of 0.9 mL and allows rotational movements.
In the absence of major trauma or structural damage to the Mandible, Temporal bone, or articular disc, the muscles which act upon the TMJ often contribute to the symptoms of pain and bruxism. Bruxism is a condition in which you grind, gnash or clench your teeth. If you have bruxism, you may unconsciously clench your teeth when you’re awake (awake bruxism) or clench or grind them during sleep. Here’s a look at the muscles which act on the TMJ.
There are four muscles that make direct contact with TMJ: masseter, temporal, and two pterygoids.
The masseter muscle has direct contact with the articular disc on the front edge. It originates from the zygomatic arch with several muscular layers and inserts on the branch of the mandible (lateral surface) and the coronoid process (lateral surface).
Its primary task is to elevate the jaw. The innervation of the muscle is through the masseteric branch of V trigeminal cranial nerve). The temporalis muscle originates from the temporal fossa of the skull and the medial face of the zygomatic process; it inserts on the coronoid mandibular process. Like the previous muscle, the temporalis also makes contact with the articular disc anteriorly. The temporalis also elevates the mandible.
The lateral or external pterygoid muscle consists of an upper head and a lower head. It contacts the disc at the anteromedial aspect. Bilateral activation of the external pterygoid protrudes the mandible, while, if activated unilaterally, causes contralateral lateral deviation of the mandibular bone. The external pterygoid muscle pulls the condyle forward in the opening phase of the mouth; anteromedially it pulls the disc in the closing phase. The two upper and lower bundles are active in the early stages of opening and in the first stages of closing the mouth. The internal or medial pterygoid muscle originates from the pterygoid fossa, from the pyramidal process of the palatine and from the maxillary tuberosity, to terminate on the medial face of the angle and of the mandibular branch. The internal pterygoid muscle elevates and protrudes the mandible.

Symptoms of TMJ Dysfunction
The following are some specific symptoms which could be the result of TMJ dysfunction.
• Inability to open mouth correctly with right ear pain.
• Clicking of jaw upon opening mandible.
• Clicking, locking, and stiffness upon opening.
• Jaw and ear pain with frequent clicking.
• Popping when opening jaw and increasing pain upon chewing.
• Pain in jaw from clenching and a temporal headache.
• Jaw pain from clenching.
• Pain on other joints, including the jaw.
Diagnosis of TMJ Dysfunction
The TMJ examination begins with palpation of the muscles in the face and neck regions. These regions include the elevator muscles, depressor muscles, cervical muscles and intraoral muscles. If the patient has a history of fibromyalgia, pain points around the rest of the body may be examined. Patients with more acute temporomandibular joint disorders have the majority of muscle pain in the elevator muscles.
Radiographic examination and MRI testing are performed less frequently but can lead to a detailed understanding of anatomical or inflammatory conditions within the TMJ causing symptoms.
Conservative Treatment of TMJ Pain
According to the National Institute of Dental and Craniofacial Research, some of the treatments you should consider include:
• Stress reduction
• Eating soft foods
• Having a medical professional teach you to relax, massage, and stretch the muscles near your jaw
• Avoiding activities that stress your jaw such as yawning and chewing gum
• Using heat and cold packs on your neck and face
• Exercising
• Using pain and anti-inflammatory medications such as ibuprofen, naproxen, or acetaminophen
• Discussing with your doctor if you should use muscle relaxers
• Work with your dentists to try a mouth guard or other non-permanent appliance
Chiropractic care can also be an extremely useful approach to treatment of TMJ pain. In m y practice, I utilize the results of a comprehensive examination to determine the best course. At times, a referral to the dentist is the best option. However, spinal manipulation, TMJ manipulation, and other soft tissue treatments of the muscles associated with or affected by TMJ dysfunction above can achieve satisfactory results.
In a 2015 study published by the National Center for Biotechnology Information titled; ‘Chiropractic Treatment of Temporomandibular Dysfunction: A retrospective Case Series‘ revealed that all participants showed a reduction in temporomandibular symptoms after receiving chiropractic care. Three chiropractic physicians utilized chiropractic manipulation of the spine and TMJ, trigger point therapy to the lateral and internal pterygoid muscles, temporalis, and masseter muscles. A reduction in TMJ based headaches was also realized in the study.
When applying treatment to the pterygoid muscles, latex gloves are used and specific techniques are utilized to release tension and help decreased pressure placed on the TMJ. These same techniques are applied to the temporalis and masseter muscles. The temporalis muscle is often a major culprit for headaches while simultaneously being a major muscle of mastication (eating) acting on the mandible. Specific soft tissue techniques are very helpful in reducing TMJ based headaches with treatment of the temporalis muscle.
If you are experiencing symptoms of TMJ pain, seek advice from your medical professional whether it be your family physician, chiropractic physician, or dentist. Request a full comprehensive examination but don’t be pressured to undergo a barrage of expensive testing initially. Explore some of the remedies listed above from the National Institute of Dental and Craniofacial Research and consider finding a practitioner trained in spinal and soft tissue manipulation chiropractic physician, osteopathic physician, physical therapist, or certified acupuncturist. Be mindful not to rely solely on pain medication or non-steroidal anti-inflammatory medications. Often times, you will find the relief you need without having to go through expensive diagnostic procedures or complex treatments requiring anesthesia.

If you have questions, feel free to email me at: drray@thefamilymedgroup.com