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Temporomandibular joint (TMJ): What is it? 

At the widest moment of a big yawn, you might hear and feel a click in your jaw. For most people, a clicking jaw is an occasional annoyance or surprising pop now and then. For others, it's a symptom of a problem that may originate in the jaw but can radiate to other parts of the body, causing headaches and earaches. Your jaw is one of the most complicated joints in your body. It has up-and-down, side-to-side, and forward sliding ranges of motion. Several muscles tether your jaw to your skull on both sides of your head and control the motions of chewing, talking, and yawning. And the small disc that cushions the bones, the temporomandibular joint (TMJ), acts as a shock absorber or damper. When something gets thrown out of whack in the works of this complex joint, you might experience a temporomandibular disorder (TMD). The most common problems that affect the temporomandibular joint are jaw muscle problems, disc disorders, and degenerative changes associated with the jaw joints. These problems are generally referred to as temporomandibular disorders (TMD). But just because your jaw clicks or pops doesn't necessarily mean you have TMD and not everyone with TMD experiences clicking or popping in their jaw. TMD can have various causes including tight muscles, joint problems, arthritis, or clenching and grinding of the teeth. 

The most common symptoms of TMD include: 

headaches 

earaches 

muscle 

soreness or tenderness clicking or locking of the jaw 

dizziness 

neck pain or stiffness 

difficulty opening the mouth 

If you have any of these symptoms, talk to your doctor or dentist so they can assess you for TMD. 

TMD: Treatment overview 

Most uncomplicated cases of TMD are treated using a combination of any of the following: education self-care physical therapy intraoral appliance therapy behavioural therapy relaxation techniques Treatment of TMD must be individualized according to the cause and other factors. Even after successful management, episodes of pain and dysfunction may recur. Re-injury or factors that contributed to earlier episodes may be responsible. For the small group of people whose TMD progresses to a chronic pain disorder, treatment becomes more complex. These cases usually require more comprehensive management 

What you can do 

Track your symptoms. Jot down when symptoms hit and describe their severity and nature. You can make a note in your calendar, write about it on your blog, or write in your journal. See if you notice a pattern or triggers. 

Check your posture. 

Slumping, slouching, or any posture problems can lead to imbalances that put stress on the muscles of your back, shoulders, neck, face, and jaw. Try your best to sit up, imagining a thread lifting the back of your head up and letting your chin lower slightly. Many people jut their chin out, especially as they drive or work on computers. This can stress the neck and exacerbate jaw pain. 

Unclench. 

Check throughout the day and see if you're clenching your jaw. You might be doing it right now as you read, resting your chin on your hand or leaning forward to better read your monitor. Stress can make us grit our teeth together and hold our whole face in a tense, tight mask. Relax, stretch a bit, and let your jaw hang a bit slack, allowing your teeth to not touch together. 

Soothe. 

Use your fingertips to slowly but firmly stroke the area that's giving you the most pain. Apply heat or ice. Try over-the-counter medication for the pain, but check with your doctor before you do. Give a weary jaw some rest by eating softer foods for a while. 

Strengthen. 

In some cases, TMD may be triggered by weaknesses in different muscle groups. For instance, think of your abdominal core. A strong core helps to support your back, which in turn supports better posture. Regular physical activity can also make it easier to relax and handle stress better. 

Seek help. 

If your attempts at self-care do not lead to some relief, take your symptom journal and visit a doctor or a dentist. 

Managing chronic pain of TMD 

Integrating behavioural therapy and relaxation techniques in chronic pain management to treat TMD is effective. Self-care and habit awareness may not be sufficient in some cases to change behaviours that are contributing to symptoms. A more structured program supervised by a clinician competent in behavioural therapy offers a greater chance of addressing issues that are contributing to muscle tension or pain. Medical professionals generally agree that behavioural and educational therapies are effective in the management of chronic pain disorders. Relaxation techniques, hypnosis, cognitive-behavioural therapy, and biofeedback have all been used to produce symptom reduction in TMD. Relaxation techniques: These techniques generally decrease sympathetic nervous activity. 

Cognitive-behavioural therapy: 

This therapy is directed toward exploring and altering the thoughts, beliefs, and attitudes associated with the problem that may be preventing or negatively affecting recovery. 

Biofeedback: 

This is a treatment method that provides continuous feedback. It involves using surface electrodes or temperature of the skin to measure the electrical activity of a muscle. You perform relaxation exercises aimed at either lowering the electrical activity of the muscle or raising skin temperature. Repetitive practice using the biofeedback instrumentation provides training for you to achieve a more relaxed state and also a greater sensitivity to the activities that have adverse effects. 

Physiotherapy (physical therapy)

is sometimes used as a adjuvant to other methods of treatment in TMD. There are many different approaches described, but exercises aiming to increase the range of mandibular movements are commonly involved. Jaw exercises aim to directly oppose the negative effects of disuse that may occur in TMD, due to pain discouraging people from moving their jaw. After initial instruction, people are able to perform a physical therapy regimen at home. The most simple method is by regular stretching within pain tolerance, using the thumb and a finger in a "scissor" maneuver. Gentle force is applied until pain of resistance is felt, and then the position is held for several seconds. Commercial devices have been developed to carry out this stretching exercise (e.g. the "Therabite" appliance). Over time, the amount of mouth opening possible without pain can be gradually increased. A baseline record of the distance at the start of physical therapy (e.g. the number of fingers that can be placed vertically between the upper and lower incisors), can chart any improvement over time. It has been suggested that massage therapy for TMD improves both the subjective and objective health status. "Friction massage" uses surface pressure to causes temporary ischemia and subsequent hyperemia in the muscles, and this is hypothesized to inactivate trigger points and disrupt small fibrous adhesions with in the muscle that have formed following surgery or muscular shortening due to restricted movement 

Osteopathic manipulative treatment (OMT),

used by some osteopathic physicians (D.O.’s), is also used to treat TMD. OMT is a non-invasive manual treatment, similar to physical therapy, that uses precise forces applied by the physician to improve the function of muscles and ligaments and to optimize blood flow to an area Like other manual therapies, OMT can improve symptoms of TMD OMT has been shown to improve maximal mouth opening and maximal mouth opening velocity. OMT has also been shown to be as effective as conventional conservative therapy in reducing pain and improving function, and may also reduce the need for NSAID and muscle relaxant medications. Occasionally physiotherapy for TMD may include the use of transcutaneous electrical nerve stimulation (TENS), which may override pain by stimulation of superficial nerve fibers and lead to pain reduction which extends after the time where the TENS is being actually being applied, possibly due to release of endorphins. Others recommend the use of ultrasound, theorized to produce tissue heating, alter blood flow and metabolic activity at a level that is deeper than possible with surface heat applications. Low level laser therapy a controversial treatment using lasers at levels which do not kill cells within the target tissues. "Laser photobiomodulation" is theorized to reduce TMD pain and give anti-inflammatory effects. The mechanisms of action are not thought to be related to the generation of heat in the tissue, but rather via a promotion of cellular and tissue alterations which increase the recovery and healing potential of the tissue). Low level laser therapy may be effective in reducing TMD pain There is some evidence that some people who use nighttime biofeedback to reduce nighttime clenching experience a reduction in TMD.

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