- Integrative Medicine
- Health Blog
It is estimated that at least 40% of the population suffers from one or several symptoms associated with Temporomandibular (TMJ, or jaw) dysfunction. It is a cause of migraine, clicking, locking and pain in the jaw, ears and sinus region. It has been called many names, the most common labels as listed below:
For the purposes of this page, we will use the most common appellation, TMD.
Over the years, many different treatments have been devised for the management of jaw problems, based on different theories about what causes jaw dysfunction. Traditionally, the dental profession has been heavily involved in managing TMD, though in recent decades, physical therapy, psychology and even complementary and alternative therapies have emerged as potential treatment options for these conditions. What has emerged through research is that TMD is a multifactorial, complex and difficult condition to cure permanently. Patient education and self care should be the foundation of any treatment plan.
It has long been assumed that the way the teeth come together can cause stresses into the jaw joints, such that normal movement might be impaired. The joint might then get inflamed and deteriorate, or jaw muscles might become spasmed and irritable as a result. While this assumption has now come under criticism from many researchers, it could still be considered desirable to maintain good tooth contact for aesthetic or other reasons. Consequently, various approaches have been implemented in correcting these defects, but we must be absolutely certain that occlusion is to blame before setting out to correct it for the sake of TMD. Many people have poor occlusion but do not suffer from TMD.
It might be worth pointing out that there is still much debate as to whether bruxism actually causes TMD. Where some relationship has been identified, there are strong associations with stress and anxiety. So how do they affect the jaw?
One theory which accounts for the reason we grind our teeth (proposed by New Zealand Dentist Ron Every in the 1960′s) is called Thegosis, which asserts that bruxism is not actually a pathological process, but the dental aspect of the flight / fight response. That is, it is based on the premise that our teeth (rather than hands) remain our most primitive and primary “weapons system”, and that bruxism is a sharpening mechanism meant to hone the incisors to a sharp edge for cutting (in this case for defensive purposes, though it can also be thought of as advantageous for feeding purposes). This phenomenon is seen in many animals (including primates), where the sharpening occurs primarily in the canines, carnassial or molar teeth. As humans have short canines and short faces, our incisors (front teeth) have grown correspondingly and this sharpening behaviour was adapted to our rear and front teeth. With this process we can easily sharpen our incisors and make side-slicing actions (like using scissors) with our front teeth. Since other primates have long canines, they are restricted in their ability to slice sideways, so they use their canines as a piercing weapon instead. When we look at their teeth compared to ours, humans look deceptively under-armed. But in fact our incisor bite force is remarkably powerful, comparable to that of many predators, and our ability to slice sideways can cause vicious lacerations. Further to that, our short snout has allowed for a greater development of the frontal part of our brain (intelligence!) and a much more subtle use of facial expressions and eventually speech when communicating . That modern man arose as the toolmaker belies the evolutionary fact that he was (and remains) a product of primate evolution, with many behaviours merely adapted to the new facial morphology. We have been making tools for about 2.5 million years, but we have been biting for a whole lot longer!
Where bruxism (thegosis) might lead to a painful condition at the jaw, it may be considered to be the chronic result of social conditioning to suppress (or repress) instinctual aggression, or due to a chronic failure to deal with psychosocial and emotional triggers that perpetuate defensive behaviours. This purportedly explains why stress is such a common factor in people who experience elevated levels of bruxism, particularly at night when they are asleep and not suppressing those emotions. These sufferers also report increased levels of shoulder, neck and back pain. Their teeth are often severely worn down, chipped or even cracked through to the roots.
The pathology here therefore, may not be intrinsically dental or muscular, but rather sociological, which suggests that bruxism ought to be primarily addressed from a psycho-emotional perspective, rather than a dental or physical one. Nevertheless, if the teeth are not positioned in their optimal positions, the process of thegosis may be restricted or interfered with, resulting in more likelihood of damage to teeth and also damage to other structures.
Palliative and ancillary measures might include restricting the ability of muscles to maximally clench with a “point stop” mouth splint, releasing chronically spasmed muscles as well as manipulating the jaw to remove disc adhesions and promote better function. In this way the process of recovery may be further improved.
Some researchers have identified digestive conditions such as intestinal parasites and allergies / food sensitivities as potentially being related to bruxism, but there has been very little research along these lines. Nevertheless it may be of value to mention any disturbances in digestion or immunity to your health care practitioner so they can have you screened appropriately.
An impact to the jaw can cause sprains, strains and even fractures and dislocations much like any other musculoskeletal structure. Conservative management of an acute case involves rest, ice and anti-inflammatory medications to help reduce initial symptoms. In the case of fracture or dislocation medical or surgical intervention at hospital is necessary and should be sought immediately.
Where the injury has left chronic joint or muscle damage, it is not unusual to find your jaw locking in either the open or closed position from time to time.
Being educated about the role of stress in TMD conditions can in some cases cause a cathartic recovery, while in many others it can initiate a sufficient state of self awareness that leads to a gradual diminution of symptoms. Chiropractic treatment of the spine and jaw can help maintain good jaw motion as well as improve posture and promote relaxation. Chiropractic can help balance the function of the jaw and how it integrates with other musculoskeletal systems. Being non-invasive makes Chiropractic an inexpensive and conservative option for managing TMD. Much co-management has been going on over the last 10 years between Chiropractors and Dentists, as each can manage the patient from a different perspective. A dentist may then design and construct a splint based on your needs. Making permanent changes to your bite pattern is an option your dentist may further recommend but we need to be mindful that when it comes to orthodontics (braces etc.), there is insufficient statistical evidence that they will effectively treat or prevent TMD, so they should not be recommended as a first choice since they are an invasive, irreversible and very expensive treatment modality. There is also the possibility that they may exacerbate TMJ problems further.
Other physical therapy modalities such as massage, physiotherapy and osteopathy may be of some assistance in managing the restrictions and spasms inherent in many cases of TMD, and would be worth considering.
Finally Psychological counseling, relaxation therapies and self-care exercises can help to ensure that long term outcomes are maximised and maintained. For a useful set of jaw exercises go to this page.
Otherwise call our clinic on (02) 9822 0588 to make an appointment with Dr Allan Kalamir, who specialises in the conservative management of TMJ disorders.