TMJ pain - Treat first with these low tech tips
How to stop grinding your teeth and unlock that jaw.
Temporomandibular joint (TMJ): These are the two joints connecting the jawbone to the skull.
Problems with muscles, ligaments, or cartilage near the TMJ can cause tinnitus and facial pain/headache. Stress, sleep deprivation and bruxism sometimes lead to chronic jaw tension. Any misalignment of the bite alters the vector forces, destabilizes the joint, damaging it in the longterm.
TREATMENTS
While oral appliances such as splints and bite guards are the most common treatment for facial pain from temporomandibular disorders, patients rate them as less helpful than self-care efforts.
A recent study supports self-care techniques as the the first line of treatment for muscle-related TMD. A total of 125 TMD+ women were enrolled. Treatment histories and self-reported treatment-related improvement were obtained via interview. Improvement in their pain came from common self-care activities, including jaw exercises, yoga or exercise, meditation, massage, and warm compresses. Fewer reported that oral appliances helped even a little. Some who used oral appliances said that oral appliances made their pain worse.
Tongue tip to hard palate drops jaw
A sure fire way to improve symptoms: develop the ‘habit’ of placing the tip of your tongue on the junction of hard palate to front teeth. It automatically relaxes the jaw, causing it to gently drop open.
Self-massage
Tension also builds naturally in your jaw and mouth when speaking or singing. Starting from the top of your jaw and working toward your chin, massage your face with the heels of your hands. Knead the muscles along your jaw and mouth in small circles, pressing gently inward and downward as you move toward your chin. Your jaw should relax and open as you progress down your face to your chin.
Yodeling
This ancient alpine musical art has migrated into country western and is similar to jazz scatting. It can only happen with a relaxed open mouth.
Yodeling requires you to switch between your chest register (normal voice) and upper register (falsetto). Where normal voice transitions to falsetto, there will be a break or voiceless gap in your tone. You’ll have to vocally jump back-and-forth across this break when yodeling. Your normal voice will vibrate your chest and have a mellow sound. The break occurs where your normal voice transitions up to breathier, shriller, non-chest vibrating tone, which is your falsetto. Emphasize the break between chest voice and falsetto when you practice; the break is essential for yodeling.
Simhasana – Lion Roar yoga pose
In simhasana, the body and face are manipulated at once to invoke the force and intensity of a lion’s roar. This posture is thought to be one of the best face exercises. Simhasana stimulates the platysma, which is a thin, rectangular-shaped muscle in the front of throat. It relieves tension in the face and chest, improving circulation of blood.
Botox Injections
Botox injections are used off label to manage jaw and facial pain, but there is a concern it may harm bone density. A recent clinical trial did not result in clinically significant changes in the jaw bones when used only for short term and in low doses. However, they did find evidence of some bone loss when higher doses were used.
Background: Adverse effects of masticatory muscle injections of Botulinum Toxin (Btx) have been noted in animal and, less dramatically, human studies. Objective: Among women treated in multiple community-based private practices, to compare TMJ bone density and mandibular condylar volume between patients with myofascial TMJD receiving multiple masticatory muscle Btx treatments and similarly diagnosed women not receiving such treatment. Methods: Cohorts consisted of women whose treatment charts indicated a diagnosis of myofascial TMJD: 35 received at least 2 Btx treatment cycles; 44 received none. Bone density at pre-specified regions of interest (ROI) was defined by grey scale values from Cone Beam CT, adjusting for a fixed density phantom included in each scan. Mean bone density and mandibular condyle volume were compared between groups. Dose-response effects were tested within the Btx-exposed group. Results: The mean density of primary and secondary ROIs was similar between exposure groups, as was condylar volume. Among Btx-exposed women, increasing dose of Btx to the temporalis muscle was inversely proportional to the density of the trabecular area of the mandible body. Many Btx-exposed women received smaller doses of Btx to the masseter muscles than in most TMJD Btx clinical trials. Conclusion: Masticatory muscle injections of Btx failed to produce clinically significant TMJ bone-related changes. Should Btx receive regulatory approval for treatment of myofascial TMJD, a phase IV study is recommended to evaluate potential adverse effects of Btx on bone and muscle when administered at higher doses and/or for more treatment cycles. - KG Raphael et al
Surgical Alignment to correct bite
Jaw asymmetry is one causative factor of jaw joint pain. Surgical correction of facial asymmetry is effective in improving or even curing patients suffering from jaw joint pain. Patients with facial asymmetry have a difference in the length of the left and right side of the jaws, resulting in a deviated face as well as a shifted bite. Jaw correction surgery [orthognathic surgery] is the surgical treatment for patients with dentofacial deformities including facial asymmetry. Deformed jaws are surgically corrected into a planned and normalized position so as to improve the patient's masticatory and speech function, as well as symmetry and facial profile. It takes three to six weeks to recover. The prevalence of TMD in patients with facial asymmetry reduces in those who undergo jaw correction surgery.
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Well, that certainly gives us plenty to chew on. Bon Appétit!
REFERENCES
V Santiago et al. Perceived helpfulness of treatments for myofascial TMD as a function of comorbid widespread pain. Clinical Oral Investigations (2019). DOI: 10.1007/s00784-018-02797-6
KG Raphael et al. Effect of Multiple Injections of Botulinum Toxin into Painful Masticatory Muscles on Bone Density in the Temporomandibular Complex. Journal of Oral Rehabilitation (2020). DOI: 10.1111/joor.13087
AQJ Toh et al. Mandibular asymmetry as a possible etiopathologic factor in temporomandibular disorder: a prospective cohort of 134 patients. Clinical Oral Investigations (2021). DOI: 10.1007/s00784-020-03756-w