Common Causes of TMJ Pain and Dysfunction
TMJ pain and dysfunction can be due to a host of problems. Recovery is easy if early diagnosis followed by appropriate treatments. However, many that suffer from a TMJ pain are unaware of issues until there is significant pain. Therefore, it is a good idea to have some basic understanding of the common causes of TMJ pain and dysfunction. Chiropractic Specialty Center has the best clinical teams of Chiropractors in Kuala Lumpur who are backed with advanced physiotherapists. Our Jaw pain treatments follow the best principles of care from chiropractic as well as from the field of physiotherapy. in essence, you get the best of both when you see our chiropractors and physiotherapists in Malaysia.
It ‘s nice to have some basic information as to the possible causes of TMJ pain. Having this information may assist you, and our clinical team will treat you with a higher degree of efficacy. It is, for this reason, we have provided you on this page a list of the more common causes of TMJ pain and dysfunction. We have divided them into articular (joint) and extra-articular causes. The jaw joint rooted issues leading to TMJ pain are those related to the jaw joint, while the extraarticular sources are those related to an indirect source. Without any delay here are the typical intra-articular (joint related) causes for a TMD (TMJ dysfunction):
- Intra-Articular causes/Internal derangement (internal structural changes within the TMJ
- Extra-Articular sources (problems with structures aside from the Jaw Joint)
In addition to the intra-articular causes of TMJ pain (TMD: Temporo-Mandibular Disorder), there are numerous extra-articular causes of pain or discomfort. These may include conditions involving muscle and soft tissues that are in proximity to the jaw and even pathology (cancer). It behooves one not to account for all possible causes before initiating care. Therefore, it is only befitting to include the extra-articular causes in our discussion of TMJ pain (the non-articular or extra-articular sources of a TMD or TMD-like discomfort). The two most common nonarticular causes are:
- Cervical spine instabilities (neck pain or neck problems)
- Over-activity of the jaw muscles such as seen with those that chew gum
To familiarize you better, we will discuss some of these (Intra-articular and extra-articular) sources of pain in a degree of greater detail.
Intra-Articular sources of TMD (Jaw Pain)
These are conditions and problems that occur within the jaw joint better known as the “Intra-Articular sources of TMD (TMJ pain or jaw pain).” The intra-articular sources of jaw pain are perhaps the most common causes of TMJ pain and dysfunction. It is also, the hardest one to fix. Furthermore, when the intra-articular sources go untreated for a period, it will lead to involvement of some extra-articular tissue. Thus, a complicated case and the reason why so many go on suffering needlessly. Avoid worsening of your jaw pain by getting the best non-surgical jaw pain treatments from our Amercian teams of Chiropractic Doctors in Malaysia.
Inflammation (swelling): is a significant direct source of TMJ pain
Inflammatory condition(s) within the joint is always a steady source of pain. While this applies to any joint, it bears a vital importance when to comes to the TMJ. As with any joint, an inflammatory source of pain is often the result of a direct trauma. In TMJ this injury can include a blow to the chin or jaw. Trauma, such as whiplash injury, heavy chewing, bruxism (grinding) or clenching of the jaws are the culprit in any inflammatory process involving the jaws. In addition to what we have already covered, there is evidence that even loss of dental height that results from either premature wear and tear or missing teeth can have an impact on the health of your jaws.
Two inflammatory terms apply to this particular source of pain:
- Synovitis – Synovitis is a term used to associate an inflammatory condition to the synovium or the capsule of a joint when they are found to be inflamed. The synovium is the layer providing protection for joints and tendons sheaths. If this layer of tissue (synovium) is inflamed (Synovitis), pain can result. In addition to pain, there may even be a limitation of the range of motion, especially at the end of the range.
- Internal derangement – The term internal derangement as it implies to a TMJ is descriptive of a condition or conditions where there are specific structural changes within the Temporomandibular Joint (TMJ). Internal derangements of TMJ is the result of direct trauma, such as a direct blow to the jaw or falling on one’s jaw. The Indirect forms of trauma include whiplash, chronic clenching or grinding, aggressive chewing or excessive and prolonged opening of one’s mouth, such as that during a dental procedure.
For the TMJ there are two specific forms of internal defragments, and they are as follows:
- Disc displacement with reduction (DDwR)
- Disc displacement without reduction
The Disc displacement with reduction (DDwR) –
In this type of derangement, the articular disc can become displaced in any given direction. The articular disc is a thin, oval plate, placed between the two bony surfaces of the TMJ (Jaw Joint). To be exact, the articular disc lies between the condyle of the mandible and the mandibular fossa. The mandibular fossa is a depression in the zygomatic process of the Temporal bone, for the mandible.
The upper surface of the articular disc is concavo-convex.
It is made so to accommodate for the shape of the mandibular fossa and the articular tubercle. The articular tubercle lies at the inferior (lower) aspect of the zygomatic process of the temporal bone.The bottom surface of the articular disc is convex in shape as it comes in contact with the condyle of the mandible.The articular disc’s circumference connects to the articular capsule, and at the anterior (in the front) it is attached to the tendon of the Pterygoideus Externus Muscle.The articular disc is thicker at its periphery (most posterior aspect), particularly in the most posterior position than at its center.
Articular Disc displacement without reduction –
Articular disc displacement can cause significant pain and loss of range. The jaw of patients with an articular disc displacement may deviate towards the affected side. There will be no clicking sound, but often the patient may report there was a click at the time when their jaw locked.
The image above depicts a displaced disc. The picture clearly shows a stretched retro-discal tissue with an anterior displacement of the articular disc. Disc displacements are a common cause of jaw pain. Disc displacements can occur medially or laterally. Often when there is a malpositioning of the disc, there will be a “popping” sound. In patients with a displaced articular disc, this “popping” sound occurs when they open the jaw (mouth) as this causes the dysfunctional disc to displace and hence create a “popping” sound. At times this popping sound can be heard easily. It is quite audible.Most often a loud popping sound accompanying pain is suggestive of an articular disc displacement. However, at early stages of disorder or “partial disc displacement,” the disc is not entirely off of the condyle, and often there is no pain or uncomfortable feelings.
As we mentioned, earlier arthritis is common in patients with a TMD. Two types of arthritic processes can affect the TMJ:
- Degenerative Arthritis
- Inflammatory Arthritis
Degenerative arthritis – Degenerative arthritic processes are commonly in most chronic cases of jaw pain. Arthritis is identified on plain X-ray films or OPG as flattening of the condylar head. The MRI can give more information as to the osteophytic formations with views in both open and closed positions. Crepitus is common in those who have degenerative arthritis. Degenerative arthritis of the jaw is an intra-articular cause of TMD: often seen in those over the age of 50. However, younger adults with a history of trauma may also have degenerative arthritis. And as such, we encourage all jaw pain sufferers to visit one of our centers for accurate diagnosis and treatments of jaw pain before it progresses to the degenerative arthritis stage.
The inflammatory joint disease can also affect the TMJ. These conditions include rheumatoid arthritis, Ankylosing Spondylitis, infectious arthritis, Reiter syndrome and gout.
Extra-Articular Causes of TMD (Jaw Pain)
In this section, we will cover some of the extra-articular causes of TMJ pain and discomfort. If you don’t find the information you are seeking here, please call our center. We ask all visitors to refrain from self-diagnose their health condition! The information is provided to help you better understand the already established diagnosis that has been rendered by your physician. Should you have any questions or concerns about any part of your diagnosis or the recommended care by either one of our experts or by others, please feel free to contact our center at 03-2093 1000. All of our Centers are here to help and assist you live a better, healthier life. In this section we will discuss the four most common extra-articular causes of TMJ pain:
- Muscle Spasm – Muscle spasms have been discovered to cause a significant amount of TMJ pain and discomfort for many. The term TRISMUS (triz-mes) is descriptive of spasms in jaw muscles. Trismus result in an inability to open the mouth. This muscular tightening can affect one or more of the jaw muscles, commonly affecting the muscles of mastication (chewing): the masseter, temporalis and pterygoid muscles. The cause may include stress, bruxism, postural dysfunction, prolonged dental procedures or anesthetics where the mouth has been held open for extended periods of time.
Cervical Postural Disorder –
Postural Disorder and neck issues will cause jaw pain. The anterior belly of the digastric muscle runs muscle runs from the point of the chin to the hyoid bone. This muscle is of extreme importance because it can lead to a TMJ malfunction and pain.
The Digastric Muscle is a small muscle, located beneath the jaw. This muscle lies below the body of the mandible (jaw bone), and extends in a curved form, from the mastoid process (out poking at the base of skull) to the symphysis menti (the chin). Now, sitting in for prolonged periods with a forward head and neck postures will have a higher risk of developing neck and jaw problems. Sitting in poor postures or stress positions: the mandibular condyle is pushed back against the retro-discal tissue, eventually causing swelling and gradual degeneration of the articular disc: yet another good reason why we ask you to mind your posture and limit your lap-top use.
- Temporal Tendonopathy – Temporal Tendinopathy is caused by excessive contraction of the temporalis muscle usually as a result of bruxism. In these patients, there will be tenderness and even swelling at the anterior portion of the temporalis tendon, which is palpable just above the zygomatic arch. There may also be tenderness of the temporalis tendon where it inserts onto the coronoid process, palpable just below the zygomatic arch when the jaw is slightly open.
- Fractures – Mandibular fractures occurring at the mandibular symphysis or the condylar neck can be a source of pain for the jaw. The mechanism of injury is often a blow to the chin or a fall on the jaw.
The Spine and TMJ correlations:
Now, that you have learned a little about the common causes of TMJ pain and dysfunction originating directly from the jaw joint, let’s look at none extra-articular sources of jaw pain. The cervical spine disorders coexist 70% of the time with TMJ. In our centers, we screened for a TMD with every neck pain sufferers and screen the neck of those that present with jaw pain. The cervical spine is a common cause of TMJ symptoms. Our centers offer research-based clinical chiropractic and physiotherapy treatments for jaw pain. Our Chiropractic methods of care in Malaysia and our Clinical Physiotherapy have succeeded even if others have failed.
The association between the jaw and the neck was a research published by Dr. Ciancaglini, Dr. Testa, and Dr. Radaelli. The title of their research was Association of neck pain with symptoms of TMJ in the general adult population, published in the Scandinavian Journal of Rehabilitation Medicine in 1999.
TMJ differential diagnoses:
Pseudo-hypomobilities: muscle spasm, surgical interventions for the jaws, intra and extracapsular irritations, neoplasm, inflammatory diseases, and trauma.
True hypomobilities: chronic post-surgical, arthritic conditions and fibrosis adhesions
We hope that the information provided about the common causes of TMJ pain and dysfunction was helpful. Please refrain from diagnosis and self-treating any part of your body. If you need help, call our center at 03-2093 1000. We will be glad to get one of our team members on the line to answer your concerns. We have a team of non-surgical specialists (chiropractors and physiotherapists) ready to get your jaw problems under control. All you have to lose is the jaw pain!