What is Bruxism and is it related to TMJ / TMD ?

Bruxism is a medical term that refers to tooth grinding that occurs at night and day or night time clenching.  The tooth grinding that occurs at night iscalled sleep bruxism and it is actually classified as a sleep movement disorder. This is further divided into primary sleep bruxism where there is no obvious cause, and secondary sleep bruxism which is related to causes such as medical conditions like depression, sleep disorders, benign tumours and medications / recreational drugs such as Ritalin, MDMA and cocaine.

Primary sleep bruxism was thought to be related to psychosocial (stress / anxiety) factors but a meta analysis carried our in 2009 of 45 papers shows no relation to sleep bruxism but there is a relation to day time clenching. (Manfredini, D. and F. Lobbezoo, Role of psychosocial factors in the etiology of bruxism. Journal of orofacial pain, 2009. 23(2): p. 153-166.)

The scientific research is still undecided as to the role of medications and neurotransmitters in sleep bruxism- i.e. further research is still required. (Macedo, C.R., et al., Pharmacotherapy for sleep bruxism. Cochrane Database Syst Rev, 2014. 10: p. CD005578)

Sleep disordered breathing has also been implicated to cause sleep bruxism. The idea is that during bruxism the lower jaw is postured forward to keep the airway open and prevent apnoeas (cessation of breathing) form happening. Population studies have shown subjects with sleep apnoea are twice as likely to suffer from sleep bruxism. (Ohayon, M.M., K.K. Li, and C. Guilleminault, Risk factors for sleep bruxism in the general population*. Chest, 2001. 119(1): p. 53-61.), Another study has shown 40 to 50% of subjects with sleep disordered breathing will suffer from sleep bruxism.  (Sleep bruxism in patients with sleep-disordered breathing. Archives of oral biology, 2000. 45(10) ) Sleep disordered breathing is also thought to cause sleep bruxism because of mini awakenings of the brain (arousals) that occur every time there is an incorrect breathing event, see below. However a meta analysis of all the research linking sleep bruxism and sleep disordered breathing suggests further research is still needed to imply a causal relationship.

The latest evidence shows that sleep bruxism is related to micro arousals (mini awakenings) during sleep.  Up to 80% of sleep bruxism episodes are associated with micro arousals. These micro arousals occur in all individuals as normal physiology with minimal consequence but for some reason, for those susceptible to sleep bruxism they suffer from more micro arousals, furthermore these micro arousals causes them to grind teeth in their sleep.  (Sleep Bruxism: A Sleep-Related Movement Disorder. Sleep Medicine Clinics, 2010. 5(1)).  

So in summary sleep bruxism is actually caused by our brains !. 

At best we can try to treat sleep disordered breathing as it can be a causeof sleep bruxism / wear orthotics to mitigate the consequences of sleep bruxism. (see below)

As mentioned above daytime clenching is more related to stress and anxiety so this is something we can work on using techniques such as meditation, cognitive behavioural therapy, mindfulness and where possible better life choices. Clenching can be related to pain in other areas of the body as well and so a holistic health approach is required.

It was once thought that bruxism was related to an incorrect bite. This concept is no longer valid. (Etiology of bruxism: morphological, pathophysiological and psychological factors (PMID:11385781)). 

So what’s the big deal about bruxism ?

During normal eating our teeth barely touch, as there is food between the teeth and the forces exerted on the masticatory system ( teeth, joints, muscle etc) is only 5-10kgs. Studies have shown that during night grinding / clenching the force exerted on the system is up to 150kgs. Furthermore during normal function are teeth only contact for 20-25 minutes a day, where as during sleep bruxism the teeth can actually contact for up to 40 minutes a day !

This repetitive clenching / grinding can cause micro trauma, i.e. too much repetitive force for the physiological capacity for a normal jaw joint. This can cause joint degeneration and also disc displacement within the joint, ie clicking which can then be associated with pain for some. Bruxism can also make the muscles more fatigued and more susceptible to pain or referring trigger points. For others the excessive force can even lead to loose teeth. It has been suggested that the weakest link suffers, be it the jaw joints, muscles, teeth or the gums from the excessive forces. (Metha et al. Different Effects of Nocturnal Parafunction on the Masticatory System: The Weak Link Theory. Journal of Craniomandicular Practice.OCT 2000, Vol 18. No.4)

For some their TMJ / TMD symptoms can often be worse first thing in the morning, indicating some sort of night time grinding / clenching.  Jaw pain and tension type headaches in the morning are common with sleep bruxism. As discussed above sometimes the night time bruxism may be due to sleep disordered breathing and it is important to diagnose this because using a “ flat plane splint” at night which is traditionally the most prescribed splint by most dentist’s can make the sleep disordered breathing worse.  (Int J Proshodontist 2004,17:447-453) This is why some may have a flat plane splint made and find they actually suffer from more bruxism, or their sleep is worse, or they actually wake in more pain as the “ flat plane splint” has simply made the driver for the bruxism worse.

When sleep disordered breathing is noted a mandibular advancement splint constructed to a neuromuscular position is recommended.

For others where TMD symptoms become worse as the day progresses a day time orthotic that mitigates the clenching forces and maintains decompression of the TMJs is necessary for successful treatment. This is particularly true if the inflammation in the TMJs is causing descending postural adaptation / forward head posture / cranial dysfunction but thats to be discussed another time…..

Dr Meetal Shah

TMJ Centre Melbourne

www.tmjcentremelbourne.com.au

 

 

 

Why does TMJ cause headaches ?

In a previous blog I discussed how TMJ can mimic tension type, sinus type headaches and migraines.

In this blog I want to discuss some of the mechanisms that occur with TMJ / TMD that can lead to these types of headaches. These can be attributed to the following,

  • Neuroanatomy and trigeminovascular physiology
  • Postural adaptation due to TMJ
  • Recruitment of neck and shoulder muscles during clenching
  • Sensitisation of the nervous system

Neuroanatomy and neurovascular physiology

We all understand the concept of referred pain. For example when you have a toothache in an upper back tooth it could present as pain in the sinus that is located directly above its roots. In this case the pain is felt in the two different structures because the sensation is supplied by the same nerve branch.

Using this principle it is important to understand that the extension of the brain into the body to control pretty much everything is via cranial nerves. Of these the biggest is the Trigeminal nerve and it is estimated to provide 50% of the input into the brain. This nerve has 3 branches that supply the entire head and face region. If there is a pain signal or other irritating signal in one of the branches it can also be perceived as pain from the other branches. Therefore pain in the TMJ for example can also cause referred headache / sinus pain.

To add to this complexity there is structure called the Trigeminal Cervical Complex which is where nerves that carry sensation from the back of the head (occipital), neck and shoulder muscles join the Trigeminal nerve and then join the same nerve root before being processed in the brain. So a problem in the TMJ could cause refereedneck and occipital pain. Conversely a problem in the neck could be perceived as face pain. 

The latest research shows that Migraines occur due to activation of the trigeminovascular system (TGVS)  which consists of the trigeminal nerve and nerve fibers which innervate blood vessels inside and outside the brain. Head Pain occurs when these blood vessels dilate following release of a ‘soup’ of neurochemicals due to activation of the TGVS. This ‘soup’ of neurochemical also causes inflammation. Activation of the TGVS can occur due to stimulation of the nerve endings of the trigeminal nerve. The trigeminal nerve endings are located in the cranium, face, teeth, jaws, jaw joints and face/jaw muscles. Therefore painful stimulation from any of these areas can cause activation of the TGVS and ultimately migraines. I am not saying that TMJ / TMD is the cause of all migraines but it can certainly contribute to severity and frequency. Indeed I have seen many patients have resolution of their migraines following suitable treatment. The research also confirms that when TMJ/TMD and comorbid migraines are present the best outcome is obtained when both occlusal splints and medication is use.

Postural adaptation due to TMJ

When there is inflammation in the TMJ, often one side is worse than the other. The body automatically adapts a forward head posture as a way of reducing the pressure on the TMJs.  As we are all aware forward head posture causes a tremendous increase in tension on the neck and shoulder muscles which can lead to increased pain in the occipital resigns and trigger points that can refer to the frontal and temple regions as well as head pain due the neuroanatomy discussed above. 

Other conditions that can cause forward head posture are chronic mouth breathing, prolonged use of mobiles, lap tops etc, poor work ergonomics and sacroiliac dysfucntion.

Recruitment of neck and shoulder muscles during clenching

Actions such as chewing , clenching and grinding are not just done by the jaw muscles. There is a considerable coordination required with the neck and jaw muscles to carry out these activities. So when we clench / grind we also “ clench” with our neck muscles, which leads to the increased fatigue, pain and prigged points mentioned above.

Sensitisation of the nervous system

I am no expert on central sensitisation but it is important to comment on this process involved in pain. When an acute pain situation is not dealt with by the body, a process termed peripheral sensitisation occurs. Simply but this process up regulates the pain signals form the localised region instead of down regulation by recruitment of extra nerve endings and faster nerves to transmit the pain signal to the brain. The peripheral sensitisation can lead to central sensitisation, particularly when the Trigeminal nerve is involved due to its importance to the brain. This over excited nervous system will then relay even usually non painful pain signals as very painful, so conditions such allodynia and hyperalgesia can occur. Further more because of the neuroanatomy involving trigeminocervical complex as well as the vagus nerve (which supplies the organs) joining the trigeminal nerve non painful stimulus can present as painful stimulus in other areas of the body. This central sensitisation is involved in a variety of conditions such as migraine, GERD, fibromyalgia, and irritable bowel syndrome. 

Dr Meetal Shah

www.tmjcentremelbourne.com.au

Do Headaches occur with TMJ ?

Unfortunately most dentists and GPs have been trained to think that the only headaches that can occur as part of TMJ / TMD is temple headaches due to clenching. The Temporalis muscles (located in the temple regions) are recruited during clenching and so the assumption is that these are the only headaches that can be attributed to TMJ/ TMD. This however is far from true. TMJ/ TMD can also mimic sinus type headaches, particularly the maxillary sinuses (in the cheek area). They can also mimic tension type headaches affecting the temple and occipital regions ( back of head) and migraine.

Population studies have shown TMJ/TMD is more common in those with chronic daily headaches, tension type headaches and migraine.* According to Dr Noshi Metha a leader in the treatment of craniofacial pain, up to 85% of headaches can be associated to muscular dysfunction that create trigger points and cause referred pain. A major cause of the muscular dysfunction can be TMJ/ TMD as well as cranial and cervical (neck) dysfunction. 

A study by former board members of the American Academy of Craniofacial Pain found occipital (back of head) headaches in 94% of subjects and temple headaches in 92% of their TMD patients. Furthermore in the same study demonstrated that treatment of TMJ/TMD lead to improvement in the occipital, frontal and temple headaches in nearly all patients . Regarding occipital headaches, following 3 months of treatment 66% of subjects reported complete elimination of the headaches and 33% reported improvement.

The same study above showed that pain behind the eye is also improved with TMD treatment, showing elimination of pain in 68% of subjects and improvement in 30%.

A randomised, double blind placebo controlled study ( therefore scientifically excellent) has shown that when it comes to this that suffer with Migraine and TMD,  treatment of TMD using splints and medication together provided the best treatment outcome. It is well known that many migraine suffered also have signs of TMD.

So if you have unexplained headaches you should consider being assessed for TMJ/ TMD

www.tmjcentremelbourne.com.au

1)Headache and Symptoms of Temporomandibular Disorder: An Epidemiological Study. Headache 2010;50:231-241

2) Anterior Repositioning Appliance Therapy for TMJ Disorders: Specific Symptoms Relieved and Relationship to Disk Status on MRI. J Craniomandibular Practice, 2005 

3)Treatment of Comorbid Migraine and Temporo- mandibular Disorders: A Factorial, Double-Blind, Randomized, Placebo-Controlled Study. Journal of Orofacial Pain. Volume 27, Number 4, 2013

Upper Airway Resistance Syndrome

You have to suffer from snoring, choking, gasping and stop breathing to suffer from the damaging effects of sleep apnoea ?  don’t you ????…… WRONG

Today we reviewed a client of our following a sleep study which was begrudgingly carried out as they said, “ But I don’t snore, choke or wake gasping" but they always woke up tired, unrefreshed, often exhausted. Blood tests game back normal and the client just assumed it was poor sleep due to worrying about life stresses and relied on medication. Incredibly the sleep study showed they woke (micro arousals) more than 30 times every hour. 

What this client was suffering from is called upper airway resistance syndrome. (UARS). UARS is part of the spectrum of sleep disordered breathing (SDB), most recognise the other end which is termed sleep apnoea.

Incredibly in UARS there is only a slight closure of the airway which increases resistance to airflow and reflex mechanisms form receptors in the upper airway ultimately cause the brain to wake (micro arousals) which lead to poor sleep and ultimately exhaustion. UARS typically affects thin patients and as mentioned before there is very little or no snoring. Many UARS patients report fatigue and insomnia.

UARS like sleep apnoea also puts your body into fight or flight mode (sympathetic overdrive) every time there is a micro arousal which ultimately affects your organs and the musculoskeletal system. UARS has been linked to chronic pain and fibromyalgia. The constant fight / flight response causes the muscles in the body to be constantly tense and this leads to pain. Poor sleep due to micro arousals also means your body does not get a chance to rest or heal, therefore leading to more pain.

Fortunately most UARS cases can be successfully treated with mandibular advancement splints, which are much easier to tolerate than CPAP machines. It is also important to establish correct breathing patterns and eliminate any obstructions of the nose.

So if you are feeling fatigued, have chronic pain there may be a simple reason. 

www.tmjcentremelbourne.com.au

 

 

 

You’ve been told you need surgery to correct your TMJ pain...

As with other joints in the body surgery is a treatment of last resort whenalternative treatment has proved ineffective. Surgery should really be restricted for those who are born with or develop jaw malformations and patients withtrue arthritis where the head of the jaw has loose fragments of bone or severely broken down condyle and may need reshaping or replacement.

According to the American Academy of Craniofacial Pain and the American Academy of Orofacial Pain 95% of patients suffering from TMJ/ TMD should be treated non surgically. In our office even patients with degenerating jaw joints have become pain free with NON SURGICAL treatment.

TMJ/ TMD often has more than one symptom, and usuallyoccurs due to many underlying causes happening at the same time, such as a combination of dislocated jaw joints, breathing dysfunction, dysfunction in the spine / cranium, stress, poor sleep, anxiety, stress, sleep disordered breathing, clenching / grinding, poor nutrition, generalised inflammation due to poor diet. Thats why a holistic approach is so fundamental to treating TMJ/TMD. 

For more information on holistic relief from TMJ/ TMD see www.tmjcentremelbourne.com.au or call us on 03 94174038

 

Benefits of Walking

Our clients often ask us about exercise while they are in pain and the answer is always the same. For those with chronic pain walking is simply the best form of exercise. Not just because it is less traumatic to your joints and muscles causing less breakdown, it has also been shown to help the brain heal and importantly calm the nervous system.

Running while good at burning calories, places you brain and body in fight / flight mode (sympathetic overdrive) which is not conducive to healing. Walking like meditation and correct breathing places your body in a healing mode by putting your body in parasympathetic mode (rest/heal/digest). 

Our bodies should be running on parasympathetic mode most of the time but with life's pressures, stress, poor diet, dysfunctional breathing, pain, poor sleep many of us walk around in sympatheic mode all the time. So an easy way to get back to parasympathetic mode and reduce pain is to go walking. Ideally at least 3 times a week gradually increasing the time. This is a great way to loose body weight and calm the mind. 

Walking also stimulates brain and body connection which stimulates neuronal synapses and plasticity and importantly neurogenesis (growth and development of brain tissue). Ultimately meaning your brain says well tuned. A healthy brain means less pain and healthy well run body for everything is run by the brain !

Many studies have shown the benefits walking which include the following;  learning and memory, protection from neurodegeneration and alleviation of depression, particularly in elderly populations.

 

Dr M Shah

www.tmjcentremelbourne.com.au

Orthotics in a day !! - Immediate Pain Relief

Using the latest in CAD CAM design, TMJ Centre Melbourne is now able to provide custom made bite plates / orthotics to the  correct neuromuscluar bite within 3 hours so that you can begin your healing journey as soon as possible. Currently to our knowledge we are the only practice in Australia to offer such incredible service to our clients. Being able to mill the orthotics using cutting edge technology the orthotics are strong, light, accurate and very comfortable.

For rapid TMJ relief call us on 03 94174038. www.tmjcentremelbourne.com.au

What should you do if you have clicking jaw joints ?

Many people with clicking jaw joints often have no pain and and can have clicking joints for decades with no problems. This is why there is much uncertainty and disagreement between partitioners about what to do regarding a clicking jaw joint. Unfortunately there seems to be no long term research due the difficulty of monitoring subjects over 5 to 10 years. the longest studies I have found have only looked at subjects over a maximum of 2 years. [1, 2]

Studies have shown however is that if you have TMJ clicking and pain, this does not get better over time and in fact becomes worse.  So as a general rule if you have TMJ clicking with pain it is best not to ignore the pain, even better the focus should be on treating pain and if possible getting rid of the clicking in the jaw joint.  Research has shown that subjects with clicking and TMJ pain syndromes show best pain improvement when jaw clicking is eliminated.[3] Further more there is always a risk of a clicking jaw causing a locked jaw as the disc becomes completely out of place, which ultimately leads to arthritic degeneration in the jaw and pain. [4]

Correcting a click non surgically, which is always the recommend way requires more than physical therapy such as physiotherapy/ osteopathy or chiropractic techniques. This is because the head of the jaw (the condyle) needs to be held in a position that allows the disc to return to its normal position 24 hrs a day. This is done using orthotics or bite plates to hold the jaw in the ideal position, allowing the disc to be “recaptured” and the muscles around the joint to relax.

As a general rule most TMJ clinicians agree that jaw clicking in children should be treated as this is most likely due to a bad bite and correcting the bite with functional orthodontics will stop the clicking and long term degenerative changes. Functional orthodontics which usually involves no removal of teeth and growing the top jaw forwards to allow the bottom jaw to sit further forwards, therefore allowing the head of the jaw to sit on the disc properly. This approach also creates a bigger upper airway as the lower jaw comes forward, therefore reduces risk of sleep apnoea as they grow up. 

 

1.    Sato, S., et al., Natural course of disc displacement with reduction of the temporomandibular joint: Changes in clinical signs and symptoms. Journal of Oral and Maxillofacial Surgery, 2003. 61(1): p. 32-34.

2.    Sato, S., et al., The natural course of anterior disc displacement without reduction in the temporomandibular joint: Follow-up at 6, 12, and 18 months. Journal of Oral and Maxillofacial Surgery, 1997. 55(3): p. 234-238.

3.    Anterior Repositioning Appliance Therapy for TMJ Disorders: Specific Symptoms Relievedand Relationship to Disk Status on MRI. Journal of Craniomandibular Practice APRIL 2005, VOL. 23, NO. 2

4.    Emshoff, R., et al., Relationship between temporomandibular joint pain and magnetic resonance imaging findings of internal derangement. Int J Oral Maxillofac Surg, 2001. 30(2): p. 118-22.

 

 

DONT IGNORE THE SNORE !

There is a lot of information about obstructive sleep apnoea (OSA) and its health consequences. We know that sleep apnoea- when you stop breathing at night causes reduced oxygen levels in the body and leads to oxidative stress and eventually endothelial dysfunction. Endothelial dysfunction leads to plaque formations in the arteries, ultimately causing atherosclerosis and this is the basic mechanism for stokes, heart attacks, increased blood pressure etc. The research is somewhat torn as to whether mild to moderate OSA leads to cardiovascular health consequences, but there is no doubt severe OSA causes three to five times increased risk of dying from cardiovascular events. ( stroke/ heart attack etc)

The repetitive micro awakenings ( you are not aware of them) will also cause the fatigue, irritability, depression and reduced performance etc.

Recent research (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542975/) has shown that snoring alone, even in the absence of apnoea ( stopped breathing) can cause atherosclerosis (plaque formation) of the carotid arteries (These are the major arteries in your neck that supply the blood to your brain). It is assumed the atherosclerosis occurs due to the direct vibration associated with snoring. 

So bottom line DONT IGNORE THE SNORE.

In further blogs I will talk about some simple solution you can try to stop / reduce your snoring. In the mean time if you're suffering from snoring, poor sleep, fatigue, and your partner’s had enough don't ignore the problem. Help is at hand.

For a holistic approach to help with snoring / sleep apnoea call us on 03 9417 4038.

www.TMJCentreMelbourne.com.au

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542975/

Can't tolerate CPAP ?

Obstructive Sleep Apnoea (OSA) is when a person stops their breathing for prolonged periods or breathes insufficiently during sleep. Left untreated, it can result in interrupted sleep, fatigue, a lack of focus during the day, and, in more severe cases it leads to high blood pressure, depression, and, up to 5x increased chance of  strokes and heart disease

The traditional treatment for OSA has always been to use a CPAP machine. Unfortunately many of you out there simply can't tolerate using the machine and have not been informed about mandibular advancement splints (MAS) or other alternatives. There is no doubt that CPAP is the absolute gold standard treatment for OSA but if you can't tolerate the machine an MAS is better than doing nothing. In fact a recent study from 2013 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738037/) of obese patients with severe OSA found no long term health differences when evaluating sleepiness, quality of life, neurocognitive ability and importantly Blood Pressure after evaluating over 2 years. What is important about this study is that the subjects were obese, with large necks and therefore assumed by most practitioners to be not suitable for treatment with MAS.

Furthermore at TMJ Centre Melbourne we have found that combining breathing retraining, myofunctional exercises, chiropractic adjustments and use of MAS has helped many of our patients. So if you're struggling to use your CPAP machine don't just ignore the problem.

Contact us on 03 9417 4038 for an appointment if you have any ongoing issues with snoring or sleep apnoea .

www.TMJCentreMelbourne.com.au

 

 

 

Athletic performance significantly improved by new TMJ mouthguard

Force Field Performance Mouth Guards are advanced bio mechanical devices that enable you to instantly balance your nervous system and create the optimal nerve pathways that enables you to unleash superior athletic performances on demand. Athletes require highly tuned and functioning nervous systems. Yet few elite sportspeople or trainers are even aware of how your 'bite' and jaw alignment impacts your physical performance.

The truth is optimal performance = optimal alignment.  That's because your jaw joint (TMJ) is the most complex and misunderstood joint in the body - It's a major nerve juncture when it's optimally aligned you are able to unleash and trigger superior physical performance and maximise airflow through your upper airway.

Testing proves that unless your jaw is synchronised  you cannot perform at your absolute best or anywhere close to optimal. So, if you're like most sports people you've probably never even thought about your jaw alignment.

Even if you don't ordinarily wear a mouthguard in your sport, any misalignment of your jaw,  caused by injury, diet, poor breathing habits or structural weaknesses you might have had since early childhood will be negatively impacting your performance.

Once your custom made guard is fitted the ForceField Performance Guard triggers rapid feedback through your nervous system in such a way that you can recover and retain your balance.  In practical terms this enhanced balance  means you can ‘think’ on your feet and you’re able to reposition yourself faster whatever sport you play.

Wearers report remarkable improved performance

  • Increased Core strength
  • Rapid Recovery
  • Endurance
  • Reaction time
  • Cardiovascular endurance; and
  • Dramatic reductions in fatigue 

Elite athletes report they feel 'switched on' and primed  are faster and much calmer under pressure, have better ball handling skills and explosive speed and can make better decisions in heat of the game. 

So why would you ever wear a mouth-guard created by someone with no understanding or awareness of how optimal jaw alignment affects your response time when you need it most? 

All Forcefield Performance Guards are 100% custom made and custom fitted using the latest advanced technology They are very comfortable to wear

Developed and based on extensive scientific and field research by Dr Meetal Shah and Dr Eric Dowker at the TMJ Centre Melbourne 

We have developed a proprietary technique and years of hands on experience Treating TMD to custom make our mouth guards to position your jaw into optimum position  which ultimately improves performance and endurance 

ForceField Performance Guards are made in Australia using the very latest in precision technology.  Custom made to suit your particular characteristics Suitable for all sports... weight lifting, archery, boxing,  swimming, football, basketball or racket sports to name a few.   ForceField Performance Guard will give you the winning edge 

To find out more, book a fitting or an assessment contact us 

Force Field Performance Guards
TMJ Centre Melbourne
Level 1, 233 Collins st, Melbourne

Tel (03) 9417 4038
ForceFieldPerformanceGuard.com

Research:

• Influence of occlusal splint on competitive athletes performances. Annali di Stomatologia 2012; III (3/4): 113-118

• Immediate effect of nonspecific mandibular mobilization on postural control in subjects with temporomandibular disorder: a single-blind, randomized, controlled clinical trial.  Braz J Phys Ther. 2013 Mar-Apr; 17(2):121-127

• STRENGTH AND BITE, PART II: TESTING ISOMETRIC STRENGTH USING A MORA SET TO A FUNCTIONAL CRITERION. Journal of Craniomandibular Practice. JANUARY 1992, Vol

• The Effect of Vertical Dimension and Mandibular Position on Isometric Strength of the Cervical Flexors. Journal of Craniomandibular Practice. APRIL 1999, VOL. 17, 

• The Effects of Condyle Fossa Relationships on Head Posture. Journal of Craniomandibular Practice. JANUARY 2005 VOL 23, NO.1

• Analysis of the postural stability in individuals with or without signs and symptoms of temporomandibular disorder. Braz Oral Res 2008;22(4):378-83

 

TMJ and Face Pain

Did you know that TMJ the more common name for TMD temporomandibular dysfunction is very commonly associated with face pain, in particular TMJ symptoms often mimic sinus type headaches? With true sinus headaches  there is usually a discharge from the nose and additionally the pain becomes much worse as you bend your head downwards. Many of our clients have been to see ENTs (Ear, Nose and Throat specialists) and come away frustrated as the ENT has found the sinuses clear with no obvious cause for the face pain. Some have even had repeated rounds of antibiotics or sinus surgery to no avail. The jaw muscles running along the cheeks  in conjunction with the with the jaw joints themselves  will cause referred pain along the cheek line, mimicking maxillary sinus pain or  face pain along the cheek line. These jaw muscles also refer pain to the lower teeth and may result in unnecessary root canal treatment.

The temporal muscles running along the side of the head around the temple region are powerful jaw muscles used during chewing, clenching and grinding. These muscles will also refer pain to the temple, mimicking tension type headaches. The temporal muscles will also refer pain to the teeth, and cheek regions.

When there is inflammation in the jaw joints, your body will adopt a forward head posture as a way of reducing the pressure on the jaw joints. In other words your body tries to get away from the pain. For every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds. This places considerable strain on the neck muscles which connect at the back of the head. When these muscles become too strained they can cause tension type headaches at the back of the head, and referred pain to the front of the head, mimicking frontal sinus pain, pain in the ears, pain the face and also cause eye pain.

Additionally long term TMJ can cause the cranium (bones around the brain and face) to become jammed which can then cause face pain and headaches. This “locking” of the cranium is known as cranial dysfunction.

So if you have face and head pain that is not going away it's important to have a comprehensive evaluation for possible jaw and cranium dysfunction. Please note the strained ligaments in the face also cause face pain as well as postural compensations due to issues in other areas of the body, but that's to be discussed another time!

Contact us on 03 9417 4038 for an appointment if you have any ongoing issues with face pain

www.TMJCentreMelbourne.com.au