Temporomandibular Joint Disorder (TMD) describes a complex group of muscular and articular disorders affecting the TMJ, leading to pain, dysfunction, and eventually degeneration.

Most causes of TMD can be divided into either myogenous (muscular) or arthrogenous (articular). TMD of myogenous origin is more common (1) and may arise from muscular hypertonicity, trigger points, fascial restrictions, and/or functional muscle imbalance of the muscles of mastication (chewing). One of the most commonly involved muscles is the masseter. Other recognized triggers for myogenous TMD include bruxism (teeth grinding), clenching, cervicocranial dysfunction (2), postural syndromes, especially a forward head posture (3,4,100), and trauma (5). TMD symptoms may occur in up to one-third of those patients involved in a whiplash injury. (6).

Disk displacement and osteoarthritis are common causes for TMD of arthrogenous origin. Other causes of TMD of articular origin include loose bodies, inflammatory arthropathy, trauma, mandibular fracture, dislocation, malocclusion, infection, and neoplasm. In TMD of articular origin, muscular dysfunction is secondary.

Studies vary on the relationship of premolar extraction to the development of TMD (7), but a systematic review suggests that the third molar location, degree of impaction, and subsequent extraction are associated with the development of TMD. (57). Nail biting, grinding of teeth, biting of lips, mouth breathing, and playing a musical instrument have a significant association with signs and symptoms of TMD. (39,86) Being overweight or having poor physical fitness are known risk factors for TMD symptoms. (82) Sleeping less than 5 hours or greater than 9 hours each night is associated with an increased rate of TMD. (80,89) The incidence of TMD is higher in patients with untreated sleep apnea. (77) Age and Previous Orthodontics treatment have not been linked to TMD. (106)

Psychosocial disturbances including stress and depression, are another widely recognized co-morbidity for TMD. (46,81,84,93,110,113) Stress alone has been identified as the most significant factor in developing TMD. (99) TMD patients with PTSD report a nearly four-fold increase in pain as compared to subjects without PTSD. (42) Patients with polycystic ovary syndrome are nearly seven times more likely to suffer from TMD. (69) Ankylosing spondylitis patients have a nearly three-fold increased risk. (85,90) TMD patients have an elevated incidence of suffering from migraine headaches. (59)

Estimates for the incidence of TMD vary between 4-31% (8,9,73). Up to 3% of Americans seek treatment for TMD each year (21). At presentation, most patients are 20-50 years old and prevalence is 2-3 times higher in females. Patients with rheumatoid arthritis have a higher incidence TMD. (60,73)

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What we do in our office to help this condition:

1. Perform a detailed exam, assessing the alignment of the spine. Due to the fact that the nerves exiting the spine in the cervical region (neck) branch off and go to the head, face, neck, shoulders, and arms, improper alignment in any of these areas may be detrimentally affecting the temporomandibular joints. This can compromise proper function and lead to potential symptoms.

2. As indicated, adjust areas of spinal and extremity subluxations (misalignments), restoring proper nerve system function which facilitates healing.

3. Perform laser therapy which penetrates to the cellular level of the soft tissues surrounding the head and neck. This promotes better oxygen and nutrients to these tissues, which can relieve pain and facilitate the healing process.

4. Prescribe stretches and exercises in conjunction with chiropractic care to strengthen the soft tissue of the neck and jaw.