Temporomandibular Joints (TMJs)

What causes jaw (TMJ) pain?

Your TMJs and their muscles share neural connections to your face, head, neck, ears, and the outer layer covering your brain called the dura mater. This nerve is also involved in migraines and tension-type headaches. TMD can cause pain in these areas, and vice versa. Similarly, the muscles that move and stabilise your jaw attach to your head and neck, which is why head and neck problems can cause TMD, and vice versa.

Increased headache frequency can lead to TMD. People who suffer 4 or more headaches per month have an increased risk of developing TMD. Conversely, TMD can cause headaches.

Headache and Neck Pain Clinic - Increased sensitisation - Neck Muscles

TMD can be caused by:

  • Misalignment of the bite pattern
  • Overuse
  • Osteoarthritis
  • Bruxism
  • Trauma (including trauma to the neck)
  • Chronic neck pain
  • Some medications and recreational drugs
  • Disorders of the jaw muscles
  • Displacement of the discs in the TMJs
  • Headaches and migraines

What Are The Symptoms Of Jaw (TMJ) Pain?

Imperfect positioning of your teeth when your jaw closes, called malocclusion, is associated with head and neck postural and movement problems because all of your jaw muscles attach to your head and neck. This is why TMD can affect your head and neck and not just your jaw. Symptoms include:

  • Headache
  • Earache
  • Pain in front of the ear, around the ear, or to the temples
  • Tenderness of the muscles involved in chewing (mastication)
  • Dental pain (it can mimic a toothache)
  • Pain when chewing or swallowing
  • Clicking or fatigue when chewing
  • Limited opening or closing of the mouth, or lockjaw
  • Ringing or roaring in the ears (tinnitus)
  • Neck pain and dysfunction
  • Hearing difficulties or ear fullness
  • Dizziness or imbalance
  • Inflammation of the lining of the nose (rhinitis)
  • Dry eyes (xerophthalmia)

What Is Tinnitus?

Tinnitus is the perception of a ringing or roaring sound when there is no ringing or roaring sound in the environment. It has many causes and affects 10–15% of adults. It is most commonly associated with dental pain or TMD, and especially with advanced TMJ pathology.

87% of TMD is accompanied by tinnitus, deafness, dizziness, imbalance, or ear fullness, known collectively as otological symptoms because they all relate to the ear. Tinnitus is the most common of these symptoms, affecting 42% of people with TMD, followed by ear fullness that affects 39%. Women make up 78% of people who suffer TMD with otological symptoms.

Up to 43% of tinnitus is related to neck or jaw dysfunction, known as somatosensory tinnitus. The loudness and pitch of somatosensory tinnitus temporarily changes with movements of the jaw, neck or eyes because these all share common innervation in the brainstem.

How Is Jaw (TMJ) Pain Treated?

TMD and related orofacial pain and headaches respond well to manual treatment and prescribed exercises for the neck and the TMJs. Research shows that 82% of people treated for TMD experience improvement or complete resolution of their somatosensory tinnitus. Likewise, somatosensory tinnitus related to neck pain or dysfunction responds well to manual treatments and prescribed exercises.

Chronic TMD (3 months or more) is common. It is frequently associated with peripheral sensitisation where the sensory nerves around the TMJs become hypersensitive to painful stimuli. It is also commonly associated with central sensitisation where the brain becomes hypersensitive to painful stimuli anywhere on the body, impairing its natural ability to regulate pain.

If left untreated TMD may lead to degeneration and osteoarthritis of the TMJs over time. In extreme cases it may be necessary to have joint replacement surgery for the damaged TMJ.

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