Temporomandibular joint disorder, TMJD (in the medical literature TMD), or TMJ syndrome, is an umbrella term covering acute or chronic pain and inflammation of the temporomandibular joint, which connects the mandible to the skull. The primary cause is muscular hyper- or parafunction with secondary effects on the oral musculoskeletal system and are seen quite often in individuals who suffer from high stress, poor sleeping (clenching of the teeth) and poor posture.
The temporomandibular joint is susceptible to many of the conditions that affect other joints in the body, and in our clinical field of corrective movement management, we see a lot of this common disorder. However, TMJ is what seems to develop after a long period of time where the client goes untreated or neglects to acknowledge the breakdown signs. Over time, our bodies adapt to our everyday movements to make it easier for us to function and get through the day; however, in time, these adaptations come at a cost and slowly change and pull our bodies out of alignment.
This specific disorder transcends the boundaries between several health-care disciplines — in particular, dentistry and neurology, corrective movement and pathology — there are a variety of treatment approaches and bridging the gap between your dentist and movement coach may be the key towards living pain free.
Yoga isn’t just for your muscles, it can also help protect your teeth and limit your trips to the dentist and need for oral corrective care. But, if you do have to go to the dentist then we have the team for you.
The teeth have it! Oral Care is a great place to start
Dr. Melissa Skinner, Dentist and local athlete, has graciously offered to lend her experience and expertise on oral care, relaxation and TMJ so that we can understand this specific disorder that plagues so many and often goes mis diagnosed. In addition to the exceptional team and the great office location; your dental experience is more like a spa. You have your own private booth, TV and head set and blanket. Yes, I said your own TV! All one would need is a green juice and a mani/pedi and you have a day at the spa.
Graduating top of her class from UBC School of Dentistry, Dr. Skinner is committed to lifelong learning, and is a member at the Kois Centre in Seattle, Washington. After finding numerous clients with TMJ related concerns, I took the liberty to ask an expert. Here are a few questions I posed to Dr. Skinner:
Q. Hw often do you see TMJ (or even the initial signs) in your patients? And how does this affect their oral care?
A. Temporomandibular disorders are very common and seen daily in the dental office. Those with jaw joint pain have difficulty opening their jaw, and commonly have limited opening. This affects oral care because it is more difficult for these patients to brush and floss their teeth.
Q. Sleep clenching seems to be a contributor to TMJ pain. Since this is more of an unconscious act many perform due to disruptive sleep and stress. What are your thoughts on this and how can it be prevented?
A. Clenching and grinding of the teeth are common habits that present themselves by chipping or wearing teeth, tired facial muscles, sore jaw joints and sensitive teeth. It can be caused by a poor bite and stress. Treatment is a removable appliance worn nightly that protects the teeth from further damage. Prevention is through bite correction, relaxation therapy, counselling to manage stress, yoga, and physiotherapy.
Q. Most of this blog piece centers around the muscles and poor posture being the major cause, but in many cases it’s the teeth that can be the initiator. Correcting the way the teeth fit together seems to be where practitioners should start when confronted with TMJ. How does one check to see if their teeth are contributing to stress and pain?
A. A bad bite can lead to clenching and grinding of the teeth. It’s a good idea to have a dentist check the bite to see if there are unhealthy tooth positions. If one tooth hits before the others, the chewing muscles become protective. Rather than bumping into that spot each time, the teeth close and the chewing muscles maneuver around the interference. This places extra strain on the muscles and they eventually become tired and painful. Interestingly enough, to reduce the pain, we clench our teeth harder! Babies do this by biting against a teething ring to decrease the pain of erupting teeth.
Q. We know that such tightness and compression in the jaw and neck can lead to arthritis, cause nerve pressure, an increase in neck muscle injuries and in oral care does this affect the necessary salvation and inner workings needed to protect our teeth and oral cavity?
A. As we mentioned, the teeth take the abuse from clenching and grinding. Our teeth are not meant to take forces all the time. So they wear down, crack, get receding gums and become sensitive. But, the rest of the oral cavity and saliva flow are not affected. So long as the patient isn’t on medications, that can commonly cause dry mouth.
Q. Are there specific treatments that you suggest in your profession to help treat TMJ related pain?
A. Any TMJ pain is worrisome. I know this is a sign that something is out of balance. It is possible that if nothing is done, the pain can get worse quite quickly. It’s important to try to identify what is causing the pain. Is it the bite? Is the patient clenching their teeth and wearing the joint? Does the patient have arthritis? Are there high levels of stress? … Once we know this, we go ahead on treat the pain. A splint to wear at night is a very common treatment to protect the teeth and provide some jaw relief by opening the bite. If it’s a bite issue, we treat anywhere from tiny tooth adjustments to full orthodontics. Stress management is important for some patients. Others with muscle fatigue would benefit from massage therapy and physiotherapy that specialize in the jaw joint.
Q. Since tooth decay is one of the leading causes of disease in children, how often do you see signs of problematic symptoms that could lead to teeth clenching, stress and changes in children’s oral structure? And what advice can you offer to new parents to help steward their children into positive practices at home?
A. A cavity in a baby tooth can get large at a very fast rate. This can cause a toothache. Pain can cause clenching, poor eating habits, poor attention and increased stress. Cavities also cause the teeth to shift forward in the mouth. This causes crowding of the permanent teeth.
My advice is to start oral hygiene habits early. Even when a baby has no teeth, it is a good idea to clean the baby’s mouth with a washcloth during bath time. Praise your kids when they clean their teeth, and be involved! Be a good role model, check that their teeth are clean and help them brush. Try making it fun by placing stickers on a calendar or using a cute timer to let your child know when it’s been long enough. Of course, getting regular dental visits is not only important to check for cavities, but teaches the child to love the dental office.
Q. I feel very privileged to not only have you as my dentist, but as my friend and supporter. Third Street Dental is the key sponsor for the upcoming “RUN4MOM” Memorial run focused on supporting the positive face of mental health and education on the mental well-being of our community. What do you do to stay healthy? And Who is your dentist?
A. Being healthy helps me tremendously at work. It helps me manage stress and helps my body handle the physical demands of dentistry. I absolutely love hiking with my adorable Labrador. I enjoy yoga and love running. I recently ran my first half-marathon!
My dentist is the amazing Dr. Gail Landsberger, who also works with me at Third Street Dental!
What Muscles are Affected?
Most of the time it is a result of poor posture and ergonomics at work, living with stress and not knowing how to relax and often those who hold stress in their shoulders and neck and after long periods of time begin to forward head carry. We call this upper crossed syndrome (see previous blog post on upper cross syndrome – ) When we talk about forward head carry, there are many muscles that help with head and neck movements. The top 3 that I find with clients that are hyper tonic (high stress) are the longus capitis; which helps to reduce the lordotic curve of the cervical vertebrae and is a deep flexor muscle in the neck whose job is to laterally flex, rotate, and flex the head and neck.
Next up we have the anterior scalenes, and the sternocleidomastoid (SCM). When the SCM is overworked it becomes fatigued quicker eventually leading to chronic forward head posture (head/neck extension). The levator scapulae is also a high functioning culprit where it’s main function is to lift the scapulae. It also works in conjunction with the pectoralis group (minor particularly) and the rhomboids (postural muscles).
As the muscles pull down on the base of the skull and upper neck, they also pull up on the scapula. All this adds up to compression on the cervical vertebra.
How can Yoga help?
Decompressing the muscles around the jaw line and neck are crucial to limiting stress in this area, and it starts with the practice of meditation, deep breathing and sensory awareness. Practicing a simple modified vinyasa sequence of child’s pose to downward facing dog to upward facing dog can help the flow of blood to the jaw and cranium, as well as improve the articulation of the spine.
Sequences to improve posture and reduce stress to the jaw and neck muscles:
- Seated meditation (focus on softening the tongue and facial muscles
- Seated cat flow (working in all 6 motions of the neck, extension, flexion, lateral extension, rotation)
- Cat flow series to child’s pose vinyasa (mentioned above)
- Cobra and sphinx poses (to help relax spine
- Supine cervical and lumbar corrective movement (passive hip rotations)
- Bridge pose variations to promote length in the spine and occipital ridge trigger release.
- Soft tissue rolling with the foam roller (mid back, lats, glutes)
I believe it is an important practice to work with other health care providers who believe in a holistic approach to optimal wellness. Dentistry is one of the most neglected pillars of our health and ultimately, it should be one of the first. For more information on Third Street Dental and Dr. Melissa Skinner, please see the information links below.
Third Street Dental is a community driven family oriented practice. This July 29th Dr. Skinner will be participating in my annual “RUN4MOM” Memorial Run that takes place over a span of 57km, supporting mental health and suicide prevention in our community. They also support a plethora of community initiatives centered on youth and family well-being.
- Third Street Dental: http://thirdstreetdental.com/
- Dr. Melissa Skinner: http://thirdstreetdental.com/dentists/
- Third Street Dental Facebook Page: https://www.facebook.com/#!/thirdstreetdental
- RUN4ACAUSE – www.sarahmjamieson.wordpress.com