This article is part of our comprehensive guide to exercise and rehabilitation for hypermobility.
Please click below if you would prefer to listen to this article on Temporomandibular Joint Dysfunction.
Hypermobile Population and EDS
TMJ disorders are notably more prevalent among individuals with Ehlers-Danlos syndrome. EDS, a group of inherited disorders affecting connective tissues, leads to joint hypermobility, including in the temporomandibular joints. This hypermobility can cause the jaw to dislocate frequently and lead to chronic pain and dysfunction. Studies show that up to 71% of patients with EDS report TMJ-related pain, highlighting a significant overlap between these conditions.
Other Contributing Factors
• Malocclusion: When the teeth do not fit together correctly, it can place extra stress on the TMJ.
• Stress: High levels of stress can lead to increased muscle tension around the jaw, exacerbating TMJ issues.
• Habits: Using teeth as tools, poor posture, chewing on non-food items, and excessive gum chewing can all contribute to TMJ strain.
Complications of TMJD
If left untreated, TMJD can lead to a variety of complications, including:
• Chronic Pain: Persistent jaw, ear, and temple pain.
• Limited Chewing Function: Difficulty opening the mouth fully and performing everyday tasks like chewing.
• Bruxism-Related Wear: Damage to teeth from grinding and clenching.
• Sleep Disturbances: TMJD can disrupt sleep, which can worsen pain and affect overall health.
How is it diagnosed?
Diagnosing TMJ disorders can be very complex as there is no single standard test for these conditions. Historically, TMJ disorders were primarily linked to tooth alignment (malocclusion) and jaw mechanics. When all you have is a hammer, everything looks like a nail, I guess.
This essentially means that getting a diagnosis often involves applying pressure to various parts of the face to test for sensitivity and measuring how wide a person’s mouth can open. Additionally, imaging techniques like X-rays and CT scans examine jaw and disc positions and movements.
However, a significant shift in understanding TMJ disorders emerges from the National Institutes of Health’s OPPERA study (Orofacial Pain: Prospective Evaluation and Risk Assessment). This research highlighted the need to view TMJ disorders not just as localised issues but more so as complex and systemic conditions involving genetic, immunologic, and central nervous system factors that they are. The study revealed that TMJ disorders might involve changes in the brain and spinal cord, leading to a mismatch between the severity of pain experienced and the actual physical damage seen in the jaw joint, which is something that no other study had even considered.
The OPERA study did not produce specific diagnostic tests for TMJ disorders, but it did emphasise the importance of a comprehensive approach to diagnosis and treatment. This involves assessing the “whole person” and integrating various medical and allied health specialists. While not a new diagnostic tool right now, it at least pushes us in the right direction.
Additionally, the study found that TMJ disorders often coexist with other conditions, making it essential to consider a patient’s overall health. Common comorbid conditions include irritable bowel syndrome (IBS), genital pain, tension-type/migraine headaches, bruxism (teeth clenching or grinding), poor sleep quality, and chronic fatigue. The study also noted that factors like poor sleep quality and cigarette smoking could increase the risk of developing TMJ disorders. There is evidence suggesting that higher exposure to estrogen in utero might contribute to TMJ disorders, indicating hormonal influences.
When diagnosing TMJ disorders, healthcare professionals may employ several techniques, some of theese may include physical examinations to check for swelling, tenderness, and the range of motion in the jaw. Imaging tests such as X-rays, CT scans, and MRIs are often used to provide detailed views of the bones, joint tissues, and overall structure of the jaw to highlight any abnormalities.
However, It’s very important to rule out other conditions that might mimic TMJ symptoms, which can include sinus or ear infections, dental issues like decayed or abscessed teeth, various types of headaches, facial neuralgia, giant cell arteritis, coronary artery disease, connective tissue disorders (e.g., Ehlers-Danlos syndrome, scleroderma), tumours and cancers in the head, neck, or breast, Lyme disease, acromegaly, and true serum sickness.
What is the best exercise for TMJ?
One of the main areas you should focus on when exercising and improving the TMJD is increasing the tone of surrounding muscles, such as the lateral pterygoid. Doing so helps the muscle decompress the jaw, relieving pressure from the TMJ when resting. This is very important, as many people are unaware that your teeth should only be touching when you eat. At all other times, your teeth should never touch. So, If you are reading this and have suddenly realised that your teeth are indeed touching or most likely clenched, then the TMJD exercise video below is for you.
Working the lateral pterygoid muscle is the best exercise for addressing TMJ dysfunction. The lateral pterygoid is crucial for protracting and decompressing the jaw and maintaining proper jaw alignment, helping to alleviate the pressure on the temporomandibular joint. Additionally, targeting this muscle specifically can reduce the compactness and compression that often lead to pain and dysfunction. This exercise decompresses the joint and strengthens the muscle, providing long-term benefits and improving jaw mobility. Regularly engaging in lateral pterygoid exercises can significantly decrease the occurrence of headaches and jaw discomfort, leading to better sleep and overall quality of life.
Please let us know how you get on with the exercises. Good luck!
— Adam —
