TMJ Disorders

Jaw Pain (TMJ) in Paris 6

SADAM (Syndrome Algo-Dysfonctionnel de l'Appareil Manducateur), also known internationally as Temporomandibular Disorder (TMD), is a condition affecting the temporomandibular joint (TMJ) and the muscles of mastication. It is characterised by pain in the jaw area, difficulty opening the mouth, clicking or popping sounds in the joint, and a range of associated symptoms that can significantly impact daily life. Osteopathy offers a complementary manual approach to the assessment and treatment of TMJ dysfunction.

Symptoms of TMJ Disorder

TMD can manifest through a wide variety of symptoms, which may appear gradually or suddenly:

• Jaw pain — Pain in or around the temporomandibular joint, often aggravated by chewing, yawning or speaking. The pain may be unilateral or bilateral and can vary from a dull ache to sharp, stabbing discomfort.
• Clicking, popping or grinding sounds — Audible sounds from the TMJ during jaw movement are common in TMD. These may or may not be accompanied by pain.
• Limited jaw opening — Difficulty opening the mouth fully, or a sensation of the jaw locking in an open or closed position.
• Headaches — Tension headaches, temporal headaches and pain behind the eyes are frequently associated with TMJ dysfunction.
• Ear symptoms — Ear pain, tinnitus (ringing in the ears) and a feeling of ear fullness can occur due to the proximity of the TMJ to the ear structures.
• Neck and shoulder pain — The cervical spine and TMJ are biomechanically linked. TMJ dysfunction frequently coexists with neck pain and upper back tension.

Causes and Contributing Factors

TMD is typically multifactorial. The following factors may contribute to its onset or persistence:

• Bruxism (teeth grinding or clenching) — Habitual clenching or grinding, particularly during sleep, places excessive strain on the TMJ and the muscles of mastication.
• Dental malocclusion — Misalignment of the teeth or jaw can alter the mechanics of the TMJ and contribute to dysfunction.
• Stress — Psycho-emotional stress is a major contributor to jaw clenching and muscular tension in the masticatory muscles.
• Cervical dysfunction — Restrictions in the cervical spine, particularly at the upper cervical level, can influence TMJ mechanics and vice versa.
• Trauma — Direct trauma to the jaw or face, prolonged dental procedures or whiplash injury can trigger or exacerbate TMD symptoms.
• Postural imbalance — A forward-head posture or rounded shoulders can alter the resting position of the mandible and increase tension in the jaw muscles.

Osteopathic Approach

The osteopathic assessment of TMJ dysfunction begins with a detailed clinical interview covering the history of symptoms, dental history, stress levels and associated complaints. The physical examination includes assessment of jaw opening and tracking, palpation of the masticatory muscles (masseter, temporalis, pterygoids), assessment of the cervical spine, cranial bones and posture.

Treatment may include:

• Intra-oral and extra-oral myofascial techniques — Direct work on the muscles of mastication to release tension and restore balanced muscle function.
• TMJ mobilisation — Gentle mobilisation of the temporomandibular joint to improve its mechanics and reduce clicking or locking.
• Cervical and cranial treatment — Addressing cervical restrictions and cranial bone restrictions (temporal, sphenoid) that may contribute to TMJ dysfunction.
• Postural correction — Addressing global postural factors that influence jaw mechanics, including thoracic and cervical posture.

Bruxism and TMJ

Bruxism is closely linked to TMD and is one of the most common contributing factors to jaw pain. The osteopath assesses the extent to which bruxism contributes to the patient's symptoms and works to reduce the muscular hyperactivity and mechanical strain associated with clenching or grinding. Coordination with the patient's dentist is often recommended, particularly if an occlusal splint (night guard) may be beneficial.

When to Seek Urgent Medical Advice

While most TMJ complaints respond well to conservative management, certain symptoms warrant prompt medical evaluation:

• Sudden inability to open or close the mouth (acute lock)
• Severe or rapidly worsening pain unresponsive to treatment
• Swelling, redness or heat over the TMJ area
• Numbness or weakness in the face
• Unexplained weight loss or systemic symptoms

If any of these symptoms are present, the osteopath will refer the patient to the appropriate medical professional without delay.

References

• Cuccia AM, Caradonna C, Annunziata V, Caradonna D. (2010). Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial. Journal of Bodywork and Movement Therapies, 14(2):179-184. PMID 20226365
• La Touche R, Martínez García S, Serrano García B et al. (2020). Effect of manual therapy and therapeutic exercise on pain and pressure pain sensitivity in patients with temporomandibular disorders: a systematic review and meta-analysis. Pain Medicine, 21(10):2373-2384. PMID 33114236