Tempromandibular Joint (TMJ)

TMJ is the Temporomandibular joint — if you have problems with the TMJ you have TMD (temporal mandibular dysfunction) or TMJD. (temporal mandibular joint dysfunction)

There are only a few reasons that TMD is a direct result of problems with the TMJ itself.   These include but are not limited to: direct trauma to the head or jaw, arthritis in the TMJ itself, and disc disease of the disc involved in the joint.

Most professionals believe that about 90% all TMD originates elsewhere in the body.

Anatomy of the TMJ

The articular disc, located between the temporal fossa and the condyle of the mandible, is an extra strong piece of cartilage that has minimal blood flow, its job is not only to take pressure when we open/close the jaw, but it also keeps the joint space open thereby preventing the bone from rubbing on bone.  The disc is not innervated, so pain is not felt from here.

If we look in front of the disc, the lateral pterygoid comes from the sphenoid and the mandible and attaches to the anterior portion of the disc.  When we open the jaw this muscle pulls the disc forward, keeping it between the condyle and temporal bone.

We have several muscles and some elastic tissue that assist with the closing of the jaw.  The retrodiscal elastic tissue attaches from the back of the zygomatic process of the temporal bone to the posterior portion of the disc.  Because it is composed primarily of elastic connective tissue, it is able to stretch and come back, stretch and come back when the mouth opens and closes.  It is highly innervated, so this is one place TMJ pain comes from.

As stated above most professionals believe that 90% of all TMD comes from someplace other than the TMJ itself.

Secondary causes of TMD include:

  • Craniosacral dysfunction — one of the temporal bones is not moving or the sacrum might be stuck
  • Whiplash
  • Poor posture
  • Dental problems — missing teeth, extractions or bruxism (grinding teeth)
  • Malocclusions — one side touches before the other
  • Braces — there is an undocumented correlation between scoliosis and braces in teenage girls
  • Neurological Problems — bell’s palsy or problems with CN5. All of the muscles that are involved with closing the mouth are innervated by CN 5 — the trigeminal nerve. If these muscles are tight it causes us to clench our teeth.
  • Nutrition — heavy metal toxicity – muscle spasms or cramps
  • Ear Problems — the inner ear is close to the jaw when opening and closing the mouth
  • Stress and emotional problems — When we get stressed we tend to chew or clench our jaw; all of these muscles are innervated by CN 5, the trigeminal nerve. Stress can increase our level of alertness and trigger the Reticular alarm system (RAS).

Therefore, if we are going to address the TMJ we need to treat the entire body.

Craniosacral Therapy and TMD

Pain can be felt when the lateral pterygoid muscle does not relax. The disc can get trapped forward and the condyle gets stuck in midrange, this is painful because the retrodiscal tissue, that has that nerve supply, is being over stretched.  Also, If the condyle does return to the closed position it is now riding on and compressing the retrodiscal tissues and again this is painful.

Pain can also occur if the retrodiscal tissues lose control or becomes overstretched and loses the ability to bring the disc back.  The disc moves forward and stays forward and the condyle compresses the retrodiscal tissues.

Craniosacral TMJ techniques help to break the pain cycle by relaxing the muscles.

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