TMJD - Temporomandibular Joint Disorders - Long Island City, NY 11101.

This will serve as the definitive guide to everything that you will need to know in regards to TMJ, bruxism, teeth clenching, and generalized jaw pain. It is meant to be comprehensive so prepare for some length.

This will be updated periodically so please remember to check back!

Created and maintained by Dr David Chen DDS

TMJ - Overview.jpg

Table of Contents

  1. General background information

  2. In depth analysis of what could be causing problems at the joint

  3. The four muscles of mastication

  4. Symptoms of TMJ

  5. TMJ Treatment

General Background Information by your dentist in long island city

TMJD is not a rare condition because it is actually quite common. The prevalence of it is approximately between 5% and 12%. It also seems to affect younger individuals more often than older persons. Interestingly enough, women are also about twice as likely affected as opposed to men. Apparently your temporomandibular joint has an Estrogen receptor, which may explain the increased prevalence. This was verified by this study. Consequently, individuals who are also using supplemental estrogen or oral contraceptives would be at higher risk of experiencing this disorder.

We personally feel that this is a topic that is not very well understood. We often encounter patients who've seen multiple doctors and they keep getting referred around without finding a real solution. No one is really willing to give them the type of needed comprehensive care but we believe that this isn't really anyone's particular fault. In fact, this occurs because this topic isn't specialized in one particular field such as dentistry. It is actually a multidisciplinary problem that involves dentists, physical therapists, surgeons, and possibly meditation instructors as well. With that being said...

What is TMJ?

The definition of TMJ is actually your temporomandibular joint. It is technically the joint where your lower jaw, the mandible, connects to your skull. There is also a fluid filled synovial disc that sits in between those two pieces of bone. Its function is to lubricate and provide shock absorption. It basically lets the two moving parts glide against one another without causing any damage. It is very similar to any other joint in your body, like your knee. Please refer to diagram above.

Activity occurs at your TMJ whenever you perform any one of these actions:

  • Open and close your jaw

  • Slide your jaw left or right

  • When you are talking

  • When you are chewing

As you can imagine, if you are having issues with your TMJ, it can really affect the quality of your life. You can't really avoid any of the above four functions.

Not to be a stickler but people with any of the above problems will usually refer to it as having TMJ, which is incorrect because that only describes the joint. It should be TMD or TMJD because it signifies that there is a disorder with the joint. This example would be akin to people having knee issues saying that they have "knee". Nonetheless, we understand that the general populace seem to use those two terms interchangeably. We admit, those three letters are pretty sticky sounding. 

What is the problem with TMD?

There is currently a huge problem with TMD because it is not that specific but more like an umbrella term for a lot of different issues. Whenever people feel any sort of symptoms remotely close to the jaw, ear, or face they will refer to it as TMJ. That means that there could be hundreds of different types of treatments available for just this one term.

Just an observation but what our long island city dentist have noticed since we've opened is that a lot of patients come in complaining about their TMJ. They all seem to think that there is something wrong with their joint because they hear popping, clicking, jaw pain, or their jaw slides in a different direction. Some have seen other dentists before for the issue and they've been prescribed a night guard. They may have also had multiple tmj splints made for them in the past. Even with all of that, it doesn't seem to have resolved the problem

In fact, that seems to be the default answer to TMD whenever a patient goes into a dental office for jaw pain. They get made a mouth guard for tmj. In our opinion, that isn't always the correct answer. Let's dive into why that is incorrect.

In depth analysis of what could be causing problems at the joint

Just to refresh your memory, the temporomandibular joint is the interface where two bones meet with a disc in between. Yes, you can have a problem with the disk causing it to deteriorate or degenerate.

Deteriorating TMJ Disc.jpg

Possible causes of joint deterioration:

  • Plain old overuse. Example would be people who've done marathons long term would most likely have knee problems and end up getting knee replacements. This joint is no exception.

  • It could be genetic as well, where the shape, size, and placement of the disc is not the most optimal. It could also be that your jaw is unbalanced by being lopsided. One side of your jaw is larger than the other side.

  • If you have a dental malocclusion problem where your teeth don't come together harmoniously. This is basically a problem with your bite.

Here is a simple google search for facial asymmetry to give you an idea.

Facial Asymmetry.png

If you have any of the above three conditions, then yes you've got a joint problem.

Now I would like to bring your attention to the fact that the TMJ is more than just the bones and the disc. It just so happens that there are muscles attached to it or nearby that control it's function. Without these muscles, the joint would not be able to move at all.

The four muscles of Mastication

In order for your jaw to open, close, chew, and talk, there are four muscles that help make it happen. There are some smaller accessory muscles as well but these four are the main culprits.

  • Temporalis

  • Masseter

  • Lateral Pterygoid

  • Medial Pterygoid

Chewing Muscles.jpg

Do you know anyone with back pain or neck pain? Those are muscular problems or myofascial dysfunctions. Your muscles of mastication are of no exception.

You could be having specific issues with either one of these muscles. If your TMJ issue is caused by overuse, certainly there could be something wrong with the muscles that control the joint. A great example would be one bruxism, teeth grinding and jaw clenching. A lot of people grind their teeth or clench during the middle of the night. This can cause a lot of muscle overuse problems because if you sleep 6-8 hours a day, that is the equivalent to going to the gym for the same amount of time. The only difference is that you are working out your jaw muscles

Think of how sore your muscles get when you do just an hour of lifting weights at the gym. Giving your chewing muscles an eight hour work out is pretty brutal. With that amount of activity, it is not surprising that you can develop a lot of muscle knots or trigger points within the muscles. These knots and points can sporadically cause the muscles spasm and that adds on or re-enforces the pain cycle.

Most commonly, people are grinding their teeth due to stress. The excess grinding will cause the muscles to form knots and spasm. This spasm will either cause you more pain or make you grind your teeth more. This is how the positive pain cycle becomes self sustaining.

Symptoms of TMJ

This is basically how you know if you have TMJ or TMD. We will try to list as many symptoms as possible:

  • Excessive teeth grinding or bruxism

  • Excessive teeth clenching

  • Jaw popping

  • Jaw clicking

  • Jaw pain or jaw tenderness

  • Ear pain or aching around your ear

  • Difficulty chewing or very tiring to chew

  • Sometimes your jaw locks, making it hard to open and close

  • TMJ tinnitus

  • TMJ headache

As you can see, there are a wide range of symptoms that can result from it but there are two in particular that I would like to expand upon because most people are unaware of it. The rest are pretty self explanatory.

Some people periodically get headaches and just assume that they are someone that are just naturally predisposed to getting them. If you are one of these people, you may wan to get an evaluation for your temporomandibular joint because it could be one of the muscles causing the headache. The masticatory muscles could be having a muscle spasm and referring pain across your head, which makes you think it is a normal headache but in fact you've been having TMJ headaches all along!

The other one is having jaw pain near your ear, either on one side or maybe both sides simultaneously. You may think that it is just normal ear pain but it could be coming from our joint. Please recall that the join is actually less than half an inch in front of the ear canal. So, if you are feeling a tender sensation around your ear canal, it could very well be that. Are you still wondering, can TMJ cause ear pain? Oh, yes it can.

Even though these may be most of the symptoms of TMD, it may not always be bothering you. They may not bother you most of the time but there are times when the tmj flares up and causes you pain for a few days. Then after that it could go away for awhile. If you do suffer from it chronically, you can bet that it will come back again. The TMJ pain can last as short as days but can also last as long as weeks.

Treatment for TMJ

There are a lot of different types of treatment for this disorder but they can basically be either surgical or nonsurgical.

  • Mouth guard or night guard

  • Manual or physical therapy for TMJ

  • TMJ exercises

  • Lifestyle modifications

  • Botox

  • Dry needling and corticosteroid injections

  • TMJ Arthrocentesis

  • Total surgical joint replacement

  • Arthroscopy

We would like to point out that aside from the genetic factors that affect the joint, the vast majority of the symptoms are actually caused by stress. Stress is the primary cause of most of these issues!

A splint or some sort of mouth guard

night guard.png

Night guards are commonly made at any dental office. If you just mention those three letters, you will be automatically getting one of these guards. Its been hardwired into the brain of dentists to treat this condition with some sort of splint.

We do recommend getting one since it is a simple procedure to do and it is non-invasive. All it takes to make one is to just take impressions or molds of your teeth. Then it gets sent out to the laboratory to fabricate it. They do come in a lot of variations, some you wear on your upper teeth and others you wear on your lower teeth. It is also typically made out of hard acrylic but sometimes the inside can be soft with the outside being hard. This variation will feel more comfortable than just the plain hard one.

What you do want to stay away from are the all soft ones that you can find at your local pharmacy because when they are soft, they often encourage you to grind or chew on them at night. Your body thinks its like a piece of gum and that it is meal time.

We have patients that report that the guard does help and others that have mixed reviews. If you are a bruxer and grind your teeth, this is a definite must have because you don't want to grind away your own teeth. If you wear this, you will grind away on the acrylic instead so it protects the teeth. The night guard may or may not help clenchers but they can try it to see if it helps. For those with malocclusion, this may help because it can get your jaw more aligned while you sleep!

TMJ physical therapy

This is a BIG one that we personally believe that a lot of dental offices miss out on. In fact, it isn't really even taught that much in school. Every dental student graduates knowing that they should make a night guard but barely any even knows that you can do physical therapy on the temporomandibular joint.

Why is this effective?

The chewing muscles that control the joint when they are overworked they will get sore. They will develop muscle knots and trigger points. Have you ever gotten physical therapy for your other bodily ailments? If not you should give it a try! Its okay if you haven't but have you at least tried foam rolling or rolling with a lacrosse ball at the gym? Those are all techniques for self myofascial release.

When you roll the muscles, you help bring blood flow into it. This brings fresh blood and nutrients in, which will also help you to wash out the lactic acid build up. It basically alleviates muscle soreness, reduces inflammation, and aids in recovery/repair. This type of "manual therapy" can help get rid of trigger points as well.

Trigger points are taut bands of muscles that feel like a literal knot. They are very tender or even painful to the touch. If you massage them for a few minutes for the next few days, they will usually dissipate. How do you know if you've found a trigger point? Its really quite simple, you'll feel a sensation like you've never felt before, letting you know that you've found one. If you move just a an inch or two away from the trigger point but stay on the same muscle, you won't even feel a thing. That just goes to show that there IS something wrong with that particular band of the muscle.

At our long island city dental office, we've found a lot of tmj patients presenting with trigger points in all sorts of combinations of trigger points in the four muscles of mastication. Some people have 1 affected muscle, others have 2, some have 3, and the unfortunate ones have all 4 of them affected.

We find these trigger points via manual exploration. We basically just start palpating or pressing all along and all over the muscle until we find a particular spot that triggers an intense sensation. If we don't find anything, then we move onto the next muscle. There are four of them to explore. The palpation is done with just our fingers and sometimes our thumb. There isn't really a set spot where everyone feels it. Everyone can develop these knots at various locations so you just have to find it for yourself.

We will try to guide you on how to find these spots.

Masseter Muscle.jpg

First on the list is the masseter muscle. Start pressing around from the corner of your jaw. Don't be afraid to apply a firmer pressure. Press around everywhere and work your way up towards the cheek bones. If you find a spot press on it and hold for about 15-20 seconds. You can release and take a breather if you need and then repeat. Whenever you find a spot, you should also press around the periphery of that spot as well. Just kind of roll around in a little circle. Last but not least you should press on the trigger point, hold it, and then take the muscle through active range of motion. Basically press on it and then open your jaw. Keep pressing while you close and open.

Chewing Muscles.jpg

Next up is the temporalis. You know where your temple on your head is and that is basically your temporalis. It is called that because it is attached to the temporal bone on your skull. I also bet you never knew there was a muscle there. The shape of it is typically described as a fan shaped muscle. It covers a pretty large area ranging from near your eye towards the top of your head and all the way close to the back of your skull. You really have to press around a wide area to explore the entire muscle. If you have trouble figuring out where it is just start pressing around and start opening and closing your jaw. You'll feel the muscle working. The technique for treating the trigger points is the same as above.

Lateral Pterygoid muscle.jpg

This is the lateral pterygoid, it is the smallest one out of the four. In order to access this one, you have to stick your finger inside your mouth and then close down about halfway. Then you start pressing towards the back along with outside along your cheeks. This one may be difficult for you to get to so we recommend watching a video on youtube.

Chewing Muscles.jpg

The medial pterygoid is the last one. In order to find it, you have to find the angle of your jaw and then try to wrap your thumb underneath of it. It is very close to where the lymph node under the jaw is.

We do recommend that you come in at least once so that we can show you how to find all of them. This is all something that you can do at home at your own time. We recommend massaging out these muscles for about 3-5 minutes before you go to bed and it would be helpful for you to do it when you wake up too. Give it a try for an entire week if you ever have a TMJ flare up and see how it helps. You may be surprised that it could offer more instant relief than the night guard. It would also be a good idea if you can find a physical therapist that specializes in TMJ to help you track progress.