Understanding Jaw Disorders: Perspectives From A Dentist & Physiotherapist

Jaw disorders (Temporomandibular joint disorders or TMJ disorder) have become an increasingly common condition these days and often come in conjunction with headaches and neck pain. In this article, we’ll get to take a closer look at TMJ disorders from both a physiotherapist’s and a dentist’s point of view.

How Do You Diagnose TMJ Disorders?

A Physiotherapist’s Point Of View

Diagnosing TMJ disorders require a combination of what the patient tells the physio and a physical assessment. Patients normally have one or more of the following symptoms:

  • Pain when opening the jaw, chewing, or yawning 
  • Clicking, popping, and grating sensations when opening the mouth, yawning, or chewing
  • Jaw stiffness and tightness
  • Pain around the temples, face, and neck

Other related symptoms also include:

  • Neck stiffness and tightness
  • Ear pain or ringing
  • Headache
  • Pain behind the eyes

In the physical assessment, we will assess their jaw movements, range of movement, tightness or stiffness with movement, how their jaw is moving and the quality of movement to see for any asymmetries or muscle imbalances. We also look at ways to make opening or moving the jaw less symptomatic. If their symptom(s) are localised to the TMJ and moving the jaw brings about pain, we will diagnose it as a TMJ disorder.

A Dentist’s Point Of View

Dentists diagnose TMJ disorders based on an intra-oral and extra-oral clinical examination as well as what the patient tells them.

Intra-orally:

  • Attrition wear facets on occlusal and incisal surfaces of teeth
  • History of teeth fractures resulting in a root canal, a crown, and/or extraction 
  • Sensitivity due to thinning of enamel, causing exposure of the inner layers of the teeth (Eg. Dentin, and eventually the pulp, also known as, the nerve)
  • Inner cheek ridging 

These are consistent with patients suffering from parafunctional habits (Eg. Grinding and clenching) 

Extra-orally:

  • Crepitus (sound) when opening, yawning, and chewing
  • Trismus (limited mouth opening), less than 35mm (equal to an estimate of three fingers)
  • Deviation of the lower jaw on opening 
  • Overly developed cheek muscles (masseters and buccinators)

Patient’s complaints often include:

  • Family and friends complain about hearing them grinding their teeth or clenching their jaw while sleeping
  • Teeth feels ‘weak’ and sensitive when biting and chewing harder foods 
  • Pain and stiffness/tightness in opening their jaw, chewing, or yawning
  • Headaches 
  • Waking up in the morning with a stiff or tight upper back and neck but not having a good night sleep the night before 
  • Ear pain or ringing

How Do You Treat TMJ Pain And Symptoms?

A Physiotherapist’s Point Of View

From a physiotherapy perspective, our aim is to restore pain-free mobility and quality of movement. We achieve that through a combination of manual therapy, which includes soft tissue release, dry needling, joint mobilisation, and an exercise program specific to the patient’s needs. 

There are several factors that can contribute to TMJ disorders. Check out our previous article here and get familiar with all things jaw related. As we value managing a patient holistically, we collaborate with dentists, counsellors, psychologists, and life coaches to address the various factors contributing to the patient’s condition.

A Dentist’s Point Of View

There are a plethora of risk factors associated with TMJ disorders – structural, physical and emotional. As such, there is no specific cure. It is about managing the patient’s pain and symptoms to help alleviate their quality of life.

As a dentist, our priority is to reduce the risk of teeth damage. Our first recommendation is often a custom-made night guard. A night guard is to be worn whilst the parafunctional habit occurs. It is also important that a night guard gets replaced every few years, depending on its durability.

Similarly, we also collaborate with a multidisciplinary team such as physiotherapists, counsellors, psychologists, oral surgeons, and life coaches to identify and manage the various risk factors that may contribute to a patient’s condition.

What Are 3 Tips You Have For People With TMJ Conditions?

A Physiotherapist’s Point Of View

  1. It’s normal to experience tension in your jaw during stressful and tiring periods, however you don’t have to live with it. Something can be done and there are professionals who can help!
  2. If you experience tension in your jaw or get headaches around your temples, you may try this stretch/release here.
  3. If you experience pain when chewing certain foods, you could avoid chewy or hard foods (Eg. Tough meats, chewing gum, or nuts). Alternatively, cut them up to bite-sized pieces so it’s easier on your jaw. 

A Dentist’s Point Of View

  1. Do not ignore prolonged discomfort from facial muscles, TMJ, upper neck, and back as it can worsen one’s intra-oral and extra-oral symptoms, which in turn can be debilitating to one’s quality of life.
  2. See your healthcare professional for consultation and management. 
  3. Work with your healthcare professionals patiently, as management may be long term.

Written By: Emmanuelle Chow and Jess Nantham

About Emmanuelle Chow – Senior Physiotherapist, B.Sc. (Hons) Physiotherapy (AUS), Clinical Pilates Instructor AHPRA (AUS)

Emmanuelle is an experienced Physiotherapist specialising in musculoskeletal conditions, specifically TMJ (Temporomandibular Jaw Disorder) and conditions of the neck, back, shoulders, and knees. She also specialises in chronic pain conditions and global hypermobility. Outside of her time in the clinic, you can find her pursuing her Master of Counselling Degree.

About Jessica Nantham – Dental Surgeon, BDS, GDDI

Having graduate with a Bachelor of Dental Surgery from the University of Otago in 2010, Dr Nantham went on to work in Auckland District Health Board and in private practice. She has always worked in a multidisciplinary team to ensure that a patient’s dental and medical wellbeing is achieved. In 2015, Dr Nantham came back to Singapore to challenge herself. She completed her Graduate Diploma in Dental Implantology at the National University of Singapore in 2020 so that she would be able to provide more comprehensive treatment plans to patients.

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