Temporal Mandibular Joint Pain
Many patients see a myofunctional therapist as a part of their treatment for temporal mandibular joint pain. Low tongue posture, mouth breathing, open mouth posture, tongue thrust swallow, and other dysfunctional swallowing patterns over a lifetime increase the risk of pain in the TMJ. This pain can be from the joint itself or from the muscles that allow the joint to function. This pain is interchangeably called “TMJ,” “TMD,” “TMJD,” or just simply “Jaw Pain.”
There are 4 main causes for jaw pain:
Problem 1: Clenching and Grinding - this activation of the fight/flight response of the nervous system often activates as a drive to be able to open the airway to breathe better. This activation of the facial muscles often occurs while you are sleeping, in many cases bringing the lower jaw forward (much the same way you would manually bring the jaw forward to open the airway when performing CPR). The activation of the face muscles can exert as much as 1000psi of force on the teeth often leaving them worn down, cracked, and broken over time.
Problem 2: Forward Head Posture - mouth breathing, low tongue posture, and a compromised airway lead to forward head posture. This is a subconscious attempt to breathe better – open up the airway. This can occur during the daytime or at night. As the head comes forward, the muscles of the neck become fatigued and strained, contributing to more head, neck, back, and/or shoulder pain and tenderness. This extra weight by having the head forward of its center axis can lead to head, neck, and back pain in additional to TMJ pain.
Problem 3: Fascia and Compensations - we are all connected together - from the top of our head all the way down to the feet. Fascia is a thin casing of connective tissue that surrounds and holds every organ, blood vessel, bone, nerve fiber, and muscle in place. Recent research as shown that the deep front line facia connects the tongue to the lungs, diaphragm, hips, knees, and feet. When there is a tongue restriction or a habit of low tongue posture, it changes the way that the deep front line facia works all through the body. Compensatory habits of facial muscles that result from tongue tie and dysfunctional use of the outer muscles of the tongue put additional strain on the jaw join and muscles that open and close it. Continuous dysfunctional use of those muscles and the joint itself can lead to pain.
Problem 4: Changes to Occlusion - the narrowing of the upper arch, flattening of the biting surface of the teeth, and incorrect tongue posture may lead to disc compression and displacement. Tongue posture influences growth and development. The maxilla drops, the mandible grows down and back. The maxilla “traps” the mandible from coming forward and the disc inside the TMJ is compressed.
Chronic pain is often the result of a combination of all of the problems mentioned. Changes to occlusion and craniofacial development add to the problems. No tongue-to-palate contact = no stability/support for the jaw joints.
TMD symptoms can include but are not limited to: inability to open the jaw very much, history of night guard, bite guard or splint, headaches or migraines, facial pain or tension, clicking/popping/grinding from the jaw joint, neck and shoulder pain or tension, pain in the muscles around the jaw joint or above the ear.
Myofunctional therapy can help alleviate the long-term causes of TMJ pain by restoring the muscles and the joint to their normal function by reaching correct tongue posture and a proper swallowing pattern. Myofunctional therapy for temporal mandibular joint pain is typically done in conjunction with a variety of other treatments, often including: splint therapy from a dentist, chiropractic care by specialists trained in the TMJ, intra-oral and extraoral massage therapy, physical therapy, palliative treatment, and prescription medication from medical doctors as needed for your individual care.
Dave Henrichsen has taken many hours of education in the TMJ and oral facial pain from experts in the field including Sarah Hornsby & Timothy King, and has collaborated on the care of many patients in the Seattle area helping patients find health, wellness, and freedom from pain. Dave believes that all patients deserve to be free of TMJ pain.
This video from the YouTube Channel of Dr Derek Mahony gives a great visual description of what happens to the teeth and airway when the tongue posture is low and how it effects the jaw joints.