The TMJ & Related Disorders
The Temporo-Mandibular Joint (TMJ)
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The Temporo-Mandibular Joint, more commonly known as the TMJ, is the joint complex that connects the lower jaw (mandible) to the skull and helps you move your jaw to chew, eat and talk. Most of us have a set of two TMJs, one on each side of the face in front of the ears. The TMJ is made up of an intricate system of muscles, ligaments, bone, cartilage and synovial fluid that work together to allow us to use our jaw.
It is important to recognize that there are many structures outside of the TMJ complex that can contribute to pain and dysfunction in the facial region.
Pain in the Jaw, Face, Head, Tooth & Ear Pain:
If It's Not My TMJ, Then What Else Could It Be?
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Remember, the TMJ is a joint. Not a disorder. Disorders related to the TMJ complex are collectively referred to as TMJ Disorders (TMJD or TMD). Also remember that TMJD or TMD is not a diagnosis. It is a collection of many different diagnoses. Just like if you have pain in your leg, that's not a diagnosis. Why do you have pain in your leg? Is there a skin wound? Is there an infection? Is there a broken bone? Is there a blood clot? Each of these diagnoses are different and each requires different types of care. Your jaw works the same way.
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Believe it or not, most of the time, it is not the actual joint or TMJ that is causing jaw pain or dysfunction. Muscles, not the joint, are the most common source of non-odontogenic (not related to tooth structures) pain and dysfunction in the jaw area. Muscles have the unique ability to develop trigger points (areas of tight muscle fibers, commonly known as "knots") that can refer pain outside of the immediate muscle. Muscle pain can mimic tooth aches, ear aches and head aches.
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Less commonly, pain in the facial region originates from a nerve dysfunction, which is typically not related to the TMJ. The information on this page is intended to address only TMJ disorders of muscle and/or joint origin.
Identifying the true source of your pain can help to prevent unnecessary dental and medical procedures. Dr. Wang is trained to identify the true source of your pain or dysfunction.
Muscle Referral Patterns:
Oh, The Places Your Muscle Pain Can Go
Reference: Wright EF. Referred craniofacial pain patterns in patients with temporomandibular disorder. J Am Dent Assoc. 2000 Sep;131(9):1307-15. doi: 10.14219/jada.archive.2000.0384. Erratum in: J Am Dent Assoc 2000 Nov;131(11):1553. PMID: 10986831.
step one: an accurate diagnosis
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There is a lot of unnecessary confusion around TMJ-related disorders, which can contribute to increased patient anxiety. Many times, patients and providers are quick to jump ahead to treatments instead of focusing on finding an accurate diagnosis, which can ultimately lead to a failure of treatments. The failure is not usually in the treatment, but more likely because of failure to accurately diagnose.
Once again, TMJ disorder is not a diagnosis. It is a broad category of many different types of diagnoses, with different types of therapies. An accurate diagnosis with a proper explanation so that you can understand your body, are key steps to addressing your specific set of symptoms.
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During your initial evaluation, Dr. Wang's goal is to accurately diagnose the source of your jaw pain or dysfunction. She will review a detailed history of your symptoms, prior treatments that have helped or failed, and conduct a clinical exam.
​step two: create a plan
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Before creating a therapy plan, it is important to determine what exactly is causing your pain or dysfunction. The diagnosis will dictate the treatment.
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Based on your diagnosis, a personalized care plan will be created to help you rehabilitate your jaw. Dr. Wang begins by explaining her findings, down to the exact muscle group if appropriate. Depending on your diagnosis, your therapy plan may involve active treatment and follow up with Dr. Wang, or Dr. Wang may need to coordinate a referral to another specialist.
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​Passive Jaw Stretching
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The foundation for jaw rehabilitation is learning how to do daily passive jaw stretching. Passive jaw stretching is not the same as an isometric jaw exercise. Often, jaw pain/dysfunction is due to a muscle spasm. The goal for treatment in that situation would be to help stretch and relax that tight muscle. Think about the last time you had a leg cramp. Did you try to stretch your leg or did you go try to lift weights? Same concept.
​Personalized therapy plan
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Based on your specific needs, Dr. Wang will put together a personalized therapy plan for you. Prior failed therapies are taken into consideration.
Therapy plans may include the following:
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Education (Dr. Wang begins by explaining her findings, down to the exact muscle group if appropriate)*
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Home care therapy (passive jaw stretching, heat, anti-inflammatory medications/supplements)*
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Topical compounded medication
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Oral appliance therapy
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Review of health history and medications (some medications are known to cause or aggravate jaw tension) and care coordination with the prescribing physician(s)
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Trigger point injection therapy
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Joint injection therapy
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Nerve block therapy
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Sleep hygiene care plan
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Stress management skill development
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Auricular acupuncture for pain and nervous system balance
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Supportive care coordination (osteopathic manipulation treatment, physical therapy, massage therapy, psychotherapy)
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Referral for evaluation with other dental specialist (ie oral surgeon, orthodontist)
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* these are the foundational steps to successful jaw rehabilitation
Contact our office to schedule an evaluation today.
At The Orofacial Pain Center, we are dedicated to helping you find answers and relief.