In the last two months, I have been treating two patients suffering from jaw pain. Jaw pain is certainly a less common complaint amongst my patients; the majority are usually neck and lower back pain candidates. Fortunately, chiropractors are trained in treating the temporomandibular articulation (the jaw), where treatment usually incorporates joint mobilisation techniques, soft tissue massaging for muscles of the face and jaw, and probably most importantly, a series of therapeutic home exercises.
Successful management of jaw pain depends on many factors. The initial emphasis should be on prevention by identifying the habits and functions placing a person at risk of injury. You might be surprised how active the jaw is throughout the day. Knowing how one uses their jaw throughout the day could explain discomfort felt in this region. It could also serve as a starting point for modifying any bad habits or over usage of the jaw in preventing a disorder.
Ideally, you would want to restrict the activity of your jaw to eating and speech only. Habits like nail biting, smoking, pencil biting, teeth grinding are all essentially unnecessary, and more importantly deprive this active joint of valuable rest time. Consider also how you chew your food. Do you tend to chew on one side more so than the other? In the interest of exercising both sides of muscle groups around the jaw, try to chew evenly on both sides of your mouth when eating.
Signs and Symptoms of a disorder?
- pain felt in the jaw and/or muscles
- pain felt in the area of the ear, temples or cheeks
- limited or deviated jaw mobility
- clicking, popping or grinding of the jaws
Causes of jaw pain
Jaw pain is a symptom of a variety of different diseases, disorders and conditions. If you experience pain on one or both sides of your head in front of your ears, you may have temporomandibular joint disorder [TMD]. TMD is characterized by pain, tenderness, and trouble opening your mouth. TMD can be caused by behaviors such as teeth grinding, improperly aligned teeth or bite, and age-related wear and tear on the joint and the articular disc that cushions the joint. More serious conditions that lead to jaw and joint pain include rheumatoid arthritis and neuralgia (nerve pain).
Jaw pain is a sign of inflammatory, infectious, and autoimmune processes including:
- Age-related wear and tear on the jaw joint and surrounding tissues
- Jaw alignment disorder
- Jaw dislocation or fracture
- Osteomyelitis (bone infection)
- Osteonecrosis of the jaw (loss of blood supply to an area of the jaw bone, usually occurring in people taking bisphosphonate medications for osteoporosis)
- Rheumatoid arthritis
- Teeth grinding
- Temporomandibular joint disorder
Dental conditions that cause jaw pain
- Dry socket (complication of tooth extraction)
- Impacted tooth
- Tooth abscess
- Tooth decay
- Thyroiditis (inflammation of the thyroid gland)
- Trigeminal neuralgia (pain from the nerve responsible for sensations on your face)
In some cases, jaw pain may be a symptom of a serious or life-threatening condition including:
- Heart attack
- Oral cancer
To diagnose the underlying cause of jaw pain, a therapist would ask you several questions related to your symptoms. To assist in diagnosing the underlying cause, attempt to answer these questions:
- When did the pain start?
- Did the pain develop suddenly or slowly?
- Is the pain constant or intermittent?
- Does the pain occur with any particular activity, such as eating or yawning?
- What other symptoms are you having?
In addition to the above signs and symptoms, there are two quick tests you can do that most often indicate jaw dysfunction.
3 finger test: try fitting three finger joints in your mouth.
Alignment test: stand in front of a mirror and repetitively open and close you mouth whilst observing for any deviation of the jaw to one side
During the alignment test, ensure you are performing maximal opening and closing of the jaw. When observing for deviation, understand that there will always be a degree of deviation even in individuals without a disorder. Minor deviation of up to 3mm is acceptable, but anything greater will require professional examination.
Observe the gap between your two front teeth and the gap between your two bottom teeth. Do these gaps align with each other when you bite your jaw? It doesn’t matter if they don’t, but note the misalignment and then during the alignment test, observe for further deviation from this reference point. Again, the amount of deviation from this reference point should not be greater than 3mm.
For the more serious causes of jaw pain, you will require medical assistance by your general practitioner. If you sense that your condition is more of an alignment or soft tissue disorder, one that might include painful clicking; locking; tenderness around jaw and facial muscles; or difficulty opening the jaw, manual therapy might be worthwhile.
A thorough history and examination will need to be conducted. The examination will first involve the therapist observing your jaw area for any obvious signs of swelling, changes in colour, misalignments, etcetera. He or she will also use their hands to palpate for any tender areas around the jaw. Following this therapist will likely perform a range of motion test. During this you will be asked to do certain motions of the jaw to determine any restricted movements. The alignment of your bite will be examined during this as well. The therapist might then conduct a passive range of motion test where he or she applies over pressure in each of the directions to illicit any further painful ranges of motion. A muscle test can also be conducted where you will perform certain motions against the resistance of the therapist’s hands. This will help identify any jaw muscles that may be weak or injured.
By this stage there should be enough information gathered to know whether manual therapy will be helpful. My preference for treating patients is to begin with some gentle strain/counterstrain exercises. Having identified any movement restrictions in the examination, I would have the patient perform motion in those directions against the resistance of my hand (similar to the muscle test). I might get them to hold the tension for 5-7 seconds and then have them relax whilst I push their jaw further into the opposite direction to achieve a mild stretch.
Following this, treatment is essentially a combination of soft tissue techniques and joint mobilisation/manipulation. I use active release technique [ART], the gold standard in the treatment of soft tissue injuries. Some of the muscles of the jaw can only be accessed intra-orally, specifically the pterygoid muscle. This muscle is often a key player in jaw pain. Releasing this muscle intra-orally is usually uncomfortable and sometimes painful, but it usually achieves good results.
The mobilsation and manipulations I use, again, are to improve range of motion in the directions of restriction. These are rarely painful and usually no more than slightly uncomfortable. These techniques will be more effective in treating the articular disc of the jaw joint which might be misaligned within the joint cavity, causing clicking or locking.
Finally, I provide an information sheet to my patients with guidelines on how to manage their pain, including some useful therapeutic home exercises which should be carried out daily to accelerate recovery. The information sheet contains some rather ridiculous looking photos of me so I’ve only included a few below. At the risk of looking strange, I advise my patients to carry out these exercises at home or somewhere else private.
For a copy of the full document please feel free to contact me.
Lateral jaw stretch – push your jaw sideways
Lip stretch – smile then pucker lips
*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.