Temporomandibular Joint (TMJ) Dysfunction

The TMJ is the ball and socket joint that connects the Mandible (jaw bone) and the Temporal bone (one of the bones of your skull). It’s the small joint located in front of your ear. There is a cartilage cushion in between the ball and socket, referred to as the Disc. The disc is supported by special Ligaments, which keep the disc in place. Movement problems of the disc can be responsible for creating many symptoms in the TMJ, such as clicking, crepitations, locking, muscle spasm, and pain. There are several muscles which support and control movements of the TMJ.

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You may or may not experience jaw pain or tenderness with TMJ dysfunction. The most common symptoms include:

  • jaw clicking

  • jaw popping 

  • grinding 

  • limited jaw opening, or jaw deviation while opening (which you can observe in a mirror)

  • an inability to fully clench your jaw.

TMD sufferers are often teeth grinders or clenchers.  TMD can cause jaw headaches, ear pain, dizziness and upper neck pain. Some TMJ patients report pain or inability to eat, talk or sing. Tinnitus or ear ringing can be associated with TMJ dysfunction. (Vierola et al 2012)

TMJ Disorder/Dysfunction, or TMJD/TMD, is seen more commonly in women than men. There is a 3:1 incidence in females to males, and can include one or both jaw joints. In most instances, the dysfunction is a result of an imbalance or change in the normal function of the bones, ligaments, muscles, disc, or nerve components of the TMJ complex.

What Causes Temporomandibular Disorder?

TMJ dysfunction is considered a multifaceted musculoskeletal disorder. 

The most common causes of TMD include:

  • Masticatory muscle dysfunction, 

  • Derangement/displacement of TMJ articular disc

  • Bruxism: nocturnal grinding of teeth leads to increased pressure in TMJ and asymmetrical movement.

  • Occlusal Problems: Poor bite, Asymmetrical or Retrognathic (underbite, overbite) .

Contributory factors include:

  • Mandibular malalignment secondary to occlusal appliance or orthodontic treatment.

  • Removal of wisdom teeth,

  • Prolonged mouth opening eg dental procedure, 

  • Poor cervical posture, 

  • Myofascial pain, 

  • Neuropsychological factors,

  • Stress, and 

  • Whiplash and other less common causes include: trauma (e.g., blow to the chin), infection, polyarthritic conditions, tumors, and anatomical abnormalities.

The TMJ specific muscles involved in myofascial pain dysfunction are the Temporalis and Masseter. The temporalis is a fan-shaped muscle that fills the temporal space, and inserts onto the mandible. Its function is to raise the mandible to close your jaw. The masseter is a thick and strong muscle attached at your cheekbone and runs to the angle of the mandible. Its function is to also raise the mandible to close your jaw. 

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Treatment of myofascial pain disorder is focused on desensitizing muscles through hands-on mobilization, restoration of normal functional movement pattern through exercise, and providing education regarding prognosis and self applied maintenance. Treatment may also include other muscle re-education techniques such as Intramuscular Stimulation (IMS). We look at other mechanical influences such as neck disorder and posture, to assist in maximizing treatment management. At times, we often work with your oral practitioner (dentist, orthodontist, oral surgeon), and other practitioners who deal with behavioural modification, to optimize results.