The Temporo-mandibular joint (TMJ), located just in front of our ears on either side of our jaw, performs a very important function in our everyday lives. By connecting the lower jaw (mandible) to the skull (temporal bone) on both sides, it allows us to move our mouth both up and down, and from side to side when eating, talking or yawning. Often referred to as the most used joint in the body, the TMJ joint can be activated up to 2000 times per day. When that joint and its surrounding muscles become strained or damaged, the repercussions on our health can be severe. While this problem can obviously be the result of a physical injury like a whiplash accident, or a heavy blow to the face, in my experience, TMJ dysfunction is mainly caused by emotional factors such as anxiety and stress.
In one of my recent NOVA articles, I wrote about the epidemic rise of anxiety in our society. As we know, emotions are stored deep down in our subconscious. In this case, the build up of emotional tension is manifested during the night causing many patients to grind their teeth while they are asleep. It is a problem that tends to occur more frequently in women than men.
Often the situation is so bad that the sufferer has to wear a mouth guard in bed to stop them from wearing down their teeth, and from keeping their partner awake with their grinding throughout the night. The patient is obviously totally unaware of what he, or she, is doing while asleep. Often the only evidence of these nocturnal activities is an unsuspected pain in the jaw, or a terrible headache when waking up in the morning.
In the early stages, TMJ dysfunction is often manifested by a clicking, or grating sound when opening the mouth. As the muscle tension gradually builds up, the ability to open the jaw becomes restricted. An easy way of testing the range of restriction in the TMJ joint is to get the patient to insert the first three knuckles of their hand vertically in their mouth. If they are unable to do this, it is a positive indication of restriction of movement, and the presence of active trigger points in the jaw muscle. At this point, the patient will be complaining of pain when they are yawning, or when they are chewing their food. If the problem is left untreated, the tension will gradually spread to the rest of the face, resulting in neck pain, debilitating headaches, earaches, and even dizziness.
How can it be treated? In Traditional Chinese Medicine, we often talk about "the root" (the cause) and "the branch" (symptom) approach to treatment. Obviously, if anxiety is the cause, as long as it not resolved the problem will keep coming back. But when a patient is suffering, our first goal is to eliminate the pain to improve their quality of life, then the next step is to address the neurological cause of the problem.
Acupuncture can often be successful in eliminating muscular spasms within a couple of treatments. In addition to local acupuncture points in the jaw, neck and shoulders, it has also recently been observed that tension in some of the lateral leg muscles can restrict the mobility of the mouth, so all these areas will need to be treated as well.
Personally, I like to get people actively involved in their recovery. While forcing the mouth open to stretch the muscle should be avoided, patients can easily be taught simple massage techniques to release the masseter muscle around the temporal mandible joint. Stretching exercises of the neck and shoulders when practised for even a few minutes every day can make a world of difference.
Once the sufferer realises their improvement is partly due to their own efforts, they discover they can have control over their own body. For someone who is suffering from anxiety, this feeling of empowerment, and the resulting psychological boost, can be even more beneficial in the long term than the acupuncture and herbal treatments I will be able to provide.
Then, my role as a practitioner takes on another dimension. It's as if I have become the mountain guide who leads his fellow trekkers in the right direction, providing the technical support on the way, in the understanding that the hard walk to the summit will still have to be accomplished together at a suitable pace for all involved. In a way, this is probably how most forms of medicine should be!
Olivier Lejus MHSc.(TCM), BHSc.(Acup.) is an accredited acupuncturist practising in Sydney
Olivier Lejus BHSc.MHSc. is a registered acupuncturist and Chinese herbalist practising in Sydney. A former casual university lecturer and tutor in Oriental medicine with over 15 years experience in clinical practice, Olivier specialises in Japanese- style acupuncture for the treatment of male and female infertility, migraine, pain, and insomnia.www.olejusacupuncture.com