SELF CARE PROGRAM FOR TEMPOROMANDIBULAR DISORDERS ( TMD)
The jaw meets the upper skull in front of the ear. The joint that connects them is called the Temporomandibular Joint (TMJ). The initials refer to the joint itself, and do not refer to a diagnosis. (Every one has two TMJs but no one has TMJ). People with jaw problems can have problems in their TMJ(s) and/or the muscles of their jaw. Your doctor can determine your specific temporomandibular disorder (TMD).
Noises in the TMJ are common in the general population. Joint problems, involving the TMJ, are slightly more common in woman that men. Like any joint, (hip, shoulder, and wrist), the TMJ or muscles in your jaw can be strained or injured. The injury can be the result of a specific trauma to the jaw or can result from prolonged low level trauma from oral habits. There are also other causes for jaw problems as well.
Once a joint or muscle is strained, it can be easily re-injured- like a sprained ankle which is subsequently more prone to injury. Because we use the jaw for so many activities including talking, eating, yawning, and laughing, the joint and surrounding muscles are constantly moving. Therefore, TOTAL relaxation of the jaw joint and surrounding muscles is difficult. However, allowing the jaw muscles and joints to be in a relaxed position is very manageable with practice. Regular attempts to relax the jaw muscles, and avoidance of activities that would overwork the area, will be helpful to reduce the pain and prevent additional strain to the area. The following suggestions should help:
- Apply moist heat for 15-20 minutes two to four times each day to the painful area. For example, microwave a gel pack or hot water bottle and wet towel until they are very warm. Wrap the towel around the gel pack/ hot water bottle and put it on both sides of your jaw going under your chin, or treat one side and then the other side of your jaw. This heat treatment should feel very warm but comfortable. Some people respond better to cold treatments. Try using ice wrapped in a very thin cloth (or no cloth) for 5-10 minutes two to four times each day over the painful areas of your jaw muscles and /or TMJ(s). The ice may initially give you a burning sensation this is normal. Keep the ice on the painful area only until you first feel some numbness, then remove it. Hear or ice can reduce joint or muscle pains and relaxes the muscles. You may also find that cold followed with heat is useful. Experiment.
- Eat a PAIN-FREE diet. Avoid hard foods, such as French bread or bagels. Avoid chewy foods, such as steak or candy. Cut fruits into small pieces and steam vegetables. Cut up food with a fork and knife if biting into food hurts. Chew with your back teeth. Eat anything you want as long as it does not cause pain or locking in your jaw. If soft foods cause pain, put any food you like in a blender and start on grind. Blend the food to the chewiest consistency that does not cause pain or locking in your jaw. Do not stay on a soft diet to long by periodically increasing the consistency of your diet as tolerated. Discuss the details or your diet with your doctor periodically.
- Chew your food on both sides at the same time to reduce strain on one side. Specifically, cut your food into its normal size and cut that piece in half. Then put one piece on both sides of your mouth and chew. This will take practice.
- TONGUE UP, TEETH APART AND JAW MUSCLES RELAXED.
The teeth should not be touching /resting together except occasionally they would touch lightly with swallowing. We suggest that you closely monitor your jaw position during your waking hours so that you maintain your jaw in a relaxed, comfortable position. This involves placing the tongue lightly on the top of your mouth wherever it is most comfortable while allowing the teeth to come apart, and relaxing the jaw muscles. Often putting your tongue gently on the top of your mouth where you softly say "n" is a comfortable position.
- Avoid caffeine. Caffeine is a muscle tensing drug and can make your muscles feel tighter. Caffeine or caffeine-like drugs are in coffee, tea , soda, chocolate and some aspirins. Decaffeinated coffee typically has half as much caffeine as regular.
- Avoid oral habits that put strain on the jaw muscles and joints. These include teeth clenching, teeth grinding, touching or holding the teeth gently together, biting cheeks / lips, pusching your tongue against teeth, or jaw muscle tensing. Also avoid biting on objects like pens or pencils. DO NOT CHEW GUM.
- Avoid resting your jaw on your hand.
- Avoid activities which involve wide opening of the jaw such as yawning. When you feel like yawning, put the tip of your tongue hard against the top of your mouth and let your mouth open as far as it can without letting your tongue off the top of your mouth. You can also put your hand under your jaw to limit the opening. Prolonged dental treatments with your mouth open should be avoided, if possible, until the pain has been reduced or eliminated.
- Avoid stomach sleeping since this puts strain on the jaw and neck muscles. Sleeping on your side is ok as long as you do not put a force on your jaw. Sleeping on your back is best.
- Use anti-inflammatory and pain reducing medications like ibuprofen, Tylenol and aspirin (without caffeine) to reduce joint and muscle pain as per your doctors suggestions.
- Calcium is very important for the healing and the health of your TMJ and jaw muscles. Calcium comes in many sources including dairy products and certain vegetables. Supplements can be used in the 1200 mg per day range.
** RECOGNIZE THAT THIS IS NOT A LIFE-THREATENING SITUATION, EVEN THOUGH IT CAN BE VERY UNCOMFORTABLE. INJURY TO THE TMJ AND JAW MUSCLES IS EXTREMELY COMMON, AND LOCKING OF THE JAW IS NOT UNCOMMON. MOST OFTEN THESE SYMPTOMS WILL IMPROVE OVER TIME. CHANGING HABITS, RELAXING THE AREA, AVOIDING ADDITIONAL STRAIN OR INJURY AND DOING THE ABOVE SHOULD SPEED UP YOUR RECOVERY CONSIDERABLY. **
· Gentley put your tongue on the top of your mouth where you say "n".
· Monitor the position of your TMJs with your index fingers over the TMJs.
· Open and close your mouth, slowly, stopping if you feel the condyle (ball) of the joint(s) move forward against your fingers. Do not allow your tongue to leave your palate.
· Chewing in this shortened range is often helpful. This exercise should require you to open about 2 finger widths, not more.
· Let your jaw relax (i.e. drop / sag jaw). Do not try to actively open your mouth, just let your jaw relax.
· Take a slow, deep breath as you push the inside of your fingers or palm of your hand gently, but firmly, against your jaw (masseter) muscle. The force you use should NOT be painful.
· Pull down gently as you let your fingers and/ or pallm of your hand slide slowly down along your jaw muscles and at the same time let your breath out slowly.
· You can repeat this whenever you feel your jaw tense.
· You can do this exercise on any muscle you find it useful. This includes the jaw muscle over your temples.
· Place one finger between your teeth for one minute- rest, repeat
· Then place two fingertips between your teeth for one minute- rest, repeat
· Initially, you can rest your fingertips on your upper and lower front teeth to do this stretch. After you have mastered relaxing your jaw, you may get a better stretch if you relax your jaw and do the stretch without touching your fingertips to the lower teeth. In the latter situation, it is up to you if you touch your upper teeth with your fingers but try not to touch the lower teeth.
· Do not do stretch your jaw more that two fingertips width.
· Do 3-4 times a day. Spread sessions out over the day.
· Very useful to do after you notice yourself clenching or tensing your jaw.
· It is often useful to use cold/ ice and/ or moist heat treatments before and/or after the above exercises.