If we observe basic anatomy we find that in the process of mastication (chewing) there are four muscles that are involved in said process. The temporalis muscle, responsible for elevation and retraction of the mandible with its muscular origins in the temporalis fossa (temple region) and its insertion onto the coronoid process of the mandible (jaw). The masseter muscle, which elevates the mandible with its deep and superficial aspects originating on the zygomatic arch and inserting onto the lateral aspect of the ramus (mandible). Lastly the very important pterygoid muscle the (lateral & medial) which both insert onto the pterygoid process and lie deep to the mandible.
Now that we have covered the basic anatomy we can better comprehend the possible causes/dynamics resulting in TMJ dysfunction. We can see from the above paragraph that the region involves joints, bone, musculature and tendons. Thus, TMJ disorder can be due to pathology in the joint itself, such as arthritic degeneration of the joint (osteo/rheumatoid). It may be trauma related, brought about by a car accident and subsequent whiplash or perhaps due to a dental operation that has resulted in a shift in the jaw structure & associated compensatory effects. There may be a myofascial component and a tightness/spasticity in the musculature of the region i.e. the masseter muscle may have contracted fibres either causing the imbalance or compensating for the structural shift and thus further aggravating the TMJ sings & symptoms. Bruxism (grinding/clenching teeth) is another condition that can shift the TMJ region and thus result or further aggravate TMJ dysfunction & pain. Basically anything that causes a ‘jaw’ imbalance either immediately or over time can result in TMJ dysfunction and the associated limited range of motion & pain of the mandibular region.
It is very interesting to note that in my acupuncture practice I have not met anyone who has had TMJ signs and symptoms and did not present with an emotional stress component. Emotional stress can be the ‘true’ causative factor or one of the multifactor dynamics that manifest as TMJ. Thus it goes without saying that it is imperative to address the ‘stress’ component in the acupuncture treatment process for the ‘long term’ successful amelioration of the TMJ signs and symptoms.
For example, an individual presents to the acupuncture clinic with clicking present at the left temporomandibular joint when the mouth is opened, as well as pain in the region and a contracted trigger point at the right masseter muscle. Now, if in the acupuncture treatment we only address the contracted masseter muscle by releasing it, granted the pain and clicking may dissipate if this was the only factor directly related to the said clicking and pain. However, if the ‘stress’ component and the subsequent regulation of the autonomic nervous system is not addressed this TMJ symptom will shortly return.
In my clinical practice I find that among other dynamics, ‘stress’ plays a big part in why an individual clenches there jaw in the first place or why we hold certain muscles in a contracted state. Thus if we clench our jaw and associated musculature on a long term basis (i.e. sleep or awake) we can ultimately cause a structural imbalance and even displacement of the articular cartilaginous disc that attaches to the above mentioned lateral pterygoid muscle and acts as a cushion between the two bony surfaces.
Fortunately, acupuncture has an amazing potential to treat the multi-factorial dynamics that manifest as TMJ dysfunction. Ultimately acupuncture treats the individual and through palpatory diagnosis coupled with taking detailed medical history, together we are able to regulate the meridians and ultimately achieve a betterment in the individual’s signs and symptoms.
As always, please feel free to contact me with any questions you may have.
Giancarlo Nerini – Licensed Acupuncturist