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Jaw pain, an Osteopathic Approach

Signs that may indicate you have a jaw problem:

– Clicking or popping with jaw movement.

– Locking with opening or closing of the mouth.

– Pain with chewing, talking or yawning.

– Tender points on the muscles around the jaw.

– Clenching of the teeth throughout the day and/or night.

– Frequent headaches that are exacerbated with stress.

Jaw pain

Jaw pain is common amongst adults, especially in females aged 20-40. This pain can originate from a variety of structures both within and around the jaw. The jaw joint is called the temporomandibular joint, commonly referred to as TMJ. Pain or dysfunction in this area is referred to as TMD (Temporomandibular Joint Dysfunction).

The jaw region contains muscles, bones, joints, ligaments and membranes which all have an important role in jaw function. Dysfunction or irritation to these structures can cause pain, although not all jaw pain is caused by local structures, pain in the jaw region can also be referral pain from more distant structures. For example, upper neck pain can refer to the face or even pain originating from the heart can be experienced as facial pain.

Who can help?

Navigating the healthcare system can be challenging, especially with lots of options to choose from.

Osteopathy management

Osteopaths are allied healthcare professionals and can help alleviate jaw pain. Following a thorough assessment, Osteos will create an individualised management plan to help one restore optimal jaw function. Osteopathic management is relatively non invasive and conservative. It will involve hands on assessment and treatment, a discussion about causative factors, rehabilitation exercise prescription and potential referral to a dentist or GP for dental or pain management. It is worth mentioning that particular osteopathic techniques, such as TMJ mobilisation, have been closely associated with improvements in pain and range of motion in patients with myogenous TMD (jaw pain caused by muscles). Further information on Osteopathic treatment can be found below. TMD is also commonly seen by dentists who can work can work together with osteopaths to combat jaw pain.

Dental management

There is controversy within the dental profession regarding TMD management. Many dentists advocate for dental intervention, including jaw repositioning and occlusal changes which may involve splints, surgery and other orthodontic work. However some dentists will often prefer a more conservative approach to TMD and advocate working with musculoskeletal practitioners (like osteopaths) to address underlying factors beyond the mouth. How a dentist decides to manage jaw pain will be largely practitioner dependent.

GP management

A GP will be able to guide you to an appropriate healthcare professional given your presentation. They will also be able to prescribe pharmaceutical pain relief if required.

Osteopathic management continued, what would an Osteopathic treatment entail?

-A detailed history including medical conditions, lifestyle, general health and wellbeing.

Jaw pain has shown to be closely linked to emotional stress patterns and how we manage stress. Thus it is important to manage the body as a whole as we understand that the various systems within the body are interrelated.

-An assessment of posture and surrounding structures.

The neck and shoulders are frequently involved in TMD, especially when thinking about posture and how that impacts the resting position of the jaw. For example, the further the head drifts forwards the more the jaw drifts backwards and presses backwards into the head compressing the joint.

-Treatment, including rehabilitation.

Treatment of the jaw and surrounding structures will depend on the individual presentation. It may include soft tissue treatment to the muscles both within and around the jaw, stretching, activation exercises, dry needling, joint mobilisation, advice and rehab to help with joint alignment and pain relief.

-Working within our scope of practice.

In the clinic we may uncover conditions that are beyond the Osteopathic realm, if this is the case we would send for diagnostic imaging or guide our patient to an appropriate healthcare professional. Osteopaths can work with the various joints and muscles around the jaw, neck and shoulders to good effect but if the problem is related to the bones or teeth we need to work with dentists. Also, if the pain is overwhelming, pharmaceutical interventions may be required.  

Just fix it

Jaw pain, or TMD, can be complex and require a multi faceted approach, especially if the pain has been a long term problem. TMD can be entangled with emotional stress and something called central sensitisation. Central sensitisation can be thought of as changes to the brain and body that make one more sensitive to pain. It is closely linked to the development and maintenance of chronic pain. As Osteopaths we assess for signs of central sensitization in patients as we conduct a history and physical examination. Identifying a patient who may also be suffering from central sensitization is important as treatment and management will be modified.

As with chronic pain and injury in other parts of the body, treatment alone does not always provide immediate relief. It is a long term process that requires consistent homework. Treatment of jaw pain usually involves homework for the patient to complete in between sessions to help bring awareness to daily jaw habits and to correct imbalances within and around the jaw. This is usually a long term process, the duration and treatment requirements will vary greatly from patient to patient.

Final thoughts

A large portion of the population live with jaw pain and this can be challenging to manage. When considering treatment options for jaw pain, one should consider conservative, reversible, non invasive options that address the body as a whole. Hands on osteopathy treatment in combination with rehabilitation exercises can help cultivate pain free jaw function.

References

Butts, R., Dunning, J., Pavkovich, R., Mettille, J. Mourad, F. (2017).

Conservative management of temporomandibular dysfunction: A literature review with implications for clinical practice guidelines (Narrative review part 2).  Journal of Bodywork & Movement Therapies. 21(3), 541-548

Greene, C & Bertagna, A. (2019). Seeking treatment for temporomandibular disorders: What patients can expect from non-dental health care providers.Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology.

Kalamir, A., Bonellow, R., Graham, P., Vitiellow, A., Pollard, H. (2012). Intraoral Myofascial Therapy for Chronic Myogenous Temporomandibular Disorder: A Randomized Controlled Trial. Journal of Manipulative and Physiological Therapeutics. 35(1), 26-37

Kraus, S. (2007). Temporomandibular Disorders, Head and Orofacial Pain: Cervical Spine Considerations. Dental Clinics of North America. 51(1). 161-193,

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May 23, 2019

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