Chiropractic Care For Temporomandibular Joint (T.M.J.) Disorder

From Dr. Natalie Meiri’s Clinical Pearl Stories:

Chiropractic Care For Temporomandibular Joint (T.M.J.) Disorder

This was a 50 year old patient with a chief complaint of temporomandibular joint (T.M.J.) disorder/pain bilaterally (both sides).  To be HIPAA compliant, I will call her Rachel instead of her real name. Her dentist gave her a (mouth guard) splint and a prescription for NSAIDS (nonsteroidal anti-inflammatory drugs). Rachel’s dentist told her she “grinds her teeth” and so she wore a splint at night. She came to see me since she still had pain.

She didn’t know how it happened except that it came on with a lot of stress in her life from family issues.  Rachel also had a history of trauma where she had fallen on her chin/jaw a year ago.  She had gone to an urgent care clinic for this. And she was sent home with a prescription for pain medications after they ruled out a fracture.  However, she got headaches after this and noticed her TMJ “clicked” when opening/closing her mouth.

Upon examination, Rachel’s mandibular “gait” (way lower jawbone moves) was out of alignment.  She also had involvement of the cervical (neck) spine contributing to her pain.  Moreover, her headaches were coming from both her TMJ and neck.  Tendinitis and trigger points were found by increased tenderness in the belly and tendons of the masseter  (muscles on mandible that help close the mouth) and temporalis (muscle on temporal bone that help move jaw bone).  Her neck x-rays done in my office showed moderate osteoarthritis (wear and tear type of arthritis).  Plain film x-rays are virtually useless for TMJ disorder diagnosis (except perhaps for fracture which she got at urgent care when she fell) so were not performed. If she didn’t respond to the chiropractic treatment in 12 visits or approximately a month, she would get a magnetic resonance image (MRI) of her temporomandibular joints.