TMJ Disorders

TMJ disorders and painful chewing muscles can have diverse causes, such as surgeries, accidents, injections, or overexertion, but they can also occur spontaneously. Due to these different causes, not all instructions in this brochure may apply to your specific situation. The oral surgeon will mark the instructions and exercises that are suitable for you. Please avoid performing exercises that are not suitable for you.

In general, TMJ disorders, limited mouth opening, and/or painful chewing muscles are more bothersome than dangerous. Activities like biting, chewing, drinking, talking, laughing, yawning, singing, kissing, and brushing teeth may cause discomfort. However, for most individuals, these symptoms tend to improve over time, and normal mouth function is restored without significant hindrance.

To reduce your symptoms, it is crucial to give your TMJ and jaw muscles as much rest as possible. This means avoiding excessive strain but maintaining gentle movements.

General advice:
1. Avoid opening your mouth too wide, even when yawning or laughing.
2. When eating, avoid using your front teeth to bite into food. Instead, it is less stressful on the TMJ to bite with your back teeth.
3. Refrain from consuming very hard or tough foods, such as tough meats, aged cheese, nuts, hard apples, baguettes, raw carrots, etc
4. Sometimes it is better to eat only soft foods such as minced meat, puree, applesauce and crustless bread or to grind the food with, for example, a hand blender.
5. Avoid prolonged pressure on the TMJ by breaking habits such as nail-biting, teeth grinding, clenching, or chewing gum. Also, refrain from using your teeth as tools to hold objects like pens or nails or to cut threads.
6. When chewing, make an effort to chew on the side where your TMJ is experiencing pain. This is important to reduce excessive strain on the affected side of the joint.
7. It is important to inform your dentist about your complaints before any treatment; you should not open your mouth wide for too long.

Pain Management:
1. If you experience severe pain, it is essential to follow the instructions below. The oral surgeon has discussed whether these recommendations apply to you.
2. For pain in the chewing muscles (cheeks and temples), you can use hot packs for about 20 minutes. You may repeat this treatment several times a day if needed.
3. If you have pain in the TMJ area (directly in front of the ear canal), it is better to apply a cold compress. A “cold pack” or ice cubes wrapped in a towel can be used for this cold treatment. Alternate placing the cold pack on the TMJ for one minute and then completely remove it. Repeat this exercise several times while gently opening and closing your mouth.
4. Take any prescribed medications as directed. Do not use other medications simultaneously without consulting your treating oral surgeon or physician.

Exercises:
It is better to perform short and not overly intense exercises several times a day than doing them once a day for an extended period. An exercise routine of approximately four times a day is common. During the exercises, perform the movements slowly and repeat each exercise about ten times. It is helpful to stand or sit in front of a mirror to observe how your lower jaw moves. It is normal to experience some discomfort during the exercises. However, the pain should not be too severe, as a complete absence of pain during the exercise is often less effective.

• Hinge exercises:
The goal is to gain control over the lower jaw movements during mouth opening. Minimize forward sliding of the jaw joint during this exercise. Place the middle and index fingers of one hand in front of the ear against the skin at the joint. Position your tongue against the palate as far back as possible. Open your mouth while keeping the tongue touching the back of the palate. If necessary, support the lower jaw by placing your elbow on a table and gently pressing your chin with your other palm. This way, the jaw joint undergoes minimal sliding movements. When performed correctly, you should not feel the jaw joint move forward during the initial phase (about 2 cm). Once you have mastered this form of movement, place your tongue slightly more forward against the palate during the exercise.

• Wire exercises:
The goal is to open and close the mouth in a straight manner. Use washable ink to place a dot on the tip of your nose and another on the middle of your chin. Attach a small object, like a pen, to a thin piece of string or yarn. Secure the string to a mirror with tape, creating a straight vertical line. Sit in front of the mirror so that both dots align with the line. Open and close your mouth slightly, keeping the chin dot aligned with the line. Once you have mastered this movement, you can open your mouth slightly wider, but avoid opening it too wide.

• Cork exercises: rolling movements
Rolling Movements The goal is to improve the sideways mobility of the lower jaw. Take a cork from a wine bottle (without a cap). Draw an arrow on the bottom of the cork. Stand in front of a mirror and place the cork between your front teeth, with the arrow pointing upward. Move your lower jaw from left to right, aiming to keep the arrow on the cork pointing equally to the left and right during movement.

• Cork exercises: sliding movements
The goal is to improve the sliding movements of the lower jaw. Take a cork from a wine bottle (without a cap). Stand in front of a mirror and place the cork between your front teeth, pointing it forward. Slide your lower jaw forward. When done correctly, you will see the cork tip upwards.

• Tongue spatula exercises: sliding movements
The goal is to improve the sliding movements of the lower jaw. Take a cork from a wine bottle (without a cap). Stand in front of a mirror and place the cork between your front teeth, pointing it forward. Slide your lower jaw forward. When done correctly, you will see the cork tip upwards.

• Tongue spatula exercises: stretching movements
The goal is to increase mouth opening. Take a stack of tongue spatulas between your front teeth. The stack should be large enough that you feel mild to moderate pain. Hold this position for about 5 seconds. Then slide another tongue spatula between the stack and hold for another 5 seconds. Repeat this process until the pain becomes too severe. Keep track of the maximum number of spatulas used per day OR place your middle fingers directly behind the lower canine teeth, while both thumbs rest behind the upper canines. Now perform a “scissors motion” with both hands, biting down for a few seconds in this position before repeating the stretching exercise. You may experience some pain during the exercise, which should usually subside after a short period.

• Massage exercises for the chewing muscles in the cheek
The goal is to reduce pain and/or stiffness in the jaw muscles in the cheek. Massage is most effective when using the left thumb to massage the right jaw muscle and the right thumb to massage the left jaw muscle. Move your thumb over the lower molars until you reach the back of the lower jaw. At this point, your thumb will be touching the back of the lower jaw. Move the thumb slightly outward until you feel it pressing against the cheek. To check if you are in the right position, gently close your mouth while keeping the thumb against the inside of the cheek. When in the correct position, you should feel the jaw muscle tense against your thumb. Then, move your thumb up and down approximately 5 times while pressing against the jaw muscle in the cheek. Repeat this process on the other side.

• Oroacial Physiotherapy
In some cases, you may be advised to contact an orofacial physiotherapist. An orofacial physiotherapist is a physiotherapist specializes in functional disorders and limitations in the head, neck, and jaw region. They can help you further with your complaints. You can find an orofacial physical therapist near you on the website www.nvof.nl

Occlusal splint:
If you clench or grind your teeth while sleeping, your jaw muscles or jaw joints may become irritated and painful. Wearing an occlusal splint or night guard during sleep can help alleviate your symptoms. You can have an occlusal splint made by your regular dentist or through Haaglanden Clinics.

Finally
In this brochure we have provided a general overview of the complaints and the general advice and exercises that may be important for you.

Do you have any questions after reading the brochure? Feel free to call Haaglanden Clinics. We are available by phone from Monday to Friday, from 08:30 to 12:15 and from 13:00 to 17:00, at telephone number 070 2212121.

In case of emergencies or urgent complaints outside Haaglanden Clinics’ opening hours, please contact the Emergency Department of Haaglanden Medical Center at telephone number 088 9792380.