Top Tips for Managing TMJD
I’m a TMJ Massage Therapy Specialist and Here Are My Top Tips for Managing TMJD
I’ve been a massage therapist for two decades. While I enjoy working with several specialized modalities, intraoral massage (massage inside the mouth) is one of my absolute favorites.
I focus on this particular massage modality to help folks relieve and manage jaw tension, improve the symptoms of TMJD and lessen the frequency and severity of tension headaches. I became interested in this work because jaw tension was the major concern for one of my very first clients who came to me for relief.
I developed techniques based on trial and error. After a while of honing my skills, I reached out to my local state board to inquire about the possibility of teaching what I knew and what credentials might be required.
Much to my shock and surprise, it turned out that by law I needed special training to provide that work in the first place! I
mmediately I enrolled in an intraoral massage class and I’ve been practicing my favorite techniques ever since.
The reason I love this work is because it’s relatively quick to do in one session and the results are almost always significant. Most people report excellent improvement in their symptoms; especially with regular sessions. It feels very gratifying for me to be able to help people improve their quality of life and I am always honored to be entrusted with my clients’ care. The wonderful thing is that I am constantly learning more about this condition and how to treat it through my time with them.
What is TMJD?
TMJD, or temporomandibular joint dysfunction, is dysfunction of the jaw joint (the temporomandibular joint or TMJ). Symptoms include “popping or clicking” of the joint with pain in the jaw, face, ears, neck, shoulders, etc. The TMJ is unique because it is the only joint in the body that hinges and glides at the same time (a ginglymoarthrodial joint). TMJD can be caused by several congenital and/or lifestyle factors including stress, grinding the teeth (Bruxism), orthodontia, physical trauma to the jaw, poor sleeping habits, tongue tie, narrow palate and more. TMJD can have a ripple effect in the body, which is why treating it is nuanced and complex.
How does intraoral massage work?
Firstly and foremostly, my goal is to calm the nervous system. All muscle tension begins as a pattern in the nervous system. Creating a calming environment, establishing good rapport, clear communication and expectation-setting are essential to begin all massage sessions. Then while clients are laying face up on the table, I massage their shoulders, neck and scalp before massaging the face. Finally, I put on a glove and work with one finger inside the cheek and the other hand on the outside of the cheek to target and gently release muscle tension. I repeat on the other side and sometimes use a glass facial cupping device to provide gliding, negative pressure on the front of the neck and the face. Almost always clients report that the session felt very good, effective and was not painful. People who receive this work typically return once a week during major flare ups and then graduate to once or sometimes twice monthly for maintenance.
Over the years I have learned what can be done at home or with the help of other modalities to manage or treat TMJD. Some changes are very simple; others can seem more complicated. Some methods are completely free and a few can turn out to be very expensive since, sadly, most insurance companies do not cover the cost of treating it. Overall my hope is that at least one of these tips will be helpful to you in some way.
Here are my top tips for managing TMJD and jaw tension:
Maintain proper tongue posture at rest.
Most people may not realize this or even think about it, but tongue posture is crucial for optimal breathing, supporting upper jaw width as you age and keeping your lower jaw suspended so the muscles are at their correct resting length. At rest, your tongue should be lightly suctioned to the roof of your mouth; behind your front teeth. When you open your mouth, your tongue should sustain that suction and the top of your tongue should sort of “snap” off when you open very wide. Interestingly, healthy infants naturally have proper tongue posture. When possible, make an effort to be mindful throughout the day to stick your tongue back up onto the roof of your mouth whenever you notice that tongue posture is off. This is a simple adjustment and consciously developing this habit can have a very positive impact on your overall health.
Calm the nervous system.
Stress is a major contributor to sustained low-level muscle contraction that over time becomes automatic in the body. In other words, this is how muscle tension begins. This can manifest in the jaw due to clenching the teeth or grinding; particularly during sleep. Helping to calm the nervous system is a powerful way to reduce pain symptoms throughout the body, including your jaw. Winding down and intentionally allowing for moments of stillness and rest will have a positive cumulative effect. At times when I feel rushed or I feel anxiety bubbling up, I try to allow for a moment to take a deep breath and remind myself “this is not an emergency” when I am going about my daily tasks. Try placing your palm over your heart and let your eyes come to a close or soft gaze as you deeply inhale and slowly exhale.
Sleep on your side during flare ups.
Laying on your side is the best possible position to help avoid further stress to the TMJ during sleep; especially during painful flare ups. Laying on your back can lead to the jaw sliding backward when you relax and can put further stress on the jaw. Laying face down with your head to the side can be very hard on the neck, shoulders and jaw. Side-sleeping is conducive to supporting your jaw and neck.
Avoid Botox injections in the masseter.
This is a hot take and a highly debated topic. The reason I highly advise against Botox injections into the largest jaw muscle (the masseter) is that it’s essentially akin to knocking out a load-bearing wall in a building. The masseter is the strongest muscle in the jaw and it is efficiently designed to endure plenty of force and pressure that the other supporting muscles of the jaw simply are not designed to perform without its help. I hear reports from clients that use of Botox can be very helpful at first, but soon the tension returns and often in a different manner– and eventually stops working altogether. I always say it’s like “robbing Peter to pay Paul”. This doesn’t necessarily apply to every person, but in general, this is what I understand to be true based on client feedback. Also the use of Botox can be expensive and simply put, I don’t believe this treatment is worth it. Of course, make sure you speak with your doctor to determine what treatments are right or not suitable for you.
Self-massage is a fantastic option.
I usually recommend doing intraoral self-massage while in the shower. This might sound strange, but it’s one of the rare times and places that you’re typically alone and that you’re able to drool without a mess. Also the water warms the facial muscles and you have a few minutes to multitask while your hair conditioner is setting. My advice is to start slow and with minimal pressure. Massage should always feel helpful and never painful to the point of wincing, bracing or holding your breath. Begin with a deep breath and set intentions on relaxing and “melting” the tension. With one finger (thumb or forefinger) inside the mouth and the other hand outside of the cheek, move gently with gliding, circular movements followed by moments of stillness and gentle direct pressure; using the fingers both inside and outside of the mouth simultaneously to target the tension points. Try to avoid very deep pressure and overstretching during self-massage, and repeat as necessary throughout the week.
Seek a TMJ orthotic (not a night guard) for life-changing results that last.
Night guards and TMJ orthotics are very different things. Night guards are very helpful for protecting the teeth from damage for those who grind their teeth while sleeping. Unfortunately this device does not protect the jaw joint and the force of the grinding still affects the TMJ. Specialized dentists (such as The TMJ Doc) can create a personalized TMJ orthotic to help protect the jaw joint. Though this option can be considered a high price point for some, it can ultimately improve one’s quality of life if they are suffering with chronic, painful TMJD.
Seek Myofunctional therapy.
A myofunctional therapist is a specialized professional that focuses specifically on the function of face, tongue and mouth. They evaluate and help retrain oral habits to optimize breathing, chewing and swallowing. Essentially it is physical therapy for the face, which can be super helpful long term. Developing better habits can be a great way to manage TMJD.
Give gum-chewing a break during flare ups and try to make a habit of chewing foods on both sides of the mouth.
Chewing is a repetitive motion.
Think about how folks with occupations spent at a computer desk will sometimes develop repetitive stress injuries in their forearm tissues; likely caused by typing or repetitively clicking on the mouse. The same concept applies to your jaw. Giving it more work than necessary can put undue stress on the TMJ; especially during flare ups. If you absolutely must do it, I recommend splitting it in half and chewing equal amounts on both sides simultaneously. In general, it’s best to alternate chewing with each side of the mouth when eating.
TMJD can have a huge impact on quality of life. Learning to understand it and becoming aware of the possibilities of ways to improve your jaw function can make a positive difference.