Temporomandibular joint disorder (TMJD or TMD) is a condition that causes pain and dysfunction in the jaw joint and muscles that control jaw movement. TMJD can lead to symptoms like pain or tenderness in the face, jaw locking, and painful clicking or popping noises when opening the mouth. One common question regarding TMJD is whether it can cause alignment issues in the neck vertebrae or lead to neck pain.
What is the temporomandibular joint?
The temporomandibular joints (TMJs) are the hinge joints that connect the jawbone (mandible) to the temporal bone of the skull. There are two TMJs, one on each side of the head, which allow the jaw to open and close and facilitate chewing and speech. The TMJs are complex joints that rely on muscles, ligaments, discs, and bones for smooth movement and function.
The TMJ components include:
- Mandible – the lower jawbone
- Temporal bone – the skull bone that forms part of the TMJ
- Articular disc – the cartilage disc that cushions and separates the bones
- Joint capsule – fibrous tissue that envelops the joint
- Ligaments – bands of tissue that connect bones and provide joint stability
- Mandibular muscles – muscles like the masseter that control jaw movement
Proper alignment and functioning of all these TMJ components is needed for smooth jaw movement and opening/closing. Issues with any of the bones, muscles, discs, or ligaments can lead to TMJD.
TMJD causes and symptoms
TMJD results from problems with the muscles or jaw joint itself. Common causes include:
- Injury or trauma to the jaw, face, or neck – e.g., a blow to the jaw
- Grinding or clenching of teeth, which puts pressure on the TMJ
- Dislocation of the disc between the jawbone and skull
- Arthritis or degeneration of the joint tissues
- Jaw dislocation
- Stress and emotional tension, which can lead to jaw tightening and discomfort
Symptoms of TMJD include:
- Pain, tenderness, or soreness in the face, jaw joint area, neck, or shoulders
- Clicking, popping, or grinding noises when opening or closing the mouth
- Locking of the jaw when attempting to open the mouth
- Difficulty fully opening or closing the mouth
- Ear pain or pressure, sometimes with ringing in the ears (tinnitus)
- Headaches or migraines, particularly around the temples
Can TMJ dysfunction lead to neck pain and misalignment?
There is conflicting evidence on whether TMJD causes neck pain and misalignment of the cervical vertebrae. Here is an overview of some key considerations:
Anatomically speaking, the jaw joint does have neural, muscular, and ligament connections to the cervical spine (neck vertebrae):
- The sensory and motor nerves that innervate the TMJ also branch into nerves supplying muscles and joints in the neck.
- There are muscular connections where some jaw muscles attach to the mastoid and cervical areas.
- The stylomandibular ligament links the jaw area to the cervical spine.
So in theory, problems with the TMJ could radiate out and impact neck structure or function.
TMJD pain patterns
People with TMJD do often report pain spreading from the jaw to the head, ears, temples, neck, and shoulders. Up to 70% experience some neck discomfort along with their jaw symptoms.
This refers pain pattern lends support to the idea that TMJD could contribute to neck pain in some patients, possibly due to the anatomical connections between the regions.
Excess tension in the jaw muscles and cervical muscles often co-occur in TMJD patients. Grinding, clenching, or imbalance of the jaw muscles could plausibly trigger increased tension or spasms in the neck muscles as well.
Changes to alignment and movement patterns
Some researchers propose that TMJD may cause subtle changes to alignment, posture, or movement coordination of the cervical vertebrae. Theories include:
- Imbalance of the jaw muscles could pull the neck out of alignment.
- Trying to limit jaw movement due to TMJD pain could theoretically lead to stiffening of the neck over time.
- The linked sensory nerves between the jaw and neck could disrupt alignment by impacting proprioception (position sense).
However, these ideas are hypothetical and not proven.
No clear causative, correlational link
On the other hand, many studies find no conclusive evidence that TMJD directly causes neck misalignment or pain. Key points include:
- No clear correlational relationship between the severity of TMJD symptoms and degree of neck dysfunction or pain.
- Neck dysfunction does not clearly improve after treatment for TMJD in most cases.
- TMJD and cervical dysfunction may simply co-occur due to common risk factors like injury, arthritis, and psychological stress.
So in summary, while TMJD theoretically could contribute to some neck issues due to anatomical connections, there is little solid proof it directly causes misalignment or pain in the cervical spine.
Evaluating the neck with TMJD
Given the links between TMJD and neck discomfort, experts recommend that TMJD be evaluated for any effects on the cervical spine. This may include:
- Physical exam of the neck – checking range of motion, alignment, pain points.
- Neurological exam – checking nerve function in the arms/hands.
- Imaging – X-rays, MRI may be done to assess neck structure.
- Posture analysis – looking for changes like forward head position.
This evaluation can help identify if neck issues are contributing to TMJD pain or vice versa. Some neck problems that may need specific treatment include:
- Cervical dystonia – involuntary neck muscle spasms causing abnormal head position.
- Upper cervical instability – hypermobility in the C0-C2 vertebrae.
- Cervical arthritis – facet joint or disc degeneration in the neck.
- Myofascial trigger points – knotted muscle spasms in the neck and shoulders.
Treating TMJD and neck dysfunction
An integrated treatment approach is recommended when TMJD and neck issues occur together. This may include:
TMJ and jaw treatment
- Resting the jaw – avoiding wide opening, chewing hard foods.
- Stretches and exercises – gentle movements to improve jaw mobility and muscle tension.
- Heat/ice therapy – reducing inflammation and pain.
- Medications – OTC pain relievers, muscle relaxants, anti-inflammatories.
- Jaw splint or mouthguard – stabilizing and resting the TMJ.
- Stress reduction – to limit jaw clenching and tension.
- TMJ injections – corticosteroids to reduce inflammation.
Neck and cervical treatment
- Gentle stretching and exercises – improve neck mobility and decrease muscle tension.
- Posture correction – avoid hunching shoulders or straining the neck.
- Manual therapy – massage, mobilization done by a physical therapist or chiropractor.
- Cervical traction – gently separate vertebrae to relieve pinched nerves.
- Trigger point therapy – release knotted muscle bands.
- Heat/ice therapy – reduce local neck pain and inflammation.
- Braces or taping – provide external neck support as needed.
The aim is to address all sources of pain and dysfunction in both the TMJ and cervical spine for optimal improvement.
Risks if neck misalignment from TMJD is ignored
Letting ongoing neck pain or changes in vertebrae alignment from TMJD go untreated long-term may lead to the following risks:
- Chronic neck pain – ongoing cervical discomfort can greatly lower quality of life.
- Degenerative cervical changes – increased wear and tear on the facet joints, discs.
- Muscle spasms – sustained trigger points from constant neck tension.
- Pinched nerves – misalignment can compress spinal nerves, causing numbness, tingling, weakness.
- Headaches – neck dysfunction commonly triggers cervicogenic headaches.
- Limited mobility – significantly reduced range of motion in the neck over time.
Seeking proper treatment for both TMJD and any associated neck complaints can help avoid these potential complications.
Can TMJD treatment improve neck alignment?
For patients where TMJD does seem to be contributing to cervical dysfunction or pain, properly treating the TMJD often lessens neck symptoms as well. Ways TMJD treatment may help neck alignment include:
- Relieving jaw inflammation and discomfort can decrease overall muscle tension in the neck and shoulders as well.
- Resting the jaw and TMJ may allow neck muscles like the sternocleidomastoid to relax.
- Jaw splints can help normalize jaw positioning and movement, taking pressure off the neck.
- Stretches and exercises can improve mobility in both the jaw and neck regions.
- Reducing TMJD symptoms may improve proprioception and position sense between the jaw and neck.
So while TMJD treatment does not always directly improve neck alignment, it can have positive effects in some patients where both regions are involved. However, the neck should still be evaluated and addressed in its own right too.
In summary, while the jaw joint is anatomically connected to the cervical spine, there is conflicting evidence on whether TMJD causes neck misalignment or pain directly. In many cases, TMJD and neck complaints seem to stem from common contributing factors. However, given the overlap in symptoms, experts recommend evaluating the neck for any dysfunction when TMJD is present. Treating both the TMJ and cervical spine through conservative means like exercises, posture correction, anti-inflammatories, and splint therapy tends to provide the best improvement. This integrated approach to managing TMJD-related neck discomfort can help restore proper alignment and function in both regions.