TMJ ear pain, facial stabs, migraine and neck ache are the elusive symptoms of jaw joint dysfunction.
Jaw joint and associated facial pain, and migraine type headaches are often the quite unexpected symptoms of having your wisdom teeth our under general anaesthetic.
Because the brain stem nuclei that supply the jaw muscles and the face are united with those of the neck, the jaw joint can mimic cervicogenic headache and suboccipital pain. It can also cause severe facial discomfort.
The temporo mandibular joint, as it is known, is located just in front of your ear. Place your forefingers in your ears, and open and close your mouth. Can you feel the jaw condyles in motion just millimetres in front of your fingers?
It is no coincidence that tmj pain is often confused with the ear.
Now run your fingers one centimetre forwards from the tragus, open your mouth a few times, and you will feel the jaw joints opening under your fingers.
They are amongst the most important joints in the body, and
fortunately something that some chiropractors can treat very
effectively. Could it be the source of your tmj ear pain or your
headaches? And the facial ache, too? Is your neck discomfort perhaps coming from your jaw, or your jaw troubles from your neck? It's complex obviously.
Why is the temporo mandibular joint so important? How is it that tmj ear pain can be one of the most painful of conditions? Because you use it in speech, eating, drinking, tasting and kissing. Having to work in a civilized manner with a partner some distance away on the other side of the skull gives special engineering difficulties for the jaw joints. Harmony between them is essential, and estrangement is common. Divorce is impossible! Until death do us part reigns supreme in the marriage between two jaw joints.
Thus the temporo mandibular joint has an unexpectedly large representation in the brain. Coordinating the tongue, the lips, swallowing, breathing and the jaw joints is no small task for the brain.
Consequently there are a large number of mechano receptors, and nociceptors in all these structures, giving the brain precise information about what is where, and about balance and movement. Otherwise you might accidently bite your own tongue off or break a tooth on an olive pip!
The coordination of all these parts is done via nerve impulses from the mechano receptors in these tissues that are processed by the small brain or cerebellum.
In this bizarre picture below you can see how in the cortex of the brain the sensory area, called the homunculus, gives the hands, lips, tongue, face, jaw joint and ear enormous representation.
TMJ ear pain will describe for you one of the peculiar yet profound generators of torment in the body.
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Consequently, the TMJ is the source of much pain in the head, face and neck. A punch to the jaw, or opened too wide under anaesthetic to surgically remove those nasty but not so wise teeth! Even a whiplash can can cause TMJ ear pain by injuring the jaw joints, stressing the sensitive and highly complex disc within the joint, and its ligaments and muscles.
Then noci-ceptors go firing off impulses to the brain and autonomic nervous system causing bizarre signs and symptoms. Believe you me, pain! Perhaps migraine headache and facial pain. Other symptoms, like ringing in the ears, too.
Facial torment can be agonising; it may well be associated with TMJ ear pain.
Tic Douloureux, as it is known, is one of the most painful conditions known to man. It literally has driven some to suicide. Pressure on the Trigeminal nerve, or one of its tracts, or the trigeminal nuclei, or a malfunction in the TMJ makes it extremely sensitive to normal stimuli. A breath of air on the cheek, cleaning your teeth, touching the face, even a smile or scowl or chewing; anything which stresses those areas which the trigeminal nerve supplies.
The face, teeth, jaw joint, the upper neck can cause a cascades of impulses to fire into the trigeminal nuclei causing intense stabs of pain in any of those self same areas. It often grows worse.
It can be caused by pressure on the nerve from a tumor, or from a pulsating artery, and from a disruption of the normal gait in the jaw joints. The cervical spine is not normally considered as one of the causes of this nasty condition but, because the trigeminal spinal nucleus, which is located in the neck these abnormal impulses often stab not only into the face, but over the scalp and into the suboccipital area.
Or can they emanate from the neck also? As chiropractors we feel that the cervical spine may be intimately involved in tmj ear pain.
Can you see the trigeminal spinal tract? It carries pain and sensations of warmth and cold from the jaw joint to the spinal nucleus of this, the largest cranial nerve, which is located in the neck.
In this diagram you can see the four trigeminal nuclei. Three receive input from the face, jaw, temporary mandibular joint and neck. The motor nucleus drives the four muscles of the jaw, the most powerful in the body enabling one to bite with awesome strength.
The two long structures in dotted lines are the two complete sensory Trigeminal nuclei, right and left. They are enormous, the fifth cranial nerve having more nerve material than all the other cranial nerves together.
The two heavy black arrows at the top are the impulses being carried to the sensory cortex of the brain where you experience all the normal activity of the face, jaw and neck, and all this potential pain.
Can you understand the complexity of tmj ear pain?
When diagnosing the cause of migraine headache, I as a chiropractor look first to TMJ ear pain even before the cervical spine, or considering the many dietary culprits.
Rush and hurry are not of the devil. They are the devil.
Well, not theologically sound, but you get the drift.
Notice how the trigeminal nucleus reaches right down into the upper cord, becoming continuous with the posterior horn, and receiving input from the upper neck. The cauliflower is the great coordinator, the cerebellum. It enables your jaw muscles to automatically ease off just before your molars grind down and smashing into each other whilst chewing. And to carefully pare the flesh away from the pip when eating a prune.
Incidentally, we should be eating both prunes and olives with pips on a regular basis. Prunes are the scientifically proved best solution to chronic constipation, and olives a rich source of healthy oleic acid. But do make sure your cerebellum is coordinating your chewing.
This is a hopeless complex condition that few doctors can cure, but some can help. I like to think chiropractors have a part to play. It's certainly worth consulting a chiropractor who works with both the spine and the tmj before acceding to medicine's final solution; surgically severing the trigeminal spinal tract, deep within the brain in an attempt to relieve your tmj ear pain.
Only yesterday I was treating a man with chronic migraine headaches and facial pain; it's noteworthy that patients don't walk into the office saying, doc, I have tmj ear pain. But after four visits there had been only minor improvement. At the initial consultation he had also complained of upper neck pain where I certainly found fixations, and blithely assumed they were the source of his headaches. They probably were; in part. But the neck joints were moving much more freely after four adjustments, yet there was little improvement in his headache symptoms. Was it tmj ear pain? Bingo, here was the cause of his headaches.
At his first consultation it had been a very stressed and busy day. I had six new patients that day, a record for me, and my examination of the man was found wanting.
On further examination, I quickly discovered a fixation in his left jaw joint, causing a tiny click in the right tmj and an exquisite active trigger point in a tiny hidden muscle called the external pterygoid. It was probably the result of an old rugby injury, he told me; he once took a punch at the bottom of a scrum, hidden from the ref. He'll get better.
We have a saying in health care.
"If you don't look for it, you probably won't find it".
I hadn't looked!
I leave you with a short story, Perhaps DD did it after all, about a man who came to my clinic complaining of a beehive in his head. Ringing in the ears, or tinnitus is one of those conditions that I am less confident of curing, because it often associated with other problems. But because of the close association between the ear, the neck and the jaw, sometimes chiropractic can help. Enjoy the story. The first part is 100% true, the latter obviously a figment of my fertile imagination.
There's nothing simple about tmj ear pain; one solution may be temporo mandibular joint exercises.
For more about what you do can do to help yourself, try some tmj exercises if you suffer from what you think may be a tmj syndrome. Tmj exercises ...
Chewing gum and opening your mouth too wide, yawning and giant hamburgers are also associated with jaw joint pain and migraine headaches; even biting into a whole apple.
Forced over opening of the mouth during procedures under general anaesthetic is one of the major causes of TMJ dysfunction; often there is irreparable damage to the meniscus in one or both of the jaw joints, and it clicks and pops for the rest of your life. Have your wisdom teeth out in the chair.
USEFUL LINKS @ TMJ EAR PAIN
Health breads and soups may be one way around TMJ ear pain, enabling to get the nutrition your body desperately needs; don't let the condition also cause malnutrition.
Many of the so-called health breads are heavy and chewy though. That's in part because of their full complement of the germ and bran.
But this sourdough bread recipe that I now make on alternate days is lovely and soft for the jaw, supremely tasty and even helpful if you have a gluten intolerance.
Chewing a salad may be problematic but I'm reluctant to recommend giving them up; take small mouthfuls and chew thoroughly; a parsley pesto or homemade hummus may make it more palatable.
Chewing is very important for the teeth and gums; if it's quite impossible because of TMJ ear pain, then consider the liquidiser.
Use of a pressure cooker will make these easy soup recipes quicker and may be an alternative method of ensuring you get all the necessary phytochemicals in your diet.
We use solar pressure cooking, but that's just because I'm a solar geek! The old Presto on a stove works just fine; do consider upgrading to one of these induction cookstop stoves though; they're magic and not expensive; they use half the electricity and take less than half the time.