This post was originally published at TreatingTMJ.com
So what exactly is TMJ hypermobility? Well hypermobility is characterized by early and/or excessive forward gliding (translating) of one or both TMJs. This excessive forward gliding results in laxity of the surrounding capsule and ligaments and the temporalis tendon. The over-stretching of these structures over time can lead to disk displacement/derangement to occur in one or both jaw joints or temporalis tendinitis. Unfortunately, pain, functional loss, and possibly arthritic changes can set in. In severe cases, the jaw can dislocate and remain open, known as an open lock (OUCH!).
The normal range of jaw opening is between 40 and 50 mm. The initial 25 mm of opening is primarily achieved by rotation which occurs in the bottom half of the joints between the mandibular condyle of the jaw bone and the underneath surface of the disk. The remaining 15 to 25 mm is gained primarily through the forward gliding (anterior translation) motion that occurs between the upper surface of the disk and the temporal bone of the skull. Most people who suffer from TMJ hypermobility open beyond 50mm, and might experience what we call an “eminence click”. It can occur on one side or both, and is sometimes confused as being a disc displacement with reduction.
There is a pretty simple screen I use to assess if someone has systemic hypermobility when they see me for an evaluation. I look at excessive mobility in their elbows, knees, thumbs, pinky finger and lower back. I follow the Beighton 9 point scoring system. However, for those of you at home, the below questions have been shown to have pretty good accuracy to assess systemic hypermobility, and possibly you also suffer from TMJ hypermobility.
- Can you now or could you ever place your hands on the ﬂoor by bending forward with your knees straight?
- Can you now or could you ever bend your thumb to touch your forearm?
- As a child did you amuse your friends by contorting your body into strange shapes or could you do the splits?
- As a child or teenager did your shoulder or knee cap dislocate on more than one occasion?
- Do you consider yourself double-jointed?
Answering “yes” to any two questions indicates the presence of hypermobility with a high degree of accuracy. The sensitivity and speciﬁcity were 84% and 87%, respectively.
(Data from Beighton et al. and Hakim and Grahame.)
It has been found that 79% of patients with systemic hypermobility and clenching/grinding of teeth (or nail biting) go on to develop a TMJ problem. A control group with clenching/grinding but WITHOUT systemic hypermobility were found to have only a 16% chance of developing a TMJ problem. (Rocabado)
This is something that can definitely be managed very well with proper physical therapy and I have excellent success with. In my future blog post I will include some basic exercises you can at least do at home to limit some of the stress and dysfunction to your TM joints and hopefully prevent further progression of your condition.
Hi, My 10 year old daughter has TMJ Hypermobility (and possible Condylar Hyperplasia of her jaw). Her orthodontist referred us to a PT for exercises. Besides these exercises, is there anything else we can do to cut down on joint pressure, such as a nighttime mouth guard? I suspect the TMJ, plus her teeth grinding and jaw clenching is causing a change to the structure of her bone, resulting in Condylar Hyperplasia. Thanks,
Hello Catherine, I am very sorry to hear about your daughter, can you please provide more info. Has your daughter had a cone beam scan or some imaging to confirm the diagnosis of Hyperplasia, only because you used the word “possible”? Thanks Mike
I have had back, leg and foot issues for many years and have problems if I exert joints repetitively (ie: learning flute for just one week gave me permanent trigger finger). I am unable to stretch or twist and extend without pain issues afterwards. The rheumatologist told me I have hypermobility which various physios or any doctors have refused to discuss. I have been told I clench my teeth when having TMJ syndrome investigated but I have never known myself to do this. Problems with my jaw have always been on the right side where I had a dental crown and they would come and go. When the crown decayed I had the tooth removed and a dental bridge fitted which did not fit correctly on the lower back molar tooth (I had 28 teeth in total unlike some people) and in time I had some decay under it and had to have it removed. Immediately the jaw problem was much worse and I was biting tongue and cheeks. They put a temp crown on the back right lower molar and I was hoping that with the permanent crown things would improve but because they had difficulty finding my correct bite, with the new (Zirconia)crown things are much worse and I have constant pain as well as tingling on my tongue. The supporting crowns of the bridge have moved since the original crown was removed also and the roots of the back molar slant. SO now I am inconstant pain and the dentists say they can do nothing. I would welcome any suggestions. Could an implant possibly help?
Dear Mrs. J, Thanks so much for your contribution and willingness to share. I am very sorry to hear about the complications you have had. If you are willing, please share where you live (city, state, country) so I can possibly help you find a really good TMD specialist in your area. Your situation requires a really good evaluation to determine the exact nature of your pain and then a proposed treatment regimen. Thanks, Mike
Thank you for all of the helpful info re: TMJ/TMD. Out of the many, many websites I have read in the last week your short post has been the most helpful. I really appreciate the explanation of the mechanics of the TMJ, I finally understand what has happened to my jaw!
I have had TMJ problems for much of my life, but they were generally ignored by my dentist and by myself. I have had my jaw lock open on two separate occasions, one at the dentist and one post-op after my breathing tube was taken out. Both times my TMJ was able to be massaged and everything put back together (like Humpty Dumpty, haha!) without concern. However, last week I somehow managed to dislocate my jaw while eating a tortilla chip. A full week later and I am STILL having pain. I probably have let things go a little bit too long without some sort of intervention, but I am in a small rural town in Canada that doesn’t have many services available. It seems to me like my jaw dislocated and then when sliding back into place, things didn’t really end up where they should be. I can barely open my mouth without immediate pain, I can’t chew (I have had a lot of smoothies recently!), it is hard to talk, swallow, etc. Basically all simple functions cause pain and I have realized that I can’t simply ignore this any longer.
What do you think will help fix my issue? I know it involves my temperomandibular joint, since I have previously had some issues. I am just not sure what actions/steps to take to have this fixed. I’m worried that I will need a surgical fix but that is absolutely the last route I would want to take!
If you have any input I would greatly appreciate it! I apologize for writing you a novel.
Thank you so much for reading this!
I am only 17 and have been living with horrible tmj for years s i dont at tough meat or any meat and i dont chew gum. Its so much pain im taking so much ibuprofen. And i got a bite gaurd to wear at night but its hard plastic and just sticks on the top and has very shallow places for my bottom teeth to sit in and doesnt help at all. My dentist doesnt know about tmj either. I have big issues with hyper mobility and I even had to have surgery on my knee because it dislocated multiple times. If there a better night guard?
Hello, I am sorry to hear about your situation. If you are willing to share what city and state you are in I can do my best to help you find a qualified TMD specialist. It appears to me we need to help you find an expert in TMD first, and then determine the best course of Treatment, whether it be physical therapy, or a dentist who specializes in TMD and knows how to make the appropriate splint, etc. There is no one size fits all type of thing with splints. You really need to be accurately diagnosed and then from there put in place the appropriate treatment. I look forward to hearing back from you. I hope you feel better soon. Sincerely, Mike
Hello, I am a 43 year old female struggling with subluxations, including wrists, shoulders, and metatarsals in the foot. I have always been super bendy. My jaw makes clunking noises when I move it forward to a huge under bite, or side to side. My shoulder blades also make this same noise when I stretch my back or move my shoulders backwards. My shoulders clunk when I stretch my arms up and over. The pain in my arms in unbearable when sleeping. Tingling and burning down to any or all fingertips. Getting a doctor to listen to me is infuriating to say the least. Especially now that I have a daughter that is 20 and way worse off than I am. Any help or input would be so appreciated.
Hello Tanya, I am very sorry to hear about all of this. Obviously hard for me to diagnosis without seeing you, but certainly sounds like you have pretty severe systemic Hypermobility. Have you been screened for Ehlers Danlos Syndrome? I know there are various websites that can list doctors who have an interest or expertise in systemic hypermobility or EDS but it also sounds like you need to find a really good PT in your area that can work with you regularly. Many of our systemic hypermobile patients, usually come 2x a month or once a month to at least work through any symptoms they have so we can stay on top of things. I would be curious to know too if you and or your daughter also have headaches, or migraines or GI issues. Many patients with Hypermobility syndrome have overlapping chronic pain conditions unfortunately, Please keep me posted and I wish you and your daughter well. Sincerely, Mike
I have recently been to a dentist who suspects a dislocated disc in my jaw. It’s taken years to get someone to listen to me. I was in tears when he believed me and gave me a referral to an orthodontist. Unfortunately I cannot afford to see one nor do they accept the insurance I have. As a child I used to compare myself to a snake because of my ability to open my mouth and dislocate my jaw to open it wider. I didn’t know the damage I was causing. I was also able to stretch my leg bone out of its place in my hip along with my shoulder. Coincidentally all on the left side. I have no other symptoms related to eds except for possible gastrointestinal issues thought to be ibs by the er, but no actual diagnosis. I’m in a great deal of pain and at a loss of what to do. I have an appointment to see a regular physician and would greatly appreciate any advice on how to proceed with getting these issues resolved.
I don’t know what’s happening. I’ve always been able to hyperextend my jaw bone. I used to be able to do it on both sides, but trough the year it has changed and only happens to my left jaw. So my jaw when hyperextended and ‘resting’ or relxed, stays completely on the right side of my face. It never clicks when i close my jaw- only when i open my jaw alot. I used to show my friends and family because i thought it was cool but it them became a fun habit to always move my jaw to the side and open and click it. My parents always told me to stop, saying it would cause problems in the future. when sitting in class and writting things down i would hyperextend my jaw and keep it to the right for fun. However, i stopped doing it as much. I recently developed the habit again however it’s a different feeling. The hyperextending ability on my right jaw is now completly gone, and when i do, do this it just causes extreme pain on right infront of my ears intront of the top and bottom jaw joints. and very very quickly after 1 or 2 minutes on that both of my ears go slightly def for about 15- 20 minutes and after i keep getting ticklish sensations in my ear on and off repeatedly. i can feel that i have hyperextended my jaw for a few hour after that. Also if i move my right jaw forward to ward the left side i can hear a very clear whistle sound in my ears everytime. I don’t know what’s happening help!
When I lay on my right side too long, my jaw shifts put of place and I have to force my mouth open to pop it back into place. I’m 23 and my knees and elbows pop just about every time I move them, especially when I squat down, which makes my ankles hurt. If I hold my elbows in the same position too long, they lock up and I have to force them to pop and open up similarly to my jaw… Is this the same thing in the article or something else?