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Ask Doctor Donohoe - TMJ

Ask Doctor Donohoe

I’ve been in practice now for 15 years. Over all those years I’ve been asked to answer LOTS of questions. Neighbors Newspaper has graciously agreed to open up their publication to me and YOU! Starting this month we will be accepting questions on all subjects health related. As readers of my column already know, I specialize in pediatric and pre-natal chiropractic care. However, my office is a family practice. I take care of patients young, old and everyone in between. We invite your questions on health and fitness, diet and nutrition, kids care, adult care and any alternative medicine issue. Please email your questions to I will try to answer one or two every month in this column.

Question: Submitted by Everardo L.
My wife has developed a clicking, popping and pain problem every time she opens and closes her mouth. This has made eating an uncomfortable experience and she is desperate to get a proper diagnosis and treatment for the condition. A nurse I know recommended your office and chiropractic care for what she called temporomandibular dysfunction (TMD). Can chiropractic care work on TMD and do you have experience in treating this condition?

Great question Everardo! Yes, TMD can be treated quite successfully through chiropractic care and I have treated dozens of cases over my fifteen years in practice. Please allow me to discuss for you the anatomy of the temporomandibular joint (TMJ) and how the work I do affects TMD.

TMJ Anatomy
The TMJ is a hinge and gliding joint and is the most constantly used joint in the body. The round upper end of the lower jaw, or the movable portion of the joint, is called the condyle; the socket is called the articular fossa. Between the condyle and the fossa is a disk made of cartilage that acts as a cushion to absorb stress and allows the condyle to move easily when the mouth opens and closes. There are many additional muscles and ligaments that play a major role in TMJ function and stability.

Common Symptoms of TMD

There are 3 major sets of symptoms associated with most cases of TMD. They include:
1) Pain in the joint or the muscles of the jaw or temple region.
2) Sounds such as clicking, popping or creaking when the mouth is opened and closed.
3) Incorrect jaw movement or position, such as when the jaw locks in an open or closed position, or when the jaw is difficult to open or close. Deviation of the chin from the midline when the jaw is opened or closed.

These may often be accompanied by grinding the teeth, especially at night, known as bruxism, which may also result in sleep fatigue. Also seen in TMD are biting the cheeks, lips or tongue.

Related symptoms may include headaches, neck, shoulder and facial pain accompanied by chronic muscle spasms. Other symptoms which have been found to have a significant TMJ component are other types of headaches such as migraine and cluster, whiplash disorders, facial palsies (Bell’s) and trigeminal neuralgia.

Causes of TMD

TMD is often a result of trauma introduced through the jaw or the neck. One of the very common causes I’ve seen is motor vehicle collision. A rear-end accident that causes whiplash can also cause TMD as the jaw is flung forward at a high rate of speed and causes subsequent injury to the ligaments, muscles or the cartilage disc. Of course, one cannot overlook the effect of a blow to the chin or the head as experienced in a physical altercation or even a fall.

Another cause that I have seen is the long term effect of orthodontic or dental work. The effort to move teeth in the mandible (jawbone) can inadvertently create a shift in the alignment of the TMJ. Particularly of concern to the chiropractor is the use of “headgear” which uses forces applied to the neck to cause a shift to the alignment of the teeth. Orthodontic or dental work such as implants is not often detrimental, but should not be excluded as a cause of TMD either.

TMD Treatment

In my office, I use a combination of Activator Chiropractic Technique and Neuro Cranial Integration (NCi) to identify and resolve TMD. The use of an Activator adjusting instrument to reposition the alignment of the TMJ is both safe and effective. It utilizes a low force, high speed thrust delivered by a hand held instrument to specifically adjust the alignment of the TMJ. NCi is a cranial release technique that addresses tension or restriction in the alignment or motion of the 22 cranial bones and improves cranial joint alignment and function.

Sometimes the use of a bite guard at night will be recommended to prevent grinding of the teeth which can irritate the muscles of the jaw or neck and contribute to the condition. Relaxation techniques can also be helpful in reducing stress that can play a major role as well.

Thanks again for the question Everardo, I hope this helps explain TMD a little more for you! Please send more questions in to and let’s keep this column rolling!

Dr. Donohoe is a family practice chiropractor who specializes in the unique needs of pregnant women and children. His office is located at 41880 Kalmia St., Suite 135 in Murrieta. He can be reached at 951-677-6500 or through his website at

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