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Our understanding of TMJ dysfunctions begins with the stomatognathic system that is composed of the teeth, the temporomandibular joints (TMJs) and the mastication muscles. When the upper teeth and the lower teeth don’t fit properly (malocclusion), the other two components of the stomatognathic system, muscles and TM joints must accommodate the discrepancies to guarantee the primary functions but this will lead to a structural disorganization of the cranio-cervical-mandibular biomechanical unit (“upper pole”). Any tooth gearing abnormality causes the neuromuscular system to program reflex movements for the mandible to avoid any damage to the teeth and to the temporomandibular joint when closing the mouth.
When the patient slowly opens and closes the mouth, the midline incisal path of the mandible deviates: it wobbles back and forth. The stomatognatic system is part of the cranio-cervico-mandibular biomechanical unit (“upper pole”).
The neck must be aligned with the centers of the shoulder, diaphragm and pelvic rings on a vertical line (“the line”).
The deep neck muscles are the core muscles mainly supporting the cervical vertebrae so that the head movement (“yes” and “no” movements) are possible in an efficient way.
Traumatic events like car accidents (whiplash), a blow in the head or face and loss of teeth can trigger a change in the occlusion and then cause TMJ disorders (see the article “trauma: a structural approach”). In conclusion TMJ syndrome must be evaluated and treated as part of the whole-body structural organization. We view the teeth as a set of gears which must mesh perfectly in order to provide the primary physiologic functions of the mastication and swallowing.
Each one is a synovial joint formed where the condyle of the mandible articulates with the articular tubercle of the temporal bone.
Three pairs of muscles are mainly responsible for elevating the mandible when we close the mouth. A poor organization will develop myofascial pain conditions as we have already explained in previous articles (see “chronic myofascial pain and dysfunction: break the pain cycle!”). This creates a situation in which the jaw is “limping” much as we limp with an injured ankle.
The most marked deviation from the mid-line during movement is usually away from the side of the more affected laterally pterygoid muscle.
Any deviation from this easy structural relationship means that the whole myofascial network of the upper pole is out of balance.
The sterno-cleido-mastoid muscles (SCM) are the main muscles responsible for this pattern because when they are tight short, they flex the neck on the thoracic spine and they extend the head on the top of the neck.
These muscles are surrounded by the deep prevertebral fascia (see picture showing a section of the neck).
Balancing the head on the neck at the atlas-occipital joint involves working all the myofascial tissues inside the mouth. Grinding the teeth (bruxism) overuse the masticatory muscles and this will lead to myofascial pain in this area.
Sports activities like weight lifting and scuba diving involving clenching the teeth, can also contribute to TMJ disorders. In our Chronic Pain Management program at the Pakua Integrative Health Clinic we use the therapeutic bodywork modalities structural bodywork and neuromuscular therapy to address the TMJ soft tissues dysfunctions. You can feel them work by placing your fingers just in front of your ears and opening and closing your mouth. This will close off the Eustachian tube that connects the throat to the middle ear and keeps the air pressure in the middle air the same as the outside atmosphere.


The head must be kept in balance on the top of the neck so that the jaw can track straight up and down.
A dysfunctional position of the head can lead to occlusal problem and viceversa a tooth gearing problem can affect the balance of the head on the neck.
That means that the inframandibular muscles (suprahyoid muscles) that are flexors of the head at the atlanto-occipital joint, are overstretched (tight long) in their effort to counteract the action of SCM to keep the eyes horizontal. Only after releasing the tensions in the jaw, the internal extension of the neck up to the crown of the head will be possible! Interposed between the two surfaces of the joint there is a disc composed of fibrocartilage. This changes the movement patterns of the jaw and that means that some muscles of the mastication must work too much and they go to spasm. The closing of the Eustachian tube will produce symptoms of earaches, ringing and dizziness.
Clicking occurs when the articular disc has become displaced anteriorly due to a spasm of the lateral pterygoid muscle. Evaluating the structural organization of the upper pole is crucial to understand any TMJ disorder.
This will lead to the elevation of the hyoid bone and to a change of the mandibular position (posterior-superior into the retrodiscal tissue).
Mouth breathing is characterized by a dysfunctional position of the tongue: it is between the lower and upper teeth.
When opening the jaw, the forward moving condyle bumps over the edge of the displaced disc causing a clicking sound. The tongue should rest behind the front upper teeth and during the swallowing action the tip of the tongue touches the anterior palate just above the upper teeth (roof of the mouth).
The other muscles involved in opening the mouth are the suprahyoid muscles that depress the mandible once the hyoid bone is stabilized by the infrahyoid muscles. Occlusal problems overwork especially the lateral pterygoid muscle in its effort to center the teeth against the forceful occlusion produced by the mandibular elevator muscles. The muscles elevating the mandible (masseter, temporalis and medial pterygoid) overwork to close the mouth in the mastication process because their antagonists the inframandibular muscles are too tight long. A dysfunctional tongue position in the childhood can affect the development of the teeth and the facial bones leading to occlusal problems.
The disc is anteriorly attached to the superior lateral pterygoid muscle and posteriorly to the retrodiscal material that is a thick ligament that prevents the disc sliding too forward. Myofascial trigger points (MTrPs) in this muscle are the chief source of referred pain felt in the TMJ area.
The assessment of the jaw gait gives us more information about which myofascial tissues are involved in the dysfunctional movement pattern. All this dysfunctional organization of the upper pole will develop myofascial trigger points in the head, face and neck. After the initial rotation, the condyle and the disc glide together along the articular tubercle.



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