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Understanding TMJ Subluxation Treatment: A Closer Look at "Open-Lock"

Understanding TMJ Subluxation Treatment: A Closer Look at “Open-Lock”

Author: John E. Dinan, DMD MS

Date: December 20, 2023

Real-Life Scenario: Meet “Emily”

A few weeks ago, a 23-year-old patient named Emily walked into our practice. Here’s how our conversation unfolded:

  • Me: “How can I help you today?”
  • Emily: “Well, my jaw gets stuck wide open a few times per day –
    every time I yawn. And, I can’t eat sandwiches anymore because my jaw gets stuck open.”  
  • Me: “How do you un-stick your jaw?”
  • Emily: “I use my hand to push my jaw around until it unlocks.”

The diagnosis was TMJ subluxation, and Emily had been suffering from it for several years with an increasing frequency.

Understanding TMJ Subluxation Treatment

TMJ Subluxation – Definition

TMJ subluxation is a hypermobility condition that occurs when TMJ ligaments allow the mandibular condyle to travel too far out of the temporal fossa and get stuck in front of the articular eminence. See the image below:

Understanding TMJ Subluxation Treatment

Subluxations in our practice are not that common, and those with this problem represent only a small percentage of the patients we see with jaw disorders. Amongst this group, we see patients with systemic hypermobility, describing looseness and instability in multiple joints throughout the body. A number of these patients have been previously diagnosed with Ehlers Danlos Syndrome (EDS), an inherited disorder that compromises the integrity of connective tissue in the body. In fact, though men can inherit this condition, women are diagnosed far more often.

In general, even without an EDS diagnosis, patients we see with jaw hypermobility and symptoms of jaw subluxation are women, many reporting being extremely flexible and having participated in gymnastics earlier in their life. Along with fears of their jaw getting caught in an open position they relate stories of their shoulders and elbows slipping out of place, sometimes requiring a hospital visit to “put the joint back in.”

Though some of our patients with episodes of jaw subluxation have less concerning daily symptoms of jaw muscle tension and pain, many others are completely unconcerned with their jaw until it gets stuck open during a routine yawn or chewing activity.

How We Address TMJ Subluxation

The first step to address TMJ subluxation involves educating patients on why this is occurring and helpful self-care techniques, such as:

  • Avoiding Certain Foods: Encouraging them to steer clear of foods that require opening their jaw wide, such as sandwiches and apples.
  • Careful Yawning: Teaching patients how to stabilize their jaw with their hand while yawning to prevent locking, and or instructing them how to position their tongue firmly on the roof of their mouth to prevent an unstable open mouth position.
  • Proper Techniques to Unlock the Jaw: Coaching them on the correct methods to ‘unstuck’ their open jaw, which often includes a specific  technique of pushing down on the lower molar teeth.
  • In addition, efforts are made to identify and address risk factors such as daytime jaw overuse behaviors, fatiguing head postures and sleep bruxism. All of these have the potential to compromise stability in the temporomandibular joints, allowing subluxation to more readily occur in those individuals that may have other predisposing factors in their history.
  • Referral to physical therapists that have expertise in managing hypermobility.

Some patients, however, find it too challenging to maintain self-management techniques, and or have no time to seek care with a physical therapist. For this group of patients, we discuss the option of injections which can be effective. In Emily’s case, we chose prolotherapy.

Prolotherapy: An Injection Treatment for TMJ Subluxation

Prolotherapy treatment involves injecting a solution of dextrose and lidocaine inside and around the TMJ capsule, and into the tendon attachment of the temporalis muscle.  The dextrose initiates an inflammatory reaction, which ultimately leads to new collagen deposition in the area, which can effectively “tighten” tissues. In the joint capsule the hope is to stabilize stretched ligaments, while the temporalis tendon injection is designed to create a fibrotic contracture that will ultimately reduce jaw motion capability.

With prolotherapy, the joint can become more stable, and jaw range of motion is often decreased several millimeters which makes it more difficult for the mandibular condyle to travel too far out of the temporal fossa and get stuck in front of the articular eminence.

Prolotherapy is not a ‘one and done process’ but rather requires 3-4 sessions three weeks apart to be effective. Success is certainly not guaranteed but prolotherapy has proven to be a valuable tool when confronting subluxation and TMJ hypermobility.

Over three injection sessions with three weeks in between, the frequency of Emily’s jaw locking decreased from several times a day to complete resolution. This non-surgical intervention provided Emily with a stable TMJ for the first time in years.

Conclusion

Though TMJ subluxation is not a common type of temporomandibular disorder (TMD) that we see, for those in trouble, providing accessible and non-surgical treatment strategies have led to excellent outcomes

I encourage your thoughts and discussion. Feel free to comment below.

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