Dealing with the discomfort and pain caused by Temporomandibular Joint Disorder (TMJ) can be an arduous journey, one that affects not only the jaw but also the overall well-being of an individual. Amidst conventional treatments, a non-invasive and promising solution has emerged—the Transcutaneous Electrical Nerve Stimulation (TENS) machine. Utilizing gentle electrical pulses to target specific areas of the jaw, the TENS machines offer a ray of hope for those seeking natural relief from TMJ symptoms. In this article, we delve into the world of TENS therapy, exploring TENS machine benefits, application, and how it might become a pivotal tool in restoring comfort and restoring a sense of normalcy to the lives of TMJ sufferers.What is tmj disorder?
What is tmj disorder?
Temporomandibular joint disorder (TMJ disorder) is an umbrella term used to describe a number of conditions affecting the jaw joint and muscles responsible for jaw movement [1]. For most people, the temporomandibular joint is located on either side of the jaw, where the mandible (jaw bone) connects to the skull. Like any other joint, problems around this area, such as muscular tightness and joint stiffness, can lead to TMJ disorders.
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How Does TMJ Happen?
TMJ disorders are often seen as a multifactorial condition. This means that there often isn’t a straightforward reason why people develop this problem. As a result, there are several causes of TMJ disorders, including behavioral, biological, social, and emotional reasons [2]. Specifically, these include:
- Bruxism (involuntary grinding or clenching of teeth)
- Poor head, jaw, and neck posture
- Depression and anxiety
- Missing teeth
- Dental problems
- Arthritis
- Trauma or injury to the jaw
- Jaw misalignment
- Stress
Range of TMJ Symptoms
As there are often many causes of TMJ, there are also a variety of TMJ disorder symptoms. Symptoms may vary depending on the severity, location, and characteristics of the person with the disorder. Common symptoms noticed include:
- Jaw pain, especially when chewing, eating, yawning, or talking for long periods
- Inability to fully open or close the mouth
- Clicking and popping noises when moving the mouth
- Headaches
- Neck and shoulder pain
A Common Treatment Method for TMJ
Currently, there is no single treatment that works for all cases of TMJ disorders. Appropriate treatment will determine the cause, severity, location, and personality of the individual [3]. Each person will respond differently to treatment. Common methods include:
- Seeking physiotherapy with a specialty in TMJ: TMJ physiotherapists have undergone specific training to help treat people with this disorder [4]. They may utilize a range of conservative treatments, including performing certain exercises, hands-on therapy (including mobilizations and massage), and lifestyle changes.
- Changing day-to-day behaviors: Certain habits and behaviors may cause and prolong symptoms associated with TMJ disorders. Rectifying these actions may help with recovery, including stress management, avoiding grinding teeth, and improving sleep hygiene.
- Dental treatments: Those who have dental-related TMJ problems can receive specific treatments from their dentists. Specialized splints may be effective for those with teeth-grinding and clenching behaviors. whereas botox injections may assist with the muscular causes of TMJ disorder symptoms.
- Medications: Drugs can be prescribed or recommended by your GP to help ease pain. Up to 40% of TMJ disorders will slowly disappear over time [3]. Medications can provide immediate pain relief to help people tolerate their symptoms until they slowly disappear.
- Surgery: Severe conditions that don’t respond to other treatments may seek the advice of a maxillofacial surgeon for treatment, such as surgery.
What is a TENS machine, and how can it help TMJ treatment?
A TENS machine is a portable device that helps provide pain relief for people with various pain conditions, such as TMJ disorders. It delivers electrical impulses that block nociceptive or pain-transferring signals to the brain.
What’s the best way to use a TENS machine for TMJ?
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There are several factors to consider when using a TENS machine for any specific pain disorder, including the duration, frequency, and intensity of the treatment. These will be discussed below in the context of TMJ disorders.
Here are the best practices for using a TENS unit:
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Position of electrode pads for TMJ
Due to the smaller surface area surrounding the cheek, only two electrode pads will need to be positioned for the treatment [5]. Depending on the type of TMJ disorder experienced, the first pad will be placed around the temporomandibular joint (where the skull meets the jaw bone), located next to the ear, and the second in an area ranging from the check to the base of the neck. Largely, this depends on the symptoms associated with the condition (i.e., the presence of neck pain, tight masseter muscles, etc.). If you are unsure, please speak to a physiotherapist or healthcare practitioner about the placement of these pads.
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Conductive Wearables as an alternative to Electrode Pads
Alternatively, TENS conductive electrode face pads are an alternative way to receive treatment from your TENS unit without worrying about specific placement. These have been shaped to mold onto the face seamlessly. As a result, these fitted pads target all the major myofascial trigger points, such as the masseter, temporalis, and temporomandibular joint.
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Setting the TENS Mode for TMJ
There are several settings that can be adjusted for TMJ treatment, including pulse width, pulse frequency, and intensity. However, each individual may have a varied response to these settings.
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Setting the Pulse Rate (Frequency) for TMJ
The pulse rate (Hz) refers to the number of pulses of treatment for any given period. Typically, treatments can range anywhere from 2 to 250 Hz, depending on the TENS unit purchased. Higher frequencies are used to provide more immediate relief, while lower frequencies provide more prolonged periods of pain relief. A clinical trial using TENS units in people with TMJ disorders found that a TENS setting of 60 Hz helped patients reduce their pain by 37% within 3 weeks [5].
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Setting the Pulse Width for TMJ
The clinical trial that assessed the effectiveness of TENS units for TMJ disorders also used a pulse width of 240 s to help with pain relief and even improve the ability to open the mouth by 16% [5]. However, more research needs to be conducted about the importance of pulse width.
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How Often Should You Use Your TENS Machine for TMJ?
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The TENS machine can be used regularly to help with pain relief. However, repeated usage can lead to side effects such as tingling and unusual sensations in the area of application. However, two 15-minute sessions using the TENS machine for 3 weeks helped provide more than 30% of pain relief in those with TMJ disorders [5].
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Other TMJ Exercises at Home
While the TENS unit can help provide pain relief around the TMJ, exercises are also recommended to help improve the dysfunction and movement around the jaw joint. You can view examples of effective TMJ exercises. However, it’s important to reach out to a TMJ physiotherapist to assess you and provide a specific range of exercises to overcome your TMJ issues.
Where and when not to use TENS machines
While the TENS machine is generally safe to use, there are situations and areas that require further attention. Areas to avoid using the TENS machine include areas with damaged skin (e.g., wounds, cuts, etc.), altered sensation (e.g., tingling, areas with reduced sensitivity, etc.), around swollen areas, near cancers or clots, areas exposed to radiotherapy or radiation, and around crucial arteries around the neck (i.e., the carotid area [6]). Additionally, individuals in the following situations should avoid or speak to their GP about using the TENS unit: pregnant women, people with implanted devices (i.e., pacemakers, neurostimulators, etc.), those with cognitive or mental challenges, and those who cannot consent to treatment [6].
Are there any risks of side effects when using a TENS Machine?
The most common side effects are skin irritation and unusual sensations around the treatment area. More severe side effects occur when the TENS unit is used inappropriately, in unsafe areas, or for unsuitable candidates. Rarer side effects include rashes, increased pain, seizures, disruptions to implanted medical devices, strokes, blood clots, skin damage, and burns. If you notice any side effects, it is essential to discontinue the treatment and seek medical advice from your doctor [6].
References
- Healthdirect. (n.d.). Temporomandibular Joint Dysfunction.
- Peck, C. C., Goulet, J. P., Lobbezoo, F., Schiffman, E. L., Alstergren, P., Anderson, G. C., de Leeuw, R., Jensen, R., Michelotti, A., Ohrbach, R., Petersson, A., & List, T. (2014). Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders. Journal of Oral Rehabilitation, 41(1), 2-23.
- Roberts, L. (2018). Temporomandibular dysfunction – More than just a pain in the neck. Australian Journal of General Practice, 47(4), 175-179.
- Australian Physiotherapy Association. (n.d.). One of a kind: Jaw dysfunction. InMotion.
- Shaffer, J. R., Brannon, E. D., Pesun, I. J., Warren, J. J., Chandwani, B. P., & Marshall, T. A. (2020). Prevalence and predictors of temporomandibular joint disorders (TMD) in children and adolescents in the United States. Cranio: The Journal of Craniomandibular & Sleep Practice, 38(3), 186-193.
- University of Iowa Health Care. (2018). Pain Medicine Patient Education: Contraindication & Precautions for Commonly Prescribed Medications & Therapies.
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