Dr. David Kulla, DC provides individualized conservative care for temporomandibular disorders, commonly called TMJ or TMD, at Synergy Wellness Chiropractic & Physical Therapy in New York City.
With more than 26 years of clinical experience, Dr. Kulla evaluates jaw pain and dysfunction together with the surrounding muscles, cervical spine, posture, and movement when musculoskeletal factors may be contributing to symptoms.
Our Manhattan office is located at 237 First Avenue near East 14th Street, convenient to Union Square, the East Village, and Gramercy.
What Is TMJ and What Is TMD?
The temporomandibular joint, or TMJ, is the joint located just in front of each ear where the lower jaw, or mandible, connects with the temporal bone of the skull.
Temporomandibular disorders, or TMDs, are a group of conditions that affect the TMJ, the muscles used for chewing, or both.
The joint contains an articular disc that helps the jaw move smoothly during opening, closing, chewing, speaking, and other movements.
Common Symptoms of TMJ Disorders
Symptoms vary depending on whether the primary problem involves the joint, the surrounding muscles, or a combination of both.
Common symptoms may include:
- Pain or tenderness around the jaw joint
- Pain while chewing, yawning, or opening the mouth
- Jaw stiffness
- Limited mouth opening
- Jaw locking or catching
- Clicking or popping
- Pain in the muscles of the face or jaw
- Headaches associated with jaw tension
- Ear-region discomfort without an ear disorder
- Neck or shoulder discomfort
Clicking or popping without pain or loss of function is common and does not necessarily require treatment.
What Causes Temporomandibular Disorders?
TMD can involve problems inside the joint, surrounding muscles, or both.
Potential contributing factors include:
- Jaw clenching or tooth grinding, also called bruxism
- Overuse of the chewing muscles
- Trauma to the jaw
- Arthritis affecting the TMJ
- Disc displacement within the joint
- Muscular tension or overactivity
- Repetitive gum chewing or other prolonged jaw activity
- Stress-related clenching in some patients
There is not always a single identifiable cause, and many patients have more than one contributing factor.
Muscular vs. Joint-Related TMJ Disorders
TMDs can broadly involve either the joint itself or the muscles surrounding the jaw.
Joint-related or intra-articular problems may include arthritis, inflammation, trauma, disc displacement, or other abnormalities involving structures within the TMJ.
Muscle-related TMD involves the muscles responsible for chewing and jaw movement, including the masseter, temporalis, and pterygoid muscles.
Identifying whether symptoms primarily originate from the joint, muscles, or both can help guide treatment.
TMJ, Neck Pain and Headaches
The jaw, upper cervical spine, and surrounding musculature function in close proximity, and some patients with TMD also experience neck pain or headaches.
This does not mean that every headache or neck problem is caused by the jaw. A broader examination can help determine whether cervical or postural factors appear to be contributing to an individual patient’s symptoms.
How Is TMJ Disorder Diagnosed?
Diagnosis begins with a detailed medical and dental history and a physical examination.
Dr. David Kulla, DC may evaluate:
- Location and pattern of jaw pain
- Jaw opening and closing
- Range of motion
- Joint clicking, popping, or crepitus
- Tenderness of the masseter and temporalis muscles
- Jaw deviation during movement
- Cervical-spine mobility
- Neck and shoulder muscle function
- Posture and movement patterns
Dental or oral-maxillofacial evaluation may also be appropriate depending on the patient’s symptoms and suspected diagnosis.
Do You Need an X-Ray, CT or MRI for TMJ?
Not every patient with TMD symptoms requires imaging.
Imaging may be considered when the diagnosis is uncertain, symptoms are atypical, significant trauma has occurred, neurological findings are present, or conservative treatment has not produced the expected improvement.
MRI is particularly useful when a clinician needs to evaluate the articular disc and other soft tissues within the TMJ.
CT or cone-beam CT may be useful when detailed evaluation of the bones of the joint is needed.
Conservative Treatment for TMJ Disorders
Most TMD treatment begins with conservative and reversible approaches.
Depending on the patient’s condition, treatment may include:
- Temporary modification of chewing and jaw activity
- Soft foods during painful flare-ups
- Avoiding excessive gum chewing
- Reducing jaw clenching when possible
- Heat or cold applications
- Jaw mobility and strengthening exercises
- Massage or manual therapy of the chewing muscles
- Physical therapy
- Postural and cervical-spine rehabilitation when relevant
- Dental appliances when appropriate and prescribed by a dentist
- Medical management when appropriate
Treatment should generally begin with the least invasive appropriate option. Permanent changes to the teeth, bite, or jaw should not routinely be the first treatment for uncomplicated TMD.
Physical Therapy for TMJ Disorder
Physical therapy may be useful for selected patients with jaw-muscle dysfunction, limited range of motion, cervical stiffness, or other musculoskeletal findings.
Therapy may include:
- Jaw mobility exercises
- Controlled opening and closing exercises
- Muscle relaxation techniques
- Soft-tissue treatment
- Postural training
- Cervical and upper-back mobility work
- Strengthening and motor-control exercises
Exercises should be individualized and should not repeatedly provoke significant jaw pain.
Chiropractic Care and TMJ
Chiropractic care may be incorporated when examination findings suggest that cervical-spine restriction, muscular tension, or other musculoskeletal factors are contributing to the patient’s overall symptom pattern.
Treatment may include gentle mobilization, soft-tissue techniques, cervical or thoracic treatment, exercise, and rehabilitation.
Chiropractic care should not be presented as mechanically “realigning” the jaw or replacing appropriate dental, oral-maxillofacial, rheumatologic, or medical care when those services are indicated.
Cold Laser Therapy for TMJ Symptoms
Cold laser therapy, also called low-level laser therapy or photobiomodulation, may be considered as an adjunctive treatment for selected patients with TMD-related pain.
Research on low-level laser therapy for TMD has produced promising results in some studies, particularly for pain and jaw function, but study protocols and outcomes vary. For that reason, laser therapy is used as one possible component of a broader treatment plan rather than presented as a guaranteed treatment or cure.
What About Night Guards and Oral Appliances?
Oral appliances or splints may be useful for certain patients, particularly when nighttime clenching or grinding contributes to symptoms.
These devices should generally be fitted and monitored by an appropriate dental professional.
Treatment should avoid unnecessarily altering the patient’s bite permanently as an initial approach to TMD.
When Is TMJ Surgery Considered?
Most people with TMD do not require surgery.
Referral to a dentist specializing in TMD or an oral and maxillofacial surgeon may be appropriate for:
- Persistent severe joint pain
- Significant or prolonged jaw locking
- Substantial loss of jaw function
- Major trauma
- Structural joint disease
- Symptoms that do not improve with appropriate conservative care
When invasive treatment is being considered, patients should understand the diagnosis, expected benefits, risks, and conservative alternatives.
When Jaw Pain Requires Prompt Medical or Dental Evaluation
Seek prompt evaluation for:
- Significant facial or jaw trauma
- Inability to open or close the mouth
- Severe swelling, redness, or fever
- Suspected dental infection
- New numbness or neurological symptoms
- A rapidly changing bite after trauma
- Unexplained persistent facial pain
Jaw discomfort accompanied by chest pressure, shortness of breath, sweating, nausea, fainting, or pain involving the arm or chest requires emergency medical evaluation.
TMJ Treatment Videos
These videos from Dr. David Kulla and Synergy Wellness discuss TMJ disorders, exercises, jaw mechanics, and conservative treatment approaches.
Schedule a TMJ Evaluation in New York City
If you are experiencing jaw pain, clicking with pain, restricted movement, muscle tension, headaches associated with jaw symptoms, or difficulty chewing, Dr. David Kulla, DC can evaluate the musculoskeletal components of your condition and help determine appropriate conservative treatment options.
When dental, oral-maxillofacial, or other specialist care is indicated, referral or coordinated care may be recommended.
Synergy Wellness Chiropractic & Physical Therapy
237 First Avenue, 5th Floor
New York, NY 10003
Near East 14th Street in Manhattan
Call (212) 533-4900 or book an appointment online.