I  recently had a question from a teacher who was concerned one of her students had Temporomandibular Joint Disorder (TMJD) as her jaw clicks and dislocates when she sings on an AH sound. These symptoms could be due to TMJD as common symptoms are jaw joint clicking, pain, joint locking and/or limited movement of the joint. Of course, the student needs to seek medical assessment for a diagnosis.

The cause of TMJD may be a result of several issues from misaligned teeth to trauma, overuse, teeth grinding to opening the mouth too wide, too often. TMJD is a much more common condition than most people realise. The British Dental Health Foundation says that something like 1 in 4  people suffers some kind of TMJD symptoms in their life, though not all will seek medical or dental treatment.

For a singer, this can be a very debilitating condition as it impacts on the amount you can open your mouth, which in turn impacts on your tone and volume. If it is going through a painful stage it can hamper singing immensely and certainly lessens the joy of singing. I have had TMJD for over 20 years and thought I would share my experience and knowledge to date. So here is my (edited) response to the teacher:

I suffer from TMJD. It was suggested by my cranio-sacral therapist that I had it when I told her my symptoms a few years ago. It all started with the clicking in my right jaw sometime in my 20s and got progressively painful over the years. She referred me to an orthodontist who specialises in this area. He confirmed I had the problem. On X-Ray (see below) you can see a much wider space in the joint on the left compared to the right. He recommended braces, but couldn’t guarantee the problem would be resolved after £6000 and 2 years of discomfort! I also saw an oral surgeon who totally rejected that treatment approach and said it would be something I need to live with and work around as well as to accept might get worse with age. Not fun when the jaw gets stuck open, I can tell you! I am getting better at avoiding that scenario!

In the end, I decided to be conservative. I massage the area, sometimes I massage the joint from inside the ears. I yawn either without opening the mouth too wide or by bringing the jaw back and down into the socket and not just downwards (this I do also when singing), cutting food into smaller bite sizes, don’t eat apples without cutting them up, limiting gum chewing and eating hard foods. I go back to my cranio-sacral therapist when it gets particularly bad, I LOVE it when she works from the inside of the mouth, it relieves so much of the pain.

It seems to me from my reading and discussions with other medical pros that an individual and conservative approaches are best. Dental splints at night can help some people. I agree she needs to see someone who specialises in TMJD, not just any old dentist. If singing is her career then at least 2-3 opinions from respected specialists and therapists. Orthodontic braces may cause the problem, and can certainly make it worse if not fitted properly. Surgery should be avoided unless there is bone disintegration (worst-case scenario). In the UK there are some physios who also know how to help TMJD sufferers. In London, I can recommend PhysioEd.

There are a lot of sites online with free info. It is not a life-threatening disorder so no need to rush anywhere or treat aggressively. If it is really bothering her I also recommend contacting the British Performing Arts Medicine organisation (www.bapam.org.uk) they have a free/discounted service for performers.

May you meet no jaw tension!

My Xray: Check out the space in the TMJ on the right side compared to the left.

Here are a few sites that go into more detail or offer support (Please note: these are not sites I endorse per se)

Good article on TMJD http://drperrone.com