Intraoral massage is one of the techniques that is often incorporated into an acupuncture treatment in our office. Having the inside of your mouth massaged is probably something you’ve never considered. It is most commonly used to treat temporomandibular joint (TMJ) disorder, however it has many other benefits that you may not be aware of because of the intricate muscle system involved in the jaw. Before we get into some of the benefits of intraoral massage, let’s first look at the anatomy of the TMJ.
Temporalis & Masseter
The two outer muscles for chewing are the temporalis and the masseter muscles. These two muscles help to close the jaw. Because of their attachment sites and relationship with each other, when there is tension in these muscles there is often a referral pattern for headaches.
Pterygoids
The two inner muscles for chewing are the lateral and medial pterygoids. The lateral pterygoid is the only one of these first four muscles to assist with opening the jaw while the medial pterygoid assists the temporalis and masseter in closing the jaw. Since these muscles attach to the inside of the mouth, when they are tight they generally refer pain directly into the jaw.
Although there are other muscles involved in the functioning of the TMJ, these four muscles are the primary muscles that cause pain in TMJ disorder. Simply working on these muscles can bring relief to jaw pain and headaches. However, taking into account the articulation of the TMJ with the upper cervical spine helps to bring greater awareness to the additional benefits of intraoral massage.
The Relationship Between the Jaw and Cervical Spine
“According to Guzay’s Theorem, the fulcrum for ideal mandibular motion is located at the base of the dens of the second cervical vertebra.”
– Franklin Sills, DO
In other words, in order to have full opening of the jaw, the upper cervicals have to fall forward. You can experience this by placing your fingers along the back of your upper cervical spine, just below the base of your skull. Slowly open your jaw while paying attention to your fingers. As you stretch the jaw open as far as it can go you should feel your fingers shift forward. The TMJ is not structured in a way that is able to elicit the amount of force required for biting. It requires the assistance of the upper cervical vertebrae. Therefore, tension in the neck can inhibit the functioning of the jaw and vice versa.
Referral Patterns
Intraoral massage is indicated for many conditions aside from jaw pain. The different conditions is can help include:
TMJ disorder
Clenching and grinding of the teeth
Tension headaches
Migraines
Traumatic injuries and scar tissue
Whiplash
Forward head position
Scoliosis
Strain from wearing braces
Sleep apnea
Voice related concerns
Should You Have Intraoral Massage?
Although intraoral massage can benefit many people, it is not indicated for everyone. Things to be cautious of when considering intraoral massage are:
Dental hardware – please remove any appliances before intraoral work
Chronic tinnitus, ear, or sinus infections – please be screened for any infectious or neurological causes with these symptoms
Vertigo, tremor, balance, or coordination problems – intraoral massage is ok to do after any necessary medical screening
Oral surgery – please allow 4-6 weeks for healing before engaging in intraoral work
Cancer – intraoral work should be secondary to any medical treatments for cancer. There may be increased gum sensitivity or inflammation due to medications.
Nerve or vascular impingement – intraoral work should be done slowly over time
Children, teens, and referred partners
Conditions that are contraindicated in intraoral massage are:
Active or untreated infections or inflammation
Acute trauma
Untreated emotional or psychological trauma
Active dissociation/somato-emotional release
Severe and/or unscreened neurological signs in the head, face, or special senses
Distrust between the client and practitioner
Your acupuncturist will review your current symptoms and health history with you to determine if intraoral massage should be incorporated into your treatment.
Sources:
The Heart of Listening Volume 2 by Hugh Milne
Wright, E. F. (2000). Referred craniofacial pain patterns in patients with temporomandibular disorder. The Journal of the American Dental Association, 131(9). 1307-1315. https://doi.org/10.14219/jada.archive.2000.0384
תגובות