TMJ and normal range of motion in TMJ SUPPORT Forum

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TMJ and normal range of motion

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Caletera1

TMJ and normal range of motion

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Posts: 67

(03/07/08 09:10:22)

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Does anyone know the 'normal' range of motion for a healthy jaw? Shouldn't it depend on individual body size, gender and genetics/racial characteristics? I thought I read that depending on your ancestry, you may or may not be able to open your jaw more than someone else?

I was diagnosed with marked decreased range of motion from the MRI, but I think I can open my jaw just fine. So, I'm curious!

Elaine2004

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(03/07/08 19:14:48)

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We used to have a post on our other board before it got hacked and we lost everything. I can't remember how it went. I am thinking Cymy was the one who posted it. It told what was normal and what was considered a lock etc. We will see what we can come up with.

Caletera1

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(03/07/08 20:02:59)

Thanks so much!

FPDChief

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(03/07/08 20:46:58)

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Hi Kara,
I did a little bit of research earlier and found an excellent article. I was at work and didn't think to email the url address to me here at home, but I did print a page. I'll type from the International Association for the Study of Pain - "Pain Clinical Update," June 2004 - Temporomandibular Muscle and Joint Disorders:

"Range of motion of the jaw is measured from incisal edge to incisal edge of the central incisor with a millimeter rule. Minimum normal jaw opening is considered to be about two finger widths at the knuckles of the patient's dominance hand, or approximately 40 mm. Lateral motion should be 7-10 mm to both the right and left. Normal protrusive range is between 6 and 9 mm."

I personally thought it was three fingers and closer to 50+ mm.

I haven't read anything that talks about ancestry or anything, but after having this since 1980 and doing all the research that I have, I'm inclined to believe that the skeletal structure of a body has something to do with developing TMJ. I'm Scottish and the only one in my family of 4 siblings and four cousins with a small chin and no defined jaw line. I'm the only one who developed TMJ. It would be interesting to see if such a research has ever taken place tho.

I read your bio Kara. Welcome. My bio needs to be updated, but I don't know how to do it. I have been thru an interesting journey since joining TMJ Talk and my TMJ has been relatively calm and pain-free since February 2006. For me it meant a lot of big changes in my life - the two biggies were changing my job from a very high stressful one with lots of talking to an extremely sedate payroll job with very little talking necessary, AND, various medications. I did not take pain meds for years because I hated taking pills (still do), and I was "strong" (and so stupid), and, they didn't seem to help anyway. I learned here (and elsewhere) about various types or classifications of medications that I had never heard of and have been blessed, finally, with help. AND the support here is great!!

Sorry, I got a little off-track here, didn't I? I was just so glad to see that you added your bio. Also, skeletal structure has been one area that has interested me for years. I can say emphatically, tho, that stress is our number one enemy.

God bless...
Carol

MaggieMay78

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Posts: 964

(03/07/08 21:54:17)

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just wanted to jump in here...the "normal" range of motion really varies from person to person! Men naturally have a wider range of motion (in general)...and I read somewhere that taller people usually have wider ROM. In general, anything close to 40mm is considered normal...and they generally say if you can open to three fingers width, that's good. I can fit three fingers in, and my opening is about 40-42mm.

I did come across a study saying that the average ROM for Irish people (according to a study in Ireland) was around 41mm. Interesting...I am half-Irish. My sister and I both have tiny mouths...ours would NEVER open as wide as something like 50mm! It's just not possible, and that has nothing to do with TMJ problems...it's just how we're made!

MaggieMay78

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(03/07/08 21:58:09)

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Also, Caletera, if YOU feel that your jaw opening is adequate...then try not to worry about the MRI report. Seriously. I was told by a TMJ dentist that many MRI reports are actually inaccurate...doesn't mean they all are, but he said something like 35% are inaccurate! Also, some oral surgeons will make a big fuss over the MRI report, and use it as an excuse to do surgery on you. That's why it's so important to find a conservative oral surgeon (if you even need to see a surgeon at all...surgery is always a last resort!) You don't want to find someone who will be pushy about surgery. If you feel your opening is wide enough, and don't have major problems eating, brushing teeth, getting dental work done, etc...then proceed with caution about any invasive treatments. Actually, even if your opening was truly limited...it would STILL be wise to be cautious about surgery. Invasive treatments are nothing to rush into....

MaggieMay78

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(03/07/08 22:11:18)

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I keep thinking of all these extra tidbits of information, lol. Anyway, here is one more: Did you know that when a person has TMJ surgery, most surgeons are satisfied with a 35mm opening afterward?! That is absolutely true...they consider that to be a successful outcome for range of motion after surgery....and I don't just mean immediately afterward...I mean a 35mm opening long-term. So if some dentist/surgeon tells you that your opening isn't "normal"...always consider that fact. I had one dentist tell me that I could only open 41mm, and I should be able to open "at least 50" because that's "normal." As I said before, I never could open that wide in my life, even before I had TMJ issues!!!

Caletera1

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(03/07/08 22:21:39)

Wow, thanks so much guys! I don't know what my "TMJ specialist" was talking about. I can fit three fingers in my mouth from my dominant hand and open my mouth 40 or 50 mm, i forget which one. I have trouble chewing on my left side, but I still think that's a ligament problem and due to muscle malfunction and that my left side isn't as strong as my right from chewing on my right more.

This guy just wanted to sell me a splint....4 in fact. 2 for the day (up and bottom) and 2 for night. And then braces, bridges/crowns, orthodontia to keep my jaw in the right position.

I'm rather tiny, I'm under 5 feet 2 and I'm lucky if I can get myself to weigh more than a hundred pounds. I was in fact born 3 months early at 1.5 lbs. Taking that into account, my body and my jaw will never open as wide as a 'normal' sized female, or even a male, as most studies are based on.

Thanks for such awesome info guys! I love this place!

MaggieMay78

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Posts: 964

(03/08/08 19:35:51)

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Hi Kara,

You have to follow your instincts when it comes to TMJ treatment...there are so many different treatments out there, but not much evidence to back them up. Soo, it comes down to what you're willing to try, how much money you can afford to pay, whether you trust the dentist or not, etc.

If you read around this board, you will find lots of excellent advice. You can also look all over the Internet and find more helpful tips...but always be careful about which sources you trust, and which ones might be giving "bogus" advice or trying to sell something. Some things to keep in mind: Caffeine and nicotine can exacerbate TMJ headaches and other symptoms...there are numerous sites that give info about this. Also, some supplements that are supposedly helpful include magnesium, calcium, and pantothenic acid (vitamin B5). Again, you can search online to learn more about optimal doses...and it's always best to confirm informatio with your doctor! Just be aware that getting too much of a supplement can also cause problems, so more isn't always better.

Take care, and keep us posted on your progress!

feelines

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Posts: 1878

(03/08/08 22:21:26)

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I can get 2 fingers in but not 3. I remember the first time I was evaluated by a TMJ dentist (I think I was in my early 30s), my opening was 54-56. I'm tall but have thin lips. A few years ago when I ended up with the more typical TMJD of clicking/popping/pain, my opening was 40+. I ended up with an open bite after those splints and a smaller opening of about 34 which was increased after physical therapy and Rocabodo exercises to 44-48....

Elaine2004

Stages of TMJD

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Posts: 2777

(03/18/08 18:07:28)

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STAGE CLINICAL IMAGING SURGICAL

I. EARLY

Painless clicking

No restricted motion

Slightly forward disc, reducing*

Normal osseous contours

Normal disc form

Slight anterior displacement

Passive incoordination (clicking)

II. EARLY/

INTERMEDIATE

Occasional painful clicking

Intermittent locking

Headaches

Slightly forward disc, reducing

Early disc deformity

Normal osseous contours

Anterior disc displacement

Thickened disc

III. INTERMEDIATE

Frequent pain

Joint tenderness, headaches

Locking

Restricted motion

Painful chewing

Anterior disc displacement,

reducing early progressing

to non-reducing* late

Moderate to marked disc

thickening

Normal osseous contours

Disc deformed & displaced

Variable adhesions

No bone changes

IV. INTERMEDIATE/

LATE

Chronic pain, headache

Restricted motion

Anterior disc displacement,

non-reducing

Marked disc thickening

Abnormal bone contours

Degenerative remodeling of

bony surfaces

Osteophytes

Adhesions, deformed disc

without perforation

V. LATE

Variable pain

Joint crepitus

Painful function

Anterior disc displacement,

non-reducing with perforation

and gross disc deformity

Degenerative osseous

changes

Gross degenerative changes of disc

and hard tissues;

Perforation

Multiple adhesions

I don't know if this is the right place for this post but since we are talking range of motion I guess it will fit here.

Cymy Sue

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(03/19/08 03:36:02)

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Elaine & all,

The information we had compiled from several websites:
Normal ROM would be 40-50 mm. The 3 finger (rule of thumb) was to give you a base line, not set in stone.
Doctors had differing opinions on a lock or closed lock, but never off more than a few mm. 28 - 20mm.
Many people with TMJD end up with a lot less than normal and are still able to function.
Many surgicals live with 10 - 20. This is less than a closed lock, but you can survive with that....it's not pleasant.

Many of us lived or still live with 10 - 15 - 20. It's very hard to eat and talk when you're in the 10 - 20 range.

After surgeries, 10-19 mm was the best I could manage for a long time.
With therapeutic massage and then the "splint", I now have 30-34.
Without TM Joints, this is the best I can expect and it's wonderful compared to 10.

Cymy Sue

Last Edited By: Cymy Sue 03/19/08 04:38:11. Edited 2 times.

webodespo

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Posts: 23

(03/19/08 09:33:19)

CmySue,
When you wrote, "Doctors had differing opinions on a lock or closed lock, but never off more than a few mm. 28 - 20mm," what did you mean? What is a lock or closed lock? Did you mean 18-20 or 28-30?

Cymy Sue

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(03/19/08 11:53:32)

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Sorry if that was confusing. I went from widest rom to lowest rom. I meant anything between 28mm to 20mm. (per different doctors & sources)

This is an average we came up with when we were doing a lot of research a few years ago. We had many articles on this subject at one time. They were lost when this system crashed in May 05. We have not been able to retrieve all of that information.

Some doctors considered a close lock to be 29mm, some 24mm, some 19mm.

An average of their opinions would be 28mm down to 20mm. (give or take a mm)

The lowest we could ever find was 19mm.

Those of us who were living with less always wondered what they would call our condition.

"There are two types of lock jaw. The closed lock is due to the inability of the condyle to slide under the anteriorly displaced disc. The open lock is due to the inability of the condyle to slide back over the disc into its normal position. "

Most medical information relates a closed lock to disc displacement. With many peple, that would be true.

We have had members who did not have disc displacement. They had severe muscular problems and this limited their opening or range of motion. Muscular problems would not need to be treated with invasive procedures. We've learned through our members, many times, disc displacement can be treated effectively with non-invasive methods, also.

Cymy Sue

Last Edited By: Cymy Sue 03/19/08 17:22:49. Edited 1 times.

Elaine2004

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(05/14/08 15:42:04)

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For anyone who has the Christensen Fossa implant, normal ROM is around 25mm. I just found that out when I had my CT scan done.
Buff has the total joint. Hopefully she will post soon. I would like to know her ROM out of curiosity.
Elaine

ginnic

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Posts: 460

(05/15/08 00:00:15)

Member I

I never really understood why "finger width" measurements meant much, cos everyone's fingers are a different size too! As far as MRI showing how wide one opens? I guess I never got that impression, only that an MRI showed things like soft tissue, disc placement and movement, etc. I remember they had me open my mouth at one point the two MRI's I've had, but I thought they do one set of views with your mouth open and one set closed to see if the disc "captures", moves appropriately etc? I mean, have others of you had an MRI where they tell you to open your mouth as wide as possible AND keep it there? I just don't remember that...............

My problem in some ways was the reverse of what some of you are talking about - and I think it actually led me to a delay in diagnosis - I have always had a fairly good ROM, and now, even after 2 scopes and 2 open surgeries I can get it to open to 40 mm for sure - both preop and postop. My lateral movement is not as good as the normal (more like 2-3 mm) and my forward protrusion is present now but minimal (like one tooth depth is all). However, because I always had good opening - and no headaches etc the first OS kept saying I was "fine" - this was of course with me complaining of significant pain IN the joint. Only in the joint. Nowhere else, which is what I think threw him?

Ah well, live and learn. After all these years of working as a nurse I have sure learned you cannot make patients/people be "cookie cutter" patients!

Off to bed - worked overtime tonight, no supper and exhausted - came home and need to unwind a bit but have to get up at 0600 to go in for an early shift...................I spent a bit of time with the puppy :>) Amazing how puppies (and any baby animal?!) can be so cheering and soothing....... <G> even when they are naughty?!

Ginni in WI

Elaine2004

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(05/15/08 10:55:15)

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I don't know about MRI telling how wide a person can open. I always was told by the dentist what my range of motion was. I don't think finger width is exact, it is just an example of how far you should be able to open. As for my CT scan, they didn't tell me my range of motion with that either. It was after the dentist viewed the scan and the oral surgeon told him that a person with this implant can only open to 25mm. max. So here we are trying to stretch my opening and I don't think I am going to open much further without surgery. I have an awful click just like before I had the implant so something is not right in there. He said that is probably due to the 1/4 inch space between the implant and the condyle which is due to bone loss. I haven't woke up with a headache since I got this last splint. I do find I have pain right in the joint and nowhere else. I am sure it needs more adjustment but right now it isn't too bad.
Yes, they did the open and shut pictures with the MRI and also with the CT scan. I really don't know what the CT scan showed that an MRI didn't show. I think they are pretty much the same but I could be wrong. Maybe the CT showed the screws better, I don't know.
Elaine

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TMJ and normal range of motion

TMJ and normal range of motion