{"id":11375864,"date":"2017-01-13T00:00:00","date_gmt":"2017-01-12T23:00:00","guid":{"rendered":"https:\/\/alertdiver.eu\/uncategorized\/temporomandibular-joint-dysfunction-in-diving\/"},"modified":"2023-08-10T12:42:44","modified_gmt":"2023-08-10T10:42:44","slug":"temporomandibular-joint-dysfunction-in-diving","status":"publish","type":"post","link":"https:\/\/alertdiver.eu\/en_US\/articles\/temporomandibular-joint-dysfunction-in-diving\/","title":{"rendered":"Temporomandibular Joint Dysfunction in Diving"},"content":{"rendered":"

It is not uncommon for divers to complain of pain or tenderness in the jaw, a headache or aching facial pain after diving. The gripping action required to hold a mouthpiece in place may strain the muscles used for chewing (masticatory muscles) or the temporomandibular joint (TMJ), which connects the jaw (mandible) to the temporal bone. Pain associated with the TMJ and masticatory muscles is known as temporomandibular dysfunction (TMD).<\/p>\n

\u201cDuring diving, the TMJ is subjected to a stress equal to what you would experience if you kept your mouth open \u2014 not fully, but as if you stuck three fingers into it vertically \u2014 during the entire dive,\u201d said Costantino Balestra, Ph.D., vice president of research and education at DAN Europe. \u201cThis acts on the retromeniscal neurovascular bundle and can cause myalgia or headache. By having a customized mouthpiece molded, this can be reduced or even eliminated.\u201d Balestra is the lead author of the study \u201cScuba diving can induce stress of the temporomandibular joint leading to headache,\u201d published in the British Journal of Sports Medicine<\/em> in 2004.<\/p>\n

The most common mouthpiece designs feature an elliptical airway attached to the second stage of the regulator, a labial flange to provide stability and a platform the diver bites for retention. Mouthpieces generally feature short bite tabs and are made of a soft material to accommodate use by a wide range of jaws and teeth; this requires forward movement of the jaw to effectively grip the mouthpiece. This design may not support posterior occlusion, which is the most effective contact of the molar and bicuspid teeth of both jaws for allowing the natural movements of the jaws essential to normal chewing and closure. This lack of support may result in uneven loading of the TMJ. Cold water may exacerbate this problem by impairing a diver\u2019s ability to use his or her lips to properly grip the mouthpiece.<\/p>\n

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Understanding TMD<\/strong><\/h3>\n

The TMJ is one of the most complex joints in the body; its movement involves a combination of hinging and sliding action. To locate it, place a finger directly in front of your ears. Move your jaw from side to side, or open and close your mouth. You can actually feel the mandible moving in and out of the TMJ socket. The upper section of the joint is a depression in the temporal bone of the skull; the lower section of the joint is the mandibular condyle, a rounded projection at the upper tip of the mandible. These bones, which make up the joint, are covered in cartilage and are separated by a small disc, which facilitates smooth opening, closing and side-to-side movements.<\/p>\n

In many cases, the cause of TMD is not clear. TMD may occur if this disc erodes or becomes improperly aligned, if the cartilage is damaged by arthritis or if the joint is subjected to trauma or long-term microtraumas. Researchers are still seeking to fully understand the causes of these conditions and what treatments are most effective.<\/p>\n

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Reported symptoms include:<\/em><\/p>\n

\u2022 pain or tenderness in the TMJ<\/p>\n

\u2022 TMJ clicking or crepitus (cracking or popping sound)<\/p>\n

\u2022 discomfort while chewing<\/p>\n

\u2022 difficulty opening or closing the mouth<\/p>\n

\u2022 facial pain<\/p>\n

\u2022 headache<\/p>\n

\u2022 blockage of Eustachian tubes<\/p>\n

\u2022 vestibular disturbances such as vertigo or disorientation (either of which could be hazardous should it occur underwater)<\/p>\n

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What You Can Do<\/strong><\/h3>\n

There are a few styles of standard mouthpieces designed for scuba diving. When selecting your diving equipment, try several mouthpieces to find the style and size that fits you best. For added comfort, some divers add a second-stage swivel adaptor to their regulator that adjusts to subtle head movements and reduces hose tug. Some regulators incorporate this adaptor as standard design.<\/p>\n

If you experience symptoms of TMD during or after diving, seek a dental consultation. While most cases of diving-associated TMD resolve spontaneously, your dental professional can recommend management strategies such as muscle relaxation exercises, techniques for reducing stress or, if necessary, medical intervention. Your dentist can also advise or assist in the development of a custom-fitted mouthpiece, which requires less muscular effort for retention than the traditional design. (There are also commercially available custom mouthpieces that do not require a dental consultation).<\/p>\n

\u201cThe dive industry has tried to make a mouthpiece that will fit everyone, and in doing so they had to make it soft and short due to the variability of teeth and jaws,\u201d said Dr. Randall Moles, orthodontic specialist and developer of the SeaCureTM custom mouthpiece. \u201cA customized mouthpiece is molded to fit one person and can be made out of a stiffer material that goes to the back of the mouth, which transfers the weight of the regulator to the back \u2014 where the muscles are. This provides leverage and greatly reduces the force needed to keep the mouthpiece in place. In addition, because the mouthpiece can be made of a much stiffer material, it retains the bite marks that grip the teeth instead of the diver having to constantly bite down to get a grip on the soft spongy material of the standard mouthpiece.\u201d<\/p>\n

If you opt for a custom-fitted mouthpiece, consider the proper positioning for a diver. \u201cThere is a common mistake made during the molding: People keep their head in the neutral position,\u201d Balestra noted. \u201cThis will not mold the mouthpiece correctly; instead the individual should position his head as if he was diving, tilting the head backward.\u201d<\/p>\n

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Safety Considerations<\/strong><\/h3>\n

If you decide to swap your mouthpiece for a custom one, make sure your new mouthpiece fits your regulator\u2019s second stage. Not every mouthpiece fits every regulator, and an ill-fitting mouthpiece could incur leakage or decouple from the regulator. In addition, when attaching your mouthpiece with a cable tie, confirm tightness, and use a razor blade to cut off excess and ensure there are no sharp ends.<\/p>\n

Do not use a customized mouthpiece on an air source that might be handed off to a buddy in an emergency; it may make breathing difficult or be impossible for another diver to use.<\/p>\n

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List of Scientific Publications from DAN Europe regarding TMD:<\/p>\n