Kathryn Henry
Vocal Pedagogy Term Paper
4/27/14

Is it Locked?: The Study of the Temporomandibular Joint and its Effects on Vocal Production

In this research paper, I will discuss the temporomandibular joint and its effects on vocal production. The paper begins with a definition of what the temporomandibular joint is, where it sits in the skull, and what its functions are. Following this section will be disorders and treatments of disorders that one may encounter involving the temporomandibular joint. Finally, I will discuss how temporomandibular joint disorders can negatively affect a singer’s vocal production.
The Temporomandibular Joint, or TMJ, is a joint located in front of one’s ears on each side of the face. ‘Temporo’ refers to the temple, the bone in the side of one’s head, and ‘mandibular’ refers to the mandible. The joint connects the mandible to the bone on the side of the head. The TMJ allows the mandible to move up and down as well as back when chewing, talking, or yawning. As the mouth opens, the rounded edges of the mandible, called condyles, glide along the socket of the temporal bone. As the mouth closes, the condyles slide back into their original resting positions. The TMJ is a ginglymo-arthrodial joint, meaning that the joint allows forward and backward movements, ginglymoid, as well as gliding movements within narrow limits, arthrodial.The TMJ has a combination of hinging and sliding motions, making this joint among the most complicated of the human body.
As stated in the National Instition of Dental and Craniofacial Research brochure on TMJ disorders, researchers agree that conditions for disorders of the TMJ and chewing muscles fall into three main categories:
“1)Myofascial pain involves discomfort or pain in the muscles that control jaw function, 2)Internal derangement of the joint involves a displaced disc, dislocated jaw, or injury to the condyle, and 3)Arthritis refers to a group of degenerative/inflammatory joint disorders that can affect the temporomandibular joint.”
Similar to other joints in the body, the TMJ can develop common diseases, such as Rheumatic disease. Defined in the Merriam-Webster Collegiate Dictionary, Rheumatism is “any of various conditions characterized by inflammation or pain in muscles, joints, or fibrous tissue.” Arthritis, a common type of rheumatic disease, effects the TMJ as the disease causes inflammation of tissues that line joints in the body.
TMJ disorders are very common in the general population, however, there are little to no scientific facts as to why one may develop a disorder. Scientists are currently researching the effects of female hormones on a woman’s jaw because studies show that TMJ disorders are more common in women than in men. Many researchers believe that a bad bite or orthodontics braces can trigger TMJ disorders. Commonly paired with TMJ disorders are parafuntional habits; including teeth grinding, teeth clenching, and lip biting. Research has provided evidence that anxiety, stress, and other emotional disturbances do effect the TMJ and eventually lead to disorders. As much as 75 percent of patients with TMJ disorders are also diagnosed with a psychological abnormality. Symptoms of TMJ disorders can also be caused by poor posture in daily life; sitting at a computer desk while holding the head forward is an example.
Treatments of TMJ disorders can be very simple when noninvasive therapies are used. Self-care and noninvasive therapies are more commonly prescribed and recommended to patients before attempting invasive or permanent therapies. Self-care options that one may explore are simple exercises, like stretching the jaw every day for five minutes, or stabilization splints that are worn while sleeping; these splints are the most common treatment for TMJ disorders. Noninvasive therapies treatments are encouraged to patients as the treatments can cause less trauma to the jaw area than invasive therapies. These treatments include hypnosis, acupuncture, massage, and sometimes prescription drugs. Invasive therapies can be very dangerous for a singer, as these therapies can potentially cause damage to the area where the vocal tract is located. These therapies include surgeries and/or injections, including cortisone shots.
For singers, TMJ is not an easy disorder to overcome, because it disturbs proper singing. The disorder causes jaw tension as well as tension in the tongue and layrnx. Jean Westerman Gregg states in an article from the Journal of Singing that it is common for one to push the tongue against the palate because of the tension of the society we live in. Carrying tension in the tongue is a problem for a singing, as the tongue is attached to the muscles of the hyoid bone, which is attached to the muscles of the larynx. This then causes a very strained vocal technique and will make it hard for one to have flexible vocal production. Gregg believes that some techniques used in a choral setting can lead to symptoms of TMJ disorders, as choral conductors sometimes ask that choral singers place two to three finger vertically in their mouths while singing vowels. This exercise can also cause hyper-functional use in the jaw.
Hyper-functional use in the jaw occurs when the jaw is forced down too far, pushed forward on certain sounds, or locked in one position. Some singers push the jaw forward on forward vowels, including [i], which then causes the larynx to elevate. Each singer has an individual range of motion in his or her jaw and forcing the jaw to drop can and will cause unnecessary jaw tension. Dropping the jaw should be done with ease and not forced open. Gregg states that the amount of space needed between the tongue and the palate for vowel production depends on the arch the palate possesses and not specifically by the jaw dropping an amount of space. To find a natural dropped jaw without adding extra tension in the jaw area, a singer can say “ma, ma, ma” with a loose jaw.
Tongue tension is often paired with TMJ disorders because of the connection of muscles in the surrounding area. Tension in the tongue makes it very difficult for singers to have a released sound, articulate properly, and to have enough flexibility to move through melismatic passages. In Emergent Voice by Kenneth Westerman, there are exercises that can be used to release tongue tension. Examples include flipping the tip of the tongue in and out as if pronouncing ‘la’, moving the tongue rapidly back and forth extending to both corners of the lips, and opening the mouth and pronouncing ‘gu’ by raising the back of the tongue to the soft palate. Using these exercises in warm-up times will allow the tongue to be free and have more flexibility.
Jaw tension effects vocal production in a negative way just as much as tongue tension does. Jaw tension, or locking the jaw, causes the resonators of the vocal track to get lock as well, which then causes the sound of the voice to be muddled and diminished in sound. If the jaw is forced out of place, causing tension, the muscles that support the head and neck are also tense. When these muscles are tense, the singing becomes more difficult as the larynx is not released and cannot move freely and with ease. Muscle tension in this area of the body is not good for a singer’s vocal production, but also leads to headaches and migraines, which is a common symptom of TMJ disorders.
Common exercises for jaw tension include singing the pattern of ‘ma, ma, ma, ma, ma’ on one pitch and singing [a] to [u] while releasing the jaw and letting the jaw hang with ease. The first exercise will allow the singer to release the jaw after singing through a consonant. The second exercise with exemplify that singing [a] to [u] only involves tongue and lip movements and jaw movements are not needed to accomplish pure vowel sounds.
Although TMJ disorders can cause difficulties in vocal production, it is not impossible to sing and have a career with such disorders. Where the TMJ is located affects a singer’s vocal production, as the jaw and mouth area are used through the entire period of phonation. Treatments for TMJ disorders can be helpful, as long as one takes precautions. Having surgery or receiving cortisone shots can have negative reactions on the TMJ and can potentially ruin the jaw area, making it difficult to sing or talk. There are many exercises that a singer can practice during daily warm-up sessions which will release tension in the jaw, tongue, and muscular areas of the larynx.

Works Consulted
Buescher, Jennifer J. “Temporomandibular Joint Disorders.” American Family Physician, 76 2007. Accessed April 13, 2014. http://www.aafp.org/afp/2007/1115/p1477.html.

Fotek, Paul. “TMJ Disorders.” Medline Plus Encyclopidia Online. Accessed April 17, 2014. http://www.nlm.nih.gov/medlineplus/ency/article/001227.htm.
Gregg, Jean Westerman. “On TMJ and Singing.” Journal of Singing, 54 (1997). Accessed April 13, 2014. http://www.nats.org/cgi/page.cgi/_article.html/Journal_of_Singing/On_TMJ_and_Sing ing_1997Nov_Dec.
McKinney, James C. The Diagnosis and Correction of Vocal Faults. Tennessee: Genevox Music Group, 1994.

Westerman, Kenneth N. Emergent Voice. Michigan: Edwards Brothers Inc., 1995.
National Institution of Dental and Craniofacial Research. TMJ Disorders. Bethesda, MD: National Institutes of Health, 2010. Accessed April 14, 2014. http://www.nidcr.nih.gov/nidcr2.nih.gov/Templates/CommonPage.aspx?NRMODE=Pub ished&NRNODEGUID=%7b53FD7A9D-B819-4CE4-8AFB 65BBD352BD26%7d&NRORIGINALURL=%2fOralHealth%2fTopics%2fTMJ%2fT Disorders%2ehtm&NRCACHEHINT=Guest#top.
Merriam-Webster’s Collegiate Dictionary Online. 11th ed. Springfield, MA: Merriam-Webster, 2003. Accessed April 17, 2014. http://www.merriam-webster.com/.

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[ 1 ]. Jean Westerman Gregg, “On TMJ and Singing,” Journal of Singing Vol. 54 (1997): 59-60, accessed April 13, 2014, http://www.nats.org/cgi/page.cgi/_article.html/Journal_of_Singing/On_TMJ_and_Singing_1997_Nov_Dec.
[ 2 ]. National Institution of Dental and Craniofacial Research, TMJ Disorders (Bethesda, MD: National Institutes of Health, 2010), accessed April 14, 2014, http://www.nidcr.nih.gov/nidcr2.nih.gov/Templates/CommonPage.aspx?NRMODE=Published&NRNODEGUID=%7b53FD7A9D-B819-4CE4-8AFB-65BBD352BD26%7d&NRORIGINALURL=%2fOralHealth%2fTopics%2fTMJ%2fTMJDisorders%2ehtm&NRCACHEHINT=Guest#top.
[ 3 ]. Jean Westerman Gregg, “On TMJ and Singing,” Journal of Singing Vol. 54 (1997): 59-60, accessed April 13, 2014, http://www.nats.org/cgi/page.cgi/_article.html/Journal_of_Singing/On_TMJ_and_Singing_1997_Nov_Dec.
[ 4 ]. National Institution of Dental and Craniofacial Research, TMJ Disorders (Bethesda, MD: National Institutes of Health, 2010), accessed April 14, 2014, http://www.nidcr.nih.gov/nidcr2.nih.gov/Templates/CommonPage.aspx?NRMODE=Published&NRNODEGUID=%7b53FD7A9D-B819-4CE4-8AFB-65BBD352BD26%7d&NRORIGINALURL=%2fOralHealth%2fTopics%2fTMJ%2fTMJDisorders%2ehtm&NRCACHEHINT=Guest#top.
[ 5 ]. Ibid.
[ 6 ]. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster, 2003, accessed April 17, 2014, http://www.merriam-webster.com/.
[ 7 ]. National Institution of Dental and Craniofacial Research, TMJ Disorders (Bethesda, MD: National Institutes of Health, 2010), accessed April 14, 2014, http://www.nidcr.nih.gov/nidcr2.nih.gov/Templates/CommonPage.aspx?NRMODE=Published&NRNODEGUID=%7b53FD7A9D-B819-4CE4-8AFB-65BBD352BD26%7d&NRORIGINALURL=%2fOralHealth%2fTopics%2fTMJ%2fTMJDisorders%2ehtm&NRCACHEHINT=Guest#top.
[ 8 ]. Ibid.
[ 9 ]. National Institution of Dental and Craniofacial Research, TMJ Disorders (Bethesda, MD: National Institutes of Health, 2010), accessed April 14, 2014, http://www.nidcr.nih.gov/nidcr2.nih.gov/Templates/CommonPage.aspx?NRMODE=Published&NRNODEGUID=%7b53FD7A9D-B819-4CE4-8AFB-65BBD352BD26%7d&NRORIGINALURL=%2fOralHealth%2fTopics%2fTMJ%2fTMJDisorders%2ehtm&NRCACHEHINT=Guest#top.
[ 10 ]. Jennifer J. Buescher, “Temporomandibular Joint Disorders,” American Family Physician, 76 (2007): 1477-1482, accessed April 13, 2014, http://www.aafp.org/afp/2007/1115/p1477.html.
[ 11 ]. Ibid.
[ 12 ]. Jennifer J. Buescher, “Temporomandibular Joint Disorders,” American Family Physician, 76 (2007): 1477-1482, accessed April 13, 2014, http://www.aafp.org/afp/2007/1115/p1477.html.
[ 13 ]. Paul Fotek, “TMJ Disorders,” Medline Plus Encyclopidia (2014), accessed April 17, 2014, http://www.nlm.nih.gov/medlineplus/ency/article/001227.htm.
[ 14 ]. Jennifer J. Buescher, “Temporomandibular Joint Disorders,” American Family Physician, 76 (2007): 1477-1482, accessed April 13, 2014, http://www.aafp.org/afp/2007/1115/p1477.html.
[ 15 ]. Ibid.
[ 16 ]. Ibid.
[ 17 ]. Jean Westerman Gregg, “On TMJ and Singing,” Journal of Singing Vol. 54 (1997): 59-60, accessed April 13, 2014, http://www.nats.org/cgi/page.cgi/_article.html/Journal_of_Singing/On_TMJ_and_Singing_1997_Nov_Dec.
[ 18 ]. Ibid.
[ 19 ]. James C. McKinney, The Diagnosis and Correction of Vocal Faults, (Tennessee: Genevox Music Group, 1994), 162.
[ 20 ]. Ibid.
[ 21 ]. Jean Westerman Gregg, “On TMJ and Singing,” Journal of Singing Vol. 54 (1997): 59-60, accessed April 13, 2014, http://www.nats.org/cgi/page.cgi/_article.html/Journal_of_Singing/On_TMJ_and_Singing_1997_Nov_Dec.
[ 22 ]. Ibid.
[ 23 ]. Kenneth N. Westerman, Emergent Voice, (Michigan: Edwards Brothers Inc., 1995), 70.
[ 24 ]. James C. McKinney, The Diagnosis and Correction of Vocal Faults, (Tennessee: Genevox Music Group, 1994), 162.
[ 25 ]. James C. McKinney, The Diagnosis and Correction of Vocal Faults, (Tennessee: Genevox Music Group, 1994), 162.