TMD: Temporomandibular Disorder
Does your patient have pain in your jaw or face? Clicking when they open and or close their mouth? Locking in their jaw? They may be experiencing TMD. 65-85% of the population will experience TMD at some point in their lives with the female population being up to 3 times more likely.
Due to muscle, fascial and dural attachments the Temporomandibular joint (TMJ) is closely related to the cervical spine and this area should always be assessed in conjunction with the TMJ.
There are three main categories for TMD
1) Articular (39%): hypo/hypermobility
2) Myofascial (30%)
3) Intra-articular (31%): disc displacement and locking
Treatment can be difficult as you can have one classification on one side and another on the other side, therefore a detailed assessment and proper diagnosis are key to an effective treatment. Treatment can consist of: mobilizations intra and extra-oral for joint restriction or repositioning of the disc, education, postural correction, muscle release, and exercises for strength, proprioception and rhythmical stabilization. They may also need to be referred to a dentist specialized in TMD for a night splint or guard.
There is some evidence to support active and passive oral exercises, postural exercises, laser and biofeedback. There was no detectable benefit from surgery over medical management or rehabilitation at any follow up point.
References
McNeely ML, Armijo Olivo S, Magee DJ. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Phys Ther. 2006; 86(5):710-25
Schiffman EL, Look JO, Hodges JS, Swift JQ, Decker KL, Hathaway KM, Templeton RB, Fricton JR. Randomized effectiveness study of four therapeutic strategies for TMJ closed lock. J Dent Res. 2007 Jan;86(1):58-63.