WHAT IS IT?

The temporomandibular joint or TMJ is the joint between the jaw joint between the mandible (jaw bone) and the skull. Temporomandibular disorders (TMDs) are a group of painful conditions that effect the TMJ and the muscles that control jaw movement. One or both sides of the jaw may be effected and have an influence on a persons ability to speak, eat, chew, swallow, make facial expressions or even breath.

Researchers generally agree that the condition falls into three main categories:

Myofascial pain, the most common, involving the muscles and painful trigger points in the muscles that control jaw motion, the neck and the shoulder girdle.

Internal derangement involves the joint itself and may include displacement of the disc, injury to the ligaments and capsule of the joint or injury to the condyle
.
Arthritis or wearing and inflammation of the joint

SYMPTOMS

The symptoms of TMD can vary from pain and clicking immediately around the joint when talking, chewing or yawning to:

* Headaches
* Facial pain
* Neck pain
* Shoulder pain
* Tinnitus or altered hearing
* Dry throat and difficulty swallowing
* Blurred vision and sensitivity to sunlight

In severe cases of joint derangement locking of the jaw may even present on opening or closing. Painful trigger points develop in many of the overactive muscles, which may refer pain to other areas of the body.

TMD effects women twice as often as men and is most prevalent between the ages of 20 -40 years of age.

CAUSES

There are many possible and often multifactorial causes of TMD. These can range from trauma to the joint as a result of a car accident or blow to the side of the face, bruxism (grinding the teeth), stress related clenching of the jaw muscles and poor occlusion (fit) of the teeth.

Teeth grinding and bracing as a habit can result in muscle spasm and inflammatory reactions, thus causing the initial pain. Generally, someone who has a habit of grinding his or her teeth will do so mostly during sleep. In some cases, the grinding may be so loud that it disturbs others.

TREATMENT

Treatment of TMD usually takes two approaches. The first is to attempt to identify and tackle the original cause of the problem. This may involve referral to a dentist or prosthedontist for occlusal correction of to have a splint made up to be worn at night to stop clenching and grinding of the teeth. Stress management advice may also be an important part of tackling these parafunctional habits.

 

 

After deciding on appropriate advice and onward referral if required, a large part of the physiotherapy intervention is focused on treatment of the neck and shoulder girdle and the secondary tissue adaptions and pain that results from TMD. Treatment techniques used include joint mobilizations, soft tissue stretching and release and acupuncture. Physiotherapy has been shown to be effective in the treatment of TMD both with and without internal joint derangement (1,2,3).

These tissue adaptions may result in local pain in the neck and shoulder girdle and commonly lead to headaches. Local treatment to the TMJ and surrounding musculature may also need to be carried out to resolve local and facial pain and to restore normal joint mechanics.

References

1. Nicolakis, P., Erdogmus, B., Kopf, A., Nicolakis, M. and Piehslinger, E. (2002)
Effectiveness of exercise therapy in patients with myofascial pain dysfunction
Syndrome. Journal of Oral Rehabilitation 29; 362-368

2. Nicolakis, P., Erdogmus, B., Kopf, A., Nicolakis, M. and Piehslinger, E. (2001)
Effectiveness of exercise therapy in patients with internal joint derangement of the temporomandibular joint. Journal of Oral Rehabilitation 28; 1158-1164.

3. Nicolakis, P., Erdogmus, B., Kopf, A., Nicolakis, M. and Piehslinger, E. (2000)
Exercise therapy for craniomandibular disorders. Archives of Physical Medical
Rehabilitation 81; 1137-114