TMJ PAIN

Temporomandibular Joint (TMJ) Disorder: Andrew Cook, Physiotherapist

What is it?

Temporomandibular Joint Disorder is a term associated with jaw pain, and is also known as cranio-mandibular disorder or dysfunction. It is a complex condition that is caused by acute or chronic inflammation of the joint and/or the surrounding musculature.

  • 20% of the population is affected by this problem at some point in their lives, yet only 10-20% of people seek treatment.
  • There is an increased prevalence in younger adults between the ages of 20-40
  • Females are 4 times more likely to develop TMJ pain compared to men
Diagnosis and Causes

TMJ disorders can be difficult to diagnose as pain in the area can be referred from another source like the neck. To help differentiate the disorder here are some of the common causes of TMJ:

  • Trauma to the area
  • Degeneration of the joint
  • Stress
  • Behavioural factors - Chewing/favouring one side of the jaw, Teeth grinding
  • Poor teeth alignment
  • Poor neck posture

Deniz E and Orkun A (2000)after comparing 18 TMJ disorder patients with 20 asymptomatic control patients found:

- Patients in the TMJ disorder group had greater forward head postures and rounded shoulders, which reduced their active and passive mouth opening range of motion compared to the control group

- 50% of the disorder group had cervical muscle spasm, 30% had neck pain and 20% had a restriction in neck range of movement

Treatment

Conservative management is the most preferred option for treatment and this can be offered by a dentist, psychologist or physiotherapist depending on the nature and circumstances of the condition. As physiotherapists, our treatment focuses on education of the condition and restoration or normal joint mobility. This includes:

  • Patient Education
  • Manual therapy
  • Stabilisation exercises
Where to from here?

Research has shown that physiotherapy intervention can play a role in the treatment of the condition through manual therapy, exercise and education. As the jaw and teeth alignment are often the cause of the problem, dentists can also assist in treatment. If stress is a major factor, psychologists can also help. With this in mind, a multi-disciplinary approach involving these three disciplines may be more effective in ensuring the best care for patients.

References
  • Deniz E and Orkun A Correlation of Temporomandibular Joint Pathologies, Neck Pain and Postural Differences – J.Phys. Ther. Sci. 2000; 12: 97-100
  • Dahlström L. Conservative treatment of mandibular dysfunction. Clinical, experimental and electromyographic studies of biofeedback and occlusal appliances. Swed Dent J Suppl. 1984;24:1-45.
  • Dworkin SF, Turner JA, Mancl L, Wilson L, Massoth D, Huggins KH, LeResche L, Truelove E. A randomized clinical trial of a tailored comprehensive care treatment program for temporomandibular disorders. J Orofac Pain. 2002 Fall;16(4):259-76
  • McNeely M.L, Olivo S.A and Magee D.J. A Systematic Review of the Effectiveness of Physical Therapy Interventions for Temporomandibular Disorders PHYS THER. 2006; 86:710-725.
  • Milan S.B. Pathophysiology and Epidemiology of TMJ, J Musculoskel Neuron Interact 2003; 3(4):382-390