The temporomandibular joint (TMJ) is a ginglymoid – diarthrodial type of joint. Also known as the craniomandibular articulation, it is formed by the articulation of the glenoid fossa of the temporal bone and the head of the condyle. The movement of the joint is limited by the teeth in occlusion. The surfaces of the joint are covered by fibrocartilage. The synovial fluid present between the joint not only lubricates the joint but also maintains the nutrition of the joint.
What is Temporomandibular Joint Dysfunction
It is a disorder characterized by facial pain limited to the mandibular function, muscle tenderness, joint sounds, functional derangement of the dental articulation, psychological state of mind, or physiologic state of the temporomandibular joint and its associated structures. It is a type of musculoskeletal disorder of the masticatory system.
Causes of TMJ Dysfunction
- Development jaw abnormalities
- Inflammatory disorders (Arthritis of TMJ)
- Infections
- Trauma (dislocation, fracture, ankylosis)
- Excessive stress
- Ligamentous laxity
- Psychosocial distress
- Neoplastic ( Benign or malignant tumors)
- Bruxism
- Thumb sucking Habit
- Maligned teeth
- Prolonged mouth breathing
Features
- A localized pain in the preauricular region, masseter muscle, or the temporalis muscle region.
- TMJ muscle tenderness
- Lateral deviation while opening and closing
- Reduced mouth opening
- Loss of facial symmetry
- Joint sound while open and closing the mouth.
Conservative Treatment of Temporomandibular Joint Dysfunction
The treatment for temporomandibular joint dysfunction should always begin with a conservative approach that focuses on providing reversible therapies. If needed then approach for irreversible therapies.
- Patient education
- Behavioral therapy
- Self-care Instructions
- TMJ exercises
- Soft tissue release
- Electrophysical modalities ( TENS Therapy)
- Splint therapy
- Needling ( Acupuncture)
Patient Education- Physical therapists should communicate with the patients or their family members to understand the requirements and provide the best solution. They should also explain to them that their problem is related to the facial muscles. Try removing the negative thoughts, anxiety, or stress related to their condition from their minds. Explain that their pain can be relieved by opting for physical therapy conservatively. If the condition has reached severity, simpler methods like arthrocentesis or Arthroscopy can be used as measures of treatment.
Behavioral Therapy- This is among the first steps of a conservative approach for the treatment of TMJ Dysfunction. The physical therapists reassure the patients and explain to them the nature, actual cause, and prognosis of the condition. Physical therapy focuses on eliminating any kind of strain on the masticatory muscles. Patients are advised to avoid bruxism and are provided dental appliances for this (Nightguard). They are also advised to follow relaxation techniques that help to relieve the pain.
Self-care Instructions- The physical therapists believe that following self-care instructions is often enough to control the mild to moderate cases of Temporomandibular Joint dysfunction. The self-care instructions include-
- Avoid gum chewing
- Follow a soft diet
- Avoid long conversations
- Avoid wide yawning
- Avoid intake of hard consistency food and chew from the posterior teeth
Physical therapy includes an application for an ice pack for acute pain and a warm pack for the chronic type of pain, self-massaging, and taking a warm water bath.
TMJ exercises– The types of exercises included are
- Stretching exercises
- Coordination exercises
- Mobilization exercises
All these exercises are performed initially under the observation of the physical therapists or the dentist. Later when the patients are aware of the frequency and force to be applied they are advised to perform this physical therapy by themselves at home.
Soft Tissue Release- The physical therapy techniques for soft tissue release are sufficiently effective in relieving the pain from the masticatory muscles, thereby improving the function of these muscles.
Electrophysical modalities ( TENS Therapy)- It is an electrical stimulation given through an ultrasound machine on the affected site here in this case the skin over the temporomandibular joint. TENS therapy given by the physical therapists with the machine sends down the heat in the form of Ultrasound waves to the joint to control pain and treat the joint contracture. It acts by stimulating the nerve endings and closes the central gate of the pain stimuli. It also causes activation of the endogenous opioid system.
Splint therapy- These are oral appliances that are customized for the patients of Temporomandibular Joint Dysfunction by the dentists. These appliances provide stabilization to the TMJ. It acts by evenly distributing the occlusal forces on the teeth and at the joint. These appliances also protect the teeth from habits like bruxism. The splints are designed depending on the severity of the condition. They can be
- Flat plane stabilization appliance
- Anterior repositioning appliance
- Occlusal appliances
Needling (Acupuncture)- Physical therapists insert very thin needles at the temporomandibular joint up to a certain depth to relieve pain. Pricking of the needles stimulates the production of endorphins, serotonin, and acetylcholine that act as pain relievers.
Conclusion
All these are conservative approaches in the treatment of TMJ Dysfunction. These can be followed by the patients to treat the mild to moderate cases of Temporomandibular Joint disorders at a personal level. However, these approaches are not sufficient enough to treat severe cases. Physical therapies provide the most cost-effective and long-term relief from TMJ-associated pain. The physical therapists provide the patients with comprehensive and conservative management of TMJ Dysfunction.
