Management of TMJ Disorder

Zoya Khatoon
Musculoskeletal Sciences
 Objective
 Anatomy TMJ
 Assessment of TMJ
 Management of TMJ Disorder
 Recent Advances
Anatomy
 TMJ Disorder
 TM dysfunction is a vague term that encompasses numerous clinical problems that
involve the masticatory system.
 Mechanical stress is the most critical factor in the multifactorial etiology.
 Dysfunction of either the muscles or the joint structure generally is at fault.
1. Inflammatory Conditions
2. Osseous Mobility Conditions
3. Capsular Fibrosis
4. Articular Disc Displacement
5. Degenerative Conditions
6. Head & Neck Cancer
 Signs and Symptoms of TM Joint Dysfunction
1. Pain in the area of the jaw
2. Edema around the mandibular condyle
3. Increased or decreased active or passive range of motion
4. Popping or clicking noises
5. Difficulty with functional activities (e.g., eating, talking) or parafunctional
activities (e.g., clenching, nail biting, pencil chewing) of the mandible
6. Catching or locking of the jaw
7. Forward head posture
Assessment
 History
1. Is there pain or restriction on opening or closing of the mouth?
2. Is there pain on eating? Does the patient chew on the right? Left? Both sides
equally?
3. What movements of the jaw cause pain? Do the symptoms change over a 24-hour
period?
4. Do any of these actions cause pain or discomfort: yawning, biting, chewing,
swallowing, speaking, or shouting? If so, where?
5. Has the patient complained of any crepitus or clicking?
6. Has the mouth or jaw ever locked?
7. Does the patient have any habitual head postures?
8. Does the patient have headaches? If so, where?
Observation
 Examination
 Active Movement:
1. Opening of the mouth: 35 to 55 mm
2. Closing of the mouth
3. Protrusion of the mandible
4. Lateral deviation of the mandible right and left
 Resisted Isometric Movements:
Management
 Goals of Treatment:
 Relief Pain
 Improve Muscular Coordination
 Relax Tense Muscle
 Increase ROM
 Increase muscular Strength
 Postural Correction
 Prevention of Shoulder Disability
 Relief Pain in TMJ Disorder:
 Reported concepts for the treatment modalities and pain management of
temporomandibular disorders

 Mieszko Wieckiewicz et al 2015

 The most commonly reported conservative treatments are massage therapy and
individually fabricated occlusal splints. In addition to massage, other popular methods
include manual therapy and taping, warming/cooling of aching joints, and light and laser
therapy.
 Management of pain in patients with temporomandibular disorder
(TMD): challenges and solutions
 Alfonso Gil-Martínez et al 2018

 Manual therapy (eg, joint mobilization/manipulations, soft-tissue mobilization),

therapeutic exercise, electrotherapy (eg, low-level laser therapy [LLLT], transcutaneous
electrical nerve stimulation [TENS], therapeutic ultrasound, shortwave), dry needling
(DN), and acupuncture.
Efficacy of Ultrasound Massage Therapy as an Adjuvant Pain Control Modality
in TMDs: A Clinical Study
 Roopika Handa et al 2018

 Conclusion: US massage therapy appears to be useful in relieving pain and improves

subsequent mouth opening, and hence can be considered as a valuable physiotherapy
method. Thus, US massage therapy serves as a potent and independent therapeutic modality
in TMDs.

 US: 1 MHz and pulse setting at 1:1 for 8 min each session for 4 weeks.
 Manual Therapy:
 Objectives:
 Restore movement
 Reduce Pain
 Normal Mechanics of joint
 Improve function
Systematic Review Temporomandibular disorders. Part 2: conservative management; 2014
 Stretching Exercise
 Aim:
 To Improve flexibility, ROM & Posture
 Include:
 Self Stretching
 Post Isometric Stretching
 Instrument Therabite
5X5X30 protocol: 30 sec hold 7x7x7 protocol: 7 sec hold & rest for 7 sec
5 reps 7 reps
5 sessions per day 7 session per day
 Goldfish Exercises:
 Goldfish’ Exercise 1 (partial opening)
 Goldfish’ Exercise 2 (partial opening)
 Goldfish’ Exercise 3 (full opening)
 Goldfish’ Exercise 4 (full opening)
 Repeat 6 times, 6 times a day
 EFFECT OF GOLDFISH EXERCISE ON PAIN, MOUTH OPENING AND
TEMPOROMANDIBULAR JOINT DISABILITY IN ORAL SUBMUCOUS FIBROSIS-
A RANDOMIZED CONTROLLED TRIAL

 MS. SETOO N. JAIN et al 2017

 RCT, 16 patient

 For 2 weeks duration, 5 times/week

 Conclusion: Goldfish Exercise when given along with conventional therapy improves
mouth opening and function.
 COMPARISON OF MUSCLE ENERGY TECHNIQUE AND MYOFASCIAL RELEASE
TECHNIQUE ON PAIN AND RANGE OF MOTION IN PATIENTS WITH
TEMPOROMANDIBULAR JOINT DYSFUNCTION: A RANDOMIZED CONTROLLED
STUDY

 Parth Trivedi et al 2016

 MET & MFR

 36 patient & 4 weeks

 Conclusion:Both MET and MFR are effective in reducing pain and increasing ROM in
chronic TMJD subjects. However, MET was found to be superior to MFR.
 5 times/session, 5SEC rest, and 3 times/week for 4 weeks

5 times/session and 3 times/week for 4 weeks

 Kinesio-taping
 “Y” shaped kinesio strip.

 The practitioner asked the patient to open and close his/her jaw in order to locate the TMJ.

 The base of the “Y” strip was placed slightly posterior to the TMJ with no tension.


 The superior tail of the strip was applied with very light tension (0–15% of available) after
pulling the skin from temporomandibular joint to the nose.

 Later on, inferior tail of the “Y” strip was applied by using the same technique
Assessment of the Short-Term Effectiveness of Kinesiotaping and Trigger Points
Release Used in Functional Disorders of the Masticatory Muscles
 Danuta Lietz-Kijak et al 2018

 60 patients

 Results show that the KT method and TrP inactivation brought significant therapeutic
analgesic effects in the course of pain-related functional disorders of the muscles of
mastication.

 More beneficial outcomes of the therapy were observed after using the KTmethod,
which increased the analgesic effect in dysfunctional patients.
• ischemic compression method, which was based on applying pressure to the active
trigger point until it was switched off, that is, the pain disappeared

• 3 times, on the first, third, and fifth days of therapy.

 Strengthening Exercises
 Aim:
 Strengthen jaw muscles
 Rocabado 6 x 6 Exercise Program:
 Objective:
 To learn a new postural position
 To fight the soft tissue memory of the old position
 To restore the original muscle length-tension relationships
 To restore normal joint mobility
 To restore normal body balance.

 Each activity 6 times per session and 6 times per day

Summary:
 References
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 Handa R, Sunil MK, Gupta C, Raina A, Khan T, Gulzar A. Efficacy of ultrasound
massage therapy as an adjuvant pain control modality in TMDs: A clinical study.
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 Physiotherapy management of Temporomandibular Joint (TMJ) pain: NHS Foundation
Trust
 Shaffer SM, Brismée JM, Sizer PS, Courtney CA. Temporomandibular disorders.
Part 2: conservative management. Journal of Manual & Manipulative Therapy.
2014 Feb 1;22(1):13-23.
 Baldoman D, Vandenbrink R. Physical therapy challenges in head and neck
cancer. InMultidisciplinary Care of the Head and Neck Cancer Patient 2018 (pp.
209-223). Springer, Cham.
 Trivedi P, Bhatt P, Dhanakotti S, Nambi G. Comparison of muscle energy
technique and myofascial release technique on pain and range of motion in
patients with temporomandibular joint dysfunction: a randomized controlled study.
Int J Physiother Res. 2016;4(6):1788-92.
 Jain SN, Shukla YU. Effect of Goldfish Exercise on Pain, Mouth Opening and
Temporomandibular Joint Disability in Oral Submucous Fibrosis-a Randomized
Controlled Trial. International Journal of Therapies and Rehabilitation Research.
2017;6(2):205.
 Gil-Martínez A, Paris-Alemany A, López-de-Uralde-Villanueva I, La Touche R.
Management of pain in patients with temporomandibular disorder (TMD):
challenges and solutions. Journal of pain research. 2018;11:571.