Temporomandibular Joint Disorders (TMD)

Historically temporomanidibular joint (TMJ) pain care has rested in the hands of one’s dentist. This is mainly because there is little training for this in other musculoskeletal professions. In fact most Dentists do not evaluate symptoms outside the mouth (Turp 1997, Gonzalez et al 2002,, Attnasio 2002, Steenks 2007, Napenas et al 2011). Physiotherapy care, given the advancement in the professional knowledge in the area of managing musculoskletal conditions, are best placed to manage patients with this presentation ( Schaffer 2016). But it does require specialist knowledge as the anatomical considerations of this joint are unique and does impose various challenges.

Despite the number of people seeking care for TMDs is relatively low, some studies have estimated the prevalence of them at around 16% of the general population (Al-Jundi 2008). People presenting with TMDs can do so with various symptoms. A study by Goncalves et al in 2010 found that only 16% of these people present with pain localised only to the TMJ region. 15% experience muscle pain around the face, head and neck region. 10% of people struggle with opening their mouth and 24% experience sounds such as clicking associated with movement.

Clicking in the TMJ is a common feature which is usually caused by what is known as Disc Displacement within the joint (see picture below). Although this can initially be painful it can improve with appropriate treatment and in fact the recommendation following a systematic review carried out by Naeije et al in 2013 was "primary treatment option in this instance is conservative, non-surgical options focussing on speeding up the natural process of alleviation of pain and of improvement in mouth opening”. So the main focus of the treatment will be to minimise pain and with this the clicking can reduce. There may, however, be instances when the pain does reduce but the clicking may remain unchanged.

Restriction in mouth opening can also be a common feature associated with TMD and can either be caused by stiffness of the joint / capsule (lining of the joint which can shrink in size and make the joint stiff) or due to tightness of the muscles (mouth closers, see picture below).

Commonly joint stiffness and pain in the TMJ region can also be caused or provoked by Bruxism (clenching / grinding teeth habitually). Its prevalence in people who suffer with TMD is reported to be in the region of 66% (De Laat et al 2002). Bruxism can either be awake (during the day) or nocturnal (at night, which happens subconsciously). Nocturnal Bruxism in particular can cause dental / tooth damage which your dentist may note initially as you may not know it yourself. Emotional and psychological stress is known to contribute to both forms of Bruxism. Some other factors can also include dietary habits, sugar intake, smoking, etc.