Orofacial Pain and Jaw Disfunction
What is TMD?
TMD or temporomandibular disorder describes a variety of conditions that may affect the temporomandibular joints (jaw joints), jaw muscles, regional nerves and teeth, as well as the cervical spine. The symptoms may gradually occur on one or both sides of the head, face, jaw, teeth and neck, or suddenly develop after an injury. The temporomandibular joints (TMJs) are the most used joints in the body, they are involved when eating, talking, breathing and when expressing feelings and emotions. TMD is considered to be a multifaceted musculoskeletal disorder.
What are TMJ Symptoms?
The most common symptoms of TMJ dysfunction are jaw pain and tenderness. Clicking, popping, grinding, limited opening or closing of the mouth are also often associated with TMD. Some TMJ patients report pain or difficulty with chewing, swallowing, yawning, talking or singing. TMD sufferers commonly exhibit parafunctions, e.g. teeth grinding or clenching known as bruxism. Headaches, ear pain, dizziness, neck pain and lack of concentration, as well as tinnitus (ear ringing) can equally be associated with TMJ dysfunction.
What causes Temporomandibular Disorder?
Common causes include muscle dysfunction/imbalance, derangement or displacement of the articular disc. Bruxism will lead to increased pressure in the TMJs. Occlusal problems (poor bite) may be caused by TMD or can themselves cause TMD.
Contributing factors to TMD may include:
· Mandibular misalignment secondary to dental or orthodontic treatment.
· Tooth extractions, most commonly of wisdom teeth
· Prolonged mouth opening through dental procedures
· Poor cervical posture
· Myofascial pain
· Neuropsychological factors (Stress)
· Whiplash and other traumas
· Infection, tumors, and anatomical abnormalities
How is TMJ Dysfunction diagnosed?
A physiotherapist with advanced training in the assessment and treatment of jaw dysfunction, a specialised dental practitioner or an oral and maxillofacial surgeon can diagnose TMJ dysfunction. They may recommend dental X-rays, CT scan, MRI or other imaging processes to further investigate TMJ conditions.
During a TMJ examination a complete medical history is taken and posture and facial symmetry will be assessed. The tongue and teeth will be briefly inspected and the active and passive range of motion of the cervical spine and jaw will be assessed. Furthermore, muscle tension, length, and strength, as well as TMJ co-ordination and movement pattern will be assessed. In some cases, an assessment of the cranial nerves may be necessary.
Mouth opening and closing problems may be due to:
· Muscle disorder (imbalance)
· Disc displacement: clicking, intermittent or permanent locking
· Joint disorder: joint stiffness (common with arthritis)
· Poor cervical spine posture
· Poor occlusion
Some patients may find the assessment and treatment of jaw joints confronting, since it involves working inside the mouth, wearing gloves. It is therefore important to mention that all assessments and treatments are done only with the patient’s permission.