Role of Physiotherapy in Temporo Mandibular Joint Dysfunction or Jaw Pain

Jaw pain is a very common problem. The condition is sometimes known as TMD (Temporo Mandibular Disorder). These symptoms can range from mild discomfort to severe pain with jaw restriction and locking. Pain may be felt in the jaw joint, jaw bone, teeth, jaw muscles, temple region, ears and neck. This condition can also cause headaches. TMD can have a devastating effect on your life, interfering with eating, laughing, yawning and even talking.

Causes of Jaw Pain

  • An injury, such as a blow to your jaw or a fall onto your chin.
  • Surgical procedures in and through mouth, throat, stomach or lengthy dental procedures, where the jaw has been held open for an extended period of time.
  • Clenching or grinding (bruxism) your teeth.
  • Upper and lower teeth not meeting together properly (mal-occlusion).
  • Missing several teeth in a row.
  • Arthritis and joint damage in Temporo Mandibular junction
  • Neck postural problem / stress.
  • Resting your chin on your hand as you work.
  • Dislocation or pinching of the disc in the jaw joint, this can cause locking or clicking in the joint.

Diagnosis

Making an accurate of your TMD condition is essential so an effective treatment regime can be implemented for your particular symptoms. Physiotherapists will assess your jaw joint and muscles, your neck and your posture. If there is a problem with your bite or if there is any unusual or excessive wearing of your teeth then seek opinion from dental surgeon. If your symptoms are more severe you may need to see an oro-facial specialist who will screen for any internal derangement or damage in your joint with a CT or MRI scan.

Treatment

Modalities such as TENS (Transcutaneous Electrical Nerve stimulation), Ice, Heat, Ultrasonic therapy and laser therapy to provide pain relief.

Manual therapy to restore movement to the TMJ and cervical spine.

Myofascial release of the muscles in the neck and facial areas.

Therapeutic exercise to improve joint movements, strengthening the facial muscles and correct forward head alignment.

ULTRASOUND

Pulsed ultrasound at 0.3 to 0.6 watts per sq cm over the lateral poles of the temporomandibular joint condyles with a small transducer for 2 to 3 minutes per side. The more inflamed the joint, the lower the ultrasound setting should be. If any temporomandibular joint-or ear pain reported by the patient after Ultrasound application, this treatment should be discontinued for four to five days.

Continuous or pulsed ultrasound for tender masseter and anterior temporalis musculature at 2 MHz / 0.5 watts per sq cm 3 to 5 minutes per side depending on area to be covered. This modality is most effectively applied at muscle-tendon-bone junctions.

Galvanic current

Galvanic and modulated direct current stimulation can be used over the lateral capsule of the inflamed temporomandibular joint at a comfortable sensory level for 8 to 10 minutes. The dispersal pad should be placed on the ipsilateral cervical region.

DIATHERMY

Only pulsed diathermy should be used over and around the temporomandibular joints when joint inflammation/ effusion are suspected. Treatments usually range from 6 to 10 minutes per side with settings of 15 to 30 watts. Duration and intensity should be inversely proportional to the degree of inflammation in the joint. This is an ideal treatment for the acute inflammatory response to injury.

CRYOTHERAPY

Cold compresses can be effectively used over the inflamed temporomandibular joints 15 minutes per application following other therapeutic modalities.

If you grind or clench your teeth or if you have malocclusion problems then your dentist may need to make you a night splint (occlusal splint). The splint will hold your jaw joint slightly apart while you sleep even if you are clenching, preventing compression of your jaw joint. This helps your jaw muscles to relax and reduces the swelling and inflammation in your joint.

If you have other dental problems, such as cavities, that are causing pain, you may be chewing on the other side only. With time this will cause irritation and damage to the side being overused. You will need to have these dental problems fixed to prevent a recurrence of the TMD.