Temporomandibular Joint Disorders (TMD)

What is Temporomandibular Joint(TMJ)?

TMJ is also called the jaw joint, the only moving joint in the orofacial region. TMJ is a powerful joint with great bite force; this joint helps in biting, chewing, eating, talking, laughing, yawning and other nonverbal communication. There are 2 TMJs, one on the right and the other on the left. TMJ comes under the category of a synovial diarthrodial joint, which means it has two joint cavities per joint, essentially making four joint cavities for 2 TMJs. In addition, TMJ has a large disc, which is critical in joint function and dysfunction, unlike the other synovial joints. Therefore, understanding the TMJ’s anatomy, biomechanics, and neuropathophysiology is important to treat patients with jaw pain.

What is Temporomandibular Disorder (TMD)?

TMD encompasses a group of symptoms that affects the jaw, face, head and neck. It is more common in females compared to males. The symptoms include jaw pain, jaw lock(closed lock and open lock), jaw deviation, and clicking or popping sound while mouth opening/closing. Some may experience ear pain, ear sound, ear fullness, headache, blurry vision, sinus pain and other widespread craniomandibular and orofacial symptoms. Every patient is unique, and the symptoms will vary depending on the structures and pathophysiology involved. Though the prevalence of TMD symptoms is almost 35% in the general population, only 5% need treatment. That means most symptoms are self-resolving, or they won’t affect the day-to-day functionality of the patient. But for a few patients, once the disease is established, they will suffer due to chronic pain and dysfunction. Recovery will take a long time, and some may suffer lifelong chronic TMD pain.

Why is TMD complex to treat?

TMD is one of the tricky joints in the body. It has two joints with four joint cavities. Both TMJ joints are interlinked, so a problem on one side invariably affects the other. The Trigeminal nerve is responsible for sensory motor supply to the joint, but the same nerve governs the head, face and ear. It is called a trigeminal-cervical complex. So the pathology in one area will misrepresent in the other area. For example, the TMJ disc problem can refer to pain in the ear and in the same way, the cervical Spine problem refers to pain in the jaw area. So neck issues can lead to jaw issues. The TMJ disc one displaced, and it is hard to recapture it because of a lack of muscular control to pull it back to its normal position. Parafunctional habits like bruxism(clenching teeth), nail-biting, and abnormal oral sexual activities cause or contribute to TMD. Even at the school level, TMD management is poorly taught in the regular physiotherapy or dental curriculum. So most doctors have less knowledge or experience in treating TMD. These are the reasons why TMD is hard to treat, and the most TMD patients suffer.

Whom to meet if you have TMD?

TMD patients must meet a doctor who has knowledge of TMJ Anatomy, Biomechanics, Pathomechanics, Neurophysiology, Oral Medicine, Cervical Spine Pathology, Orthotics/Splinting, Orthodontics, Exercise therapy and joint mobilization. Finding someone who integrates all the above methods while treating TMD is hard. Dentists are usually the first contact practitioners, but not all dentists are well-informed about TMD management. So as with Physiotherapists. But both Professionals can treat TMD but must have some basic understanding and training in TMD.

What is the treatment for TMD?

In earlier days, splinting was the only line of treatment for TMD. But the evidence for Splinting is very contentious. Since TMD affects TMJ, a joint like any other joint in the body, it needs joint-based and muscle-based intervention as a first line of treatment. This includes joint mobilization, joint positioning exercises, joint decompression exercises, myofascial trigger point release, dry needling, and stabilization exercises. But every patient is unique, and treatment must be tailor-made based on the patient’s presentation. For example, a hypermobile joint that is dislocating needs stabilization exercises. A closed lock (disc displacement without reduction) needs joint mobilization exercises with or without splinting. A myofascial pain needs manual trigger point release or dry needling. A cervical spine-related TMD needs posture correction and neck curve correction exercises. So a detailed assessment must be done before deciding the treatment strategies.

Do braces or appliances help in TMD?

Braces and Splints have a role to play in TMD. Before prescribing a splint, the patient must be treated with mobilization and exercises. Splinting must be added only if the initial treatment fails to improve the condition. Splints are to be given in case of bruxism or other parafunctional habits. It can also be given when there is a gross bite issue, like a crossbite or an underbite. But the splinting must be regularly adjusted as the condition progresses. There is a small risk of worsening the condition if the splints are given inappropriately.

How do we treat TMD at APTER Clinic?

We are the only clinic in the country that offers a multidisciplinary and prudent approach to TMD. We evaluate and treat the jaw joint, craniomandibular muscles, neurophysiology and cervical spine, making our approach superior to others. We don’t use fancy machines nor offer high-priced splints. Instead, we give manual therapy, mobilization, myofascial therapy, dry needling, cervical spine correction and postural correction program. Splints are prescribed only as deemed necessary. We also specialize in TMD associated with fibromyalgia, Headache, Cervical spondylitis, osteoarthritis, rheumatoid arthritis and other inflammatory/non-inflammatory diseases that affect TMJ.

We also offer workshops and certification training programs to Dentists and Physiotherapists to improve the overall skillsets of Professionals to treat TMD.

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