Temporo-mandibular Dysfunction

TMD Treatments in Kingston

Assessment. Treatment. Pain Relief. Discover the benefits of physiotherapy for TMD

What is TMD?

TMD is a group of conditions that involve the temporo-mandibular or “jaw” joint, the chewing muscles, and all of the surrounding tissues including the nerves that support the function of this area.

The most common symptom of TMD is that of pain. The pain of TMD is commonly felt immediately in front of the ear. The muscles of mastication(chewing) are in front of the ear and in the temple, the side of the head above and in front of the ear. Pain in TMD can also be felt in the ear, the temples, the teeth, or through the mandibular – jaw – region where one of the prime chewing and clenching muscles is located. The incidence of painful temporomandibular joints in the general population ranges between 10 – 15%. TMD pain is typically caused by one of three tissues – the joint itself, the disc that sits within the joint, or the muscles around the joint.

Another common complaint is loss of mobility of the jaw. People with TMD can find that opening their mouth fully is difficult and/or painful. This is often noticed when eating, or with difficulty in a dental visit during routine cleaning or with a filling. Patients with TMD will commonly have ‘joint noise’, which can express in a variety of ways including grating, clicking, popping or fine crepitations or grinding sensations. These characteristic sounds of the TMJ originate from a variety of different tissues.

Do I Need Treatment?

If you have pain associated with your temporomandibular joint you would benefit from care. A certain percentage of patients who develop TMD will have symptoms that self-resolve and will not require therapeutic intervention. However, pain and interference with eating or loss of mobility are good reasons to seek treatment. Joint noise as an isolated symptom is generally not a concern, but if the joint noise is associated with a ‘locking’ joint or a painful joint then it is important to get help.

Causes of TMD

Trauma that triggers TMD can be subdivided into:

  • Direct trauma such as a blow to the head from a baseball or a boxing glove. Other types of trauma could be unintentionally caused in the course of medical care. Dental extractions, prolonged mouth opening during a dental hygiene visit or a restoration procedure, or even prolonged mouth opening with intubation during general anaesthetic are known causes.
  • Indirect trauma such as a whiplash mechanism from a fall to the ground or in a motor vehicle collision.
  • Microtrauma caused by small repetitive forces over time that are exerted on the disc and other joint tissues, or by excessive muscular demand on the chewing muscles or a combination of both stresses. Unconscious clenching or grinding of the teeth is an example. This is referred to as bruxism.
There is a very wide range in anatomical variance in our skeletal system and it is thought that severe variances in our bone structure and also in our bite can contribute to the development of TMD. Over time studies have shown that these developmental or acquired variances do not factor as strongly as once believed.
Studies show that TMD patients experience more anxiety than healthy control groups. Stress and anxiety causeand exacerbate jaw clenching, setting and grinding(bruxism) behaviours, which physically overloads and stresses the chewing muscles and the joint tissues. We are sometimes aware of our jaw clenching habits, but may not realize how much we do it until a partner tells us of nighttime grinding behaviour while sleeping. Often, your dentist or hygienist will identify dental wear patterns or gum recession as evidence of grinding and clenching.
Factors such as tissue hypermobility, inflammatory joint conditions and genetic predisposition contribute to some cases of TMD.

What Goes Wrong?

  • Joint disease – such as inflammatory arthritis (for example, Rheumatoid Arthritis) and degenerative arthritis (Osteoarthritis)
  • Disc derangement – disc or “Internal” joint derangement is a biomechanical disorder which involves the disc getting displaced from its normal location within the temporomandibular joint. This can result in alteration in the ability to open and close the mouth fully and comfortably. The history of the condition and pattern of jaw movement often reveal the status of the disc and whether it is relevant to the person’s pain and/or jaw misbehaviour. The displaced disc will sometimes painfully block adequate opening of the mouth and can actually cause the mouth to ‘lock’ open. This will cause interference in the correct and comfortable closing and chewing function of the mouth and teeth.
  • Myofascial pain – This is pain involving primarily the muscles- the masseter and temporalis. This will often intrude on the patient’s waking day as constant aching pain of varying degrees. It will cause pain localized to the muscles themselves but can refer to the ear, the teeth and the neck as well. Eating can be painful and restriction in the amount of mouth opening can affect food portion size. The muscles also fatigue early, feeling “overworked” or exercised. Limited opening makes dental visits challenging and even the simple at home task of brushing your teeth. It is not uncommon for myofascial TMD pain to be part of the larger picture of the chronic pain profile associated with other conditions such as fibromyalgia.

Management of TMD

The success of management of your TMD is dependent on many factors, including having a team of knowledgeable health care providers working with you. It is important that you are a knowledgeable participant in the managing team as well.

  • Your Dentist: Your dentist or hygienist may be the first person to diagnose you. They may note your pain and discomfort on opening your mouth during your visit. They may note the wear patterns on your teeth, which are evidence of clenching and grinding behaviour. Other evidence of grinding, nighttime or otherwise, is gum recession, tooth fracture or a crack in a molar. Management strategies may include taking an impression of your teeth to fabricate a night guard also known as a bite plane. Night guards can minimize the effects of the powerful force of your clenching muscles on your teeth and your TMJ tissues. Many people who suffer from TMD find wearing a night guard essential to minimizing their pain. 
  • Your Family Physician: Your family doctor is your health “manager”and will evaluate your TMD concerns in context of your general health. They may suggest or prescribe medication to assist you with your pain, your inflammation or your generalized anxiety as you negotiate your TMD concerns.
  • Your Physiotherapist: Your physiotherapist is a primary care practitioner andareare qualified to assess you and provide you with a physical diagnosis. We prefer to work as a team with other health care practitioners, but being self-regulated professionals, do not require a referral to see you regarding your pain and TMD. Physiotherapy evaluation is an important componentof your TMD treatment plan. Physiotherapists understand the pathophysiology of the disorder and have multiple tools to address different aspects of your TMD. This includes techniques that focus on the mechanics of the joint and disc, the subtleties of the myofascial pain, and the interaction of stress and the nervous system on your temporomandibular joint.

Physiotherapy Treatment of TMD

This is multi-pronged, aiming to target the relevant facets of your specific TMD issues. 

  • Education – your physiotherapist will help you identify your clenching behaviours and provide strategies to lessen clenching. Good advice on head and neck posture, tongue position, and home use of heat and ice are valuable strategies to reducing symptoms and facilitating self-management.
  • Manual Therapy – joint mobilization, stretching, ‘trigger point or myofascial release’ are all potential techniques your physiotherapist could use, if appropriate for your situation.
  • Acupuncture and electrical stimulation – these tools target the sensory nerve receptors in the area of dysfunction that provide information to the brain. These higher centers in the brain control the sensitivity and behaviour of tight and painful tissues. They are key to achieving pain relief and relaxation of the sensitized tissues.
  • LASER and Ultrasound – light and sound energy both can be used to promote tissue repair if there is inflammation or injury. They also have positive secondary effects in reducing pain and sensitivity through sensory nerve receptor stimulation.
  • Referral to your family doctor or dentist if medication or imaging are needed, or if dental issues are in question and should be addressed in your program of care
  • Exercise & Mindfulness – stress management is of prime importance in settling heightened generalized tension, which leads to facial muscle tension, pain, and nighttime clenching and grinding behaviours.

James Baggs PT, with extensive training in TMD, manual therapy, acupuncture and IMS (intramuscular stimulation) draws on decades of clinical experience to help you ‘take the bite out’ of your jaw pain – call our clinic for consultation at 613.634.2378.

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