Temporomandibular joints and dysfunctions

The temporomandibular joints (TMJ) are located on either side of the face and form the junction between the temporal bones and the mandible, or lower jaw. The TMJ also consists of cartilage, articular disc, articular capsule, synovial fluid, ligaments, muscles and tendons. Each of these structures can therefore be a source of osteoarthritis, hypo or hyper mobility, disc dislocation, muscle imbalance and others. Clinical TMJ disorders are known as temporomandibular dysfunctions (TMD) and like any other musculoskeletal disorder, TMD can have several pathological causes and are generally multifactorial.

It is important to note that TMD is the 2nd most common musculoskeletal condition after chronic back pain and it mainly affects women between the ages of 20 and 50. TMDs result in a variety of signs and symptoms, including abnormal mandibular movements, such as limitations or blockages, deviations, joint noises, as well as orofacial or neck pain. Unfortunately, only 3-7% of the population with a sign or symptom of TMD will consult a health care professional to address their condition.

During the initial assessment, the physiotherapist will ask you about your signs and symptoms, including joint sounds, orofacial pain and headaches. The physiotherapist will also inquire about your lifestyle habits, as well as your history of neck injuries, orthodontic treatments and maxillofacial surgeries, if applicable. The physiotherapist will continue with the evaluation of the temporomandibular and cervical regions by assessing posture, physiological and accessory mobility, muscle strength, muscle tension, breathing pattern and others.

The physiotherapist can intervene in the treatment of TMDs associated with hypo- or hyper-mobility, disc dislocations, muscle imbalances and psychosocial factors such as stress, among others. The physiotherapist uses a variety of manual therapy techniques, both intra- and extra-oral, and is familiar with many exercises to treat the problems revealed during the initial assessment. In addition, the physiotherapist can help identify parafunctions, or bad habits, that may contribute to TMD. Examples of parafunctions include bruxism, cheek biting, jaw pressing and nail biting.

Do not hesitate to consult a physiotherapist for any sign or symptom of TMD, as they are highly equipped to handle the evaluation and treatment of these unfortunately under-addressed musculoskeletal conditions.

References

Articulation temporo-mandibulaire théorique et pratique. PHT-3313 : Physiothérapie musculosquelettique 4. [En ligne]. Université de Montréal : Faculté de médecine, Département de physiothérapie, Automne 2020. Disponible : https://studium.umontreal.ca/