TMJ, also known as TMD or temporomandibular disorder, is a pathology involving any or all of the following anatomical structures:
-The temporomandibular joint
-Muscles/ligaments/tendons surrounding the joint
-Structures surrounding the joint such as the ears, neck, cervical spine, teeth, & face
Although TMJ technically refers to the joint itself, any pathology or disorder related to this region is often medically referred to as TMJ rather than TMD. TMJ is defined as any disease impacting the jaw joint, or the muscles responsible for dental occlusion and jaw mobility. Problems arise when an imbalance occurs within any of the structures in and around the temporomandibular joint. The typical TMJ disorders are specifically defined as: pain dysfunction syndrome, arthritis, dysfunction due to trauma, or internal derangement involving the articular disk. All of these disorders typically present with the same spectrum of symptoms and respond in the same manner to treatment. Patients with TMJ often present with symptoms related to the muscles of mastication and structures involved in joining the lower lower jaw (the mandible) to the skull ( the temporal bone). Many of these symptoms occur as a result of the physical stress on the structures around the joint.
Patient history is an important element in assessing patients with suspected TMJ pathology. The following questions are ones that all Physical Therapists should ask upon evaluation and subjective exam of these patients:
Is there pain or restriction on opening or closing of the mouth?
Is there pain on eating? Does the patient chew on the right or left? both sides equally?
What movements of the jaw cause pain? do the symptoms change over a 24-hour period?
Do any of these actions cause pain or discomfort: yawning? biting? chewing? swallowing? speaking? shouting?
Does the patient breath through the nose or the mouth?
Has the patient complained of any crepitus or clicking?
Has the mouth or jaw ever locked?
Does the patient have any habits that place stress on the TMJ, such as smoking pipes? cigarettes? leaning on the chin? chewing gum? biting the nails? chewing hair? pursing and chewing lips, continually moving the mouth? or any other nervous habits?
Does the patient grind teeth or hold them tightly?
Does there appear to be any related psychological problems (often accompany TMJ)?
Are there any teeth missing or misaligned (causing grinding or altered closing of the jaw)? cross-bite/scissor-bite? overbite? under-bite?
Are any teeth painful or sensitive?
Does the patient have any difficulty swallowing?
Are there any ear problems such as hearing loss, ringing in the ears, blocking of the ears, earache, or dizziness?
Does the patient have any habitual head postures compacting or compressing on the TMJ (i.e. holding telephone on ear, reading or listing to someone while leaning on jaw)?
Has the patient noticed any voice changes (can be caused by muscle spasm around TMJ)
Does the patient have headaches?
Does the patient ever feel dizzy or faint?
Has the patient ever worn a dental splint?
has the patient ever been seen by a periodontist, orthodontist, or endodontist?
If the answer to any or all of these questions is “YES”, temporomandibular disorder is likely the cause of patient’s symptoms.The next and most crucial step is to conduct a thorough examination of the tempormandibular joint and cervical spine.
Some of the main symptoms and complaints associated with TMJ disorders may be any or all of the following:
Biting or chewing difficulty or discomfort
Clicking, popping, or grating sound when opening or closing the mouth
Bruxism (grinding of the teeth)
Dull, aching pain in the face in and around joint
Point tenderness of the jaw
Hypertonicity of the jaw muscles
Reduced ability to open or close the mouth
Excessive movement of the jaw upon opening or closing the jaw
Neck or back pain
“trigger points” (due to contracted muscles in jaw, head, and neck)
Facial or dental pain
Facial/jaw muscle fatigue and/or spasm
Changes of dental structure
Altered occlusion mechanics- cross-bite/scissor-bite, under-bite, over-bite
Because TMJ is difficult to diagnose, referral may be necessary. Some of the types of doctors that may be used for referral are: primary care physicians, ear, nose, and throat doctors, dentists, neurologists, endocrinologist, chiropractors, TMJ specialists, rheumatologists, and chronic pain specialists. Patients may need to see more than one specialist to examine TMJ pain and symptoms present to attain a conclusive diagnosis; Health care providers that should be rather experienced with TMJ are: patient’s primary care provider, a dentist, or an ear, nose, and throat (ENT) doctor, depending upon patient’s symptoms.
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