TMD Treatment Exercises

Treatment of TMD

• Acute stage treatment involves the 6x6 Exercise protocol of Rocabado, Cork exercise, and Tongue positioning during mouth opening and closing.
• Trigger Point Pressure Release involves applying pressure to the trigger point, increasing pressure as it releases and softens.
• Post Isometric Relaxation technique restores decreased range of motion by stretching and providing resistance.
• Manipulation-Mobilization involves treating unilateral anterior displacement of the articular disc with adhesion to the articular eminence using a low-amplitude high-velocity thrust.
• TMJ mobilization is performed to tear joint capsule adhesions and realign collagen fibers.
• Posture correction involves training for the neck, back, shoulder, and tongue to achieve optimal physiological state.
• Temporary Occlusal Therapy uses splints to prevent the upper and lower teeth from coming together, reducing pressure on the jaw joints and muscles.

Recommendations for TMD Patients

• Manage stress by identifying stressors and making a plan to reduce and manage them.
• Avoid opening mouth wide and moving excessively from one side to another.

Common Disorders of TMJ

Myogenic Disorders

• Myofascial pain
• Myofibrotic contracture
• Myospasm
• Neoplasia

Articular Disorders

• Congenital or developmental disorders
• Disk derangement disorders
• Fracture of the condylar process
• Inflammatory disorders
• Osteoarthritis
• TMJ dislocation

Signs and Symptoms of TMD

• Pain
• Impaired jaw function
• Malocclusion
• Deviation with/without correction
• Limited range of motion
• Joint noise and locking
• Headache, tinnitus, visual changes, and other neurologic complaints

Clinical Examination of TMJ

Inspection

• Maximum opening distance between the incisal edges of upper and lower incisors is 40-55 mm
• Normal opening can be estimated by patient's own finger (three finger end on end)
• Lateral range of movement is >7 mm

Palpation

• Intra-auricular palpation can be achieved by placing a little finger inside the external auditory meatus
• Extra auricular examination of TMJ is done by placing index finger in the pre-auricular region

Joint Sounds

• Clicks: single explosive noise of short duration
• Crepitus: continuous 'grating' noise

Range of Motion

• Clinical evaluation of muscles of mastication is essential for TMD patients
• Tenderness to muscles of mastication results from stress and fatigue

Muscles of Mastication to be Examined

• Masseter
• Temporalis
• Medial Pterygoid
• Lateral Pterygoid

Palpation of Specific Muscles

• Temporal muscle: palpate multiple areas
• Masseter muscle: palpate multiple areas
• Lateral Pterygoid muscle: palpate by using the little or index finger and placing it lateral to maxillary tuberosity and medial to coronoid process

Special Tests

• Joint compression test: manually loading the intraarticular structures
• Joint distraction test: evaluating the joint capsule and ligaments
• Resisted isometric muscle testing: pain or weakness may be elicited in the presence of muscle problems