OROFACIAL PAIN AND TMD – WHAT IS IT?
Temporomandibular dysfunction (TMD) is a set of conditions affecting the temporomandibular joint (TMJ) as well as the muscles and soft tissues surrounding the joint. The TMJ is composed of the mandible and maxilla, forming the bony portion of the joint and is surrounded by muscles, ligaments, tendons and an articular disc within each joint. This region is otherwise known as the ‘jaw’ and is one of the most frequently used joints in the body, but receives little attention.
The TMJ is technically known as a ginglymoarthrodial joint, or a “hinge and glide” joint, meaning there is smooth coupled motion of hinging and gliding to facilitate the movement of the TMJ. The function of the TMJ is important in many daily activities such as eating, talking, yawning and laughing. A cartilaginous disc to keep the movement of the jaw smooth separates the bones of the joint. When the soft tissues around the TMJ become irritated, the disc is displaced or there is an underlying joint disease this motion may become disrupted, resulting in pain and discomfort. Common signs and symptoms are popping, clicking, locking, muscle tenderness and trigger points, joint tenderness, headaches and ear pain, neck pain and lack of range of motion, all of which can affect activities of daily living.
Approximately 60-70% of the general population is affected by temporomandibular dysfunction. There are three main categories of dysfunction that patients may experience: myofascial pain, or symptoms in the musculature that control the TMJ and associated neck and shoulder muscles, internal derangement of the joint, or a displaced disc, and a degenerative condition within the joint, such as arthritis. Head, neck or TMJ injury may put people at higher risk for dysfunction. Factors such as skeletal malformations or tooth and occlusal problems can alter the mechanics and function of the TMJ. There are other factors that can contribute to temporomandibular dysfunction such as: nutrition, psychosocial factors, stress and anxiety, and disturbed sleep patterns such as clenching, grinding and bruxism. Gender seems to play a role as well, as the proportion of reported cases is 2/3 times higher in females than males.
MANAGEMENT OF TMD
Management of TMD symptoms is a shared responsibility between the dentist, physician and manual therapist (chiropractor). There are self-care and conservative methods to address and treat these issues, including eating softer foods, ice, and avoiding aggravating movements. Stress reduction techniques and practicing gentle stretching of the jaw can also help. Passive care such as spinal manipulative therapy, soft tissue therapy, education and exercise prescription have also been shown to reduce pain and manage symptoms. Intraoral myofascial release, a technique chiropractors can use to release the muscles surrounding the joint from the inside of the mouth, has also been proven to help. Chiropractors are experts on muscles and joints, and can assess the function of the TMJ and help determine the best way to manage symptoms.