Temporomandibular Joint Pain

I've taken on some specific further training in this area. This region has many complex structures and considerations for treatment.

Who is it affecting?

TMD can onset as early as birth to 5 years of age (Allori et al 2010), 6-12 years of age (Keeling et al 1994), or 12-14 years of age (Lauriti et al 2013, Fernandes et al 2015)

In Australia, there are approximately 2,553,271 people reported to have some level of TMD which includes, difficulty opening, or closing, sounds with jaw movement, muscular pain, pain at the TMJ. (Population data: Australia - http://www.censusdata. abs.gov.au/census_services/getproduct/census/2011/quickstat/0? opendocument&navpos=220.)

The evidence base for treatments for TMD is at this time still insufficient. Splints may have a place in its management, such as for reducing wear on the teeth but studies so far can't show improvement in the related pain relative to other interventions like manual therapy, medications, biofeedback, exercise prescription (S.M Shaeffer,PT, 2016 TMD workshop). When people do come in to see me for this, I've often located problems in the neck or in the pattern of muscular activation in opening and closing, or in the integrity of the tendons and joint capsules of the jaw, which can be too loose, or too stiff. There may be other problems, but soft tissue and joint manual therapy can benefit these tissues. Symptomatic control is really useful in this condition because the jaw must be used many times daily and its pain pattern radiations around the head, face, neck and ears are frequently annoying and even plain distressing. Some of these you can learn yourself.

Incidentally, changing the food consistency, using rest breaks in the acute stages and as a functional strengthening progression may be a simple and effective approach.

Clunking may be an issue for people, but its the pain on chewing, opening the mouth or the pain radiations that are more amenable to treatment than clunking.

Anywhere from posture, work related ergonomics, nutrition, dental, stress, motor pattern dysfunctions, neck and back restrictions and other systemic health issues need consideration. So lots of things can help. My aim is to use test-retest treatments that give a patient an awareness of improvement or not within the first two sessions and refer when needed on this basis.

Matthew Fourro