TMJ Treatment: What to Do? When?

What is TMJ Treatment?

TMJ (Temporomandibular Joint) dysfunction involves issues that affect the jaw joint and surrounding muscles, leading to pain, discomfort, and difficulty in jaw movement. Treatment focuses on relieving symptoms, improving jaw function, and addressing the underlying causes.

Why Does TMJ Dysfunction Occur?

TMJ dysfunction can result from various factors such as jaw misalignment, injury, arthritis, or habits like teeth grinding (bruxism). Stress, leading to muscle tension, can exacerbate symptoms. Identifying the root cause is essential for effective management and treatment of TMJ dysfunction.

How is TMJ Dysfunction Diagnosed?

Diagnosing TMJ dysfunction involves a comprehensive assessment by a physiotherapist or dentist, which may include a physical examination, patient history, and possibly imaging tests like X-rays or MRIs. The goal is to understand the nature of the dysfunction and create a tailored treatment plan.

What are the Symptoms of TMJ Dysfunction?

Common symptoms include jaw pain, clicking or popping sounds when opening or closing the mouth, difficulty chewing, and limited jaw movement. Additional symptoms may include headaches, ear pain, or neck stiffness.

Investigations and TMJ Treatment

Prompt Relief through TMJ Physiotherapy Treatment

Physiotherapy for TMJ dysfunction can offer immediate relief in many cases. Techniques to reduce muscle tension and improve jaw coordination are often effective from the first session. If further intervention is needed, particularly dental interventions, your physiotherapist may refer you to a dentist or craniomandibular specialist for additional treatment options.

Physiotherapy-Specific TMJ Treatment Interventions:

1. Manual Therapy Techniques:
   Physiotherapists often use manual therapy techniques to reduce joint stiffness and improve jaw mobility. This may include joint mobilisation, soft tissue mobilisation and massage, plus trigger point therapy and myofascial release techniques specifically targeting the jaw and neck areas.
2. Jaw Muscle Strengthening Exercises:
   Specific exercises to control and strengthen the muscles around the TMJ are crucial. These exercises may involve isometric and isotonic contractions that help in stabilising the joint, normalising movement patterns and preventing further dysfunction suggest the use of conservative physiotherapy as an initial treatment. Exercises and manual therapy are simple and safe interventions that could potentially be beneficial for patients with myogenic TMD. (Shousha et al 2018)
3. Postural Training:
   Improving jaw and head on neck posture is essential, especially if poor posture is contributing to TMJ dysfunction. Physiotherapists teach patients exercises that enhance head, jaw and neck alignment to reduce strain on the jaw joint, which can alleviate symptoms.
4. Neuromuscular & Co-ordination Re-education:
   This involves retraining the muscles and nerves around the TMJ to function correctly. Techniques can help patients become more aware of normal movement patterns, muscle tension and learn how to control it effectively. (Shimada et al 2023)
5. Dry Needling and Acupuncture:
   These techniques are used to release muscle tension and trigger points around the jaw and neck areas. Dry needling targets specific tight muscles, while acupuncture may help in reducing pain and improving blood flow to the affected area. (Dib-Zakkour et al 2022) found a significant reduction in facial pain and a reduction in muscle activity after needling trigger points.
6. TMJ Joint Mobilisation:
   Physiotherapists may perform gentle joint mobilisation to enhance the range of motion in the TMJ. This technique helps in reducing joint stiffness and improving overall jaw opening and masticatory function.
7. TMJ Stabilisation Techniques:
   Exercises aimed at improving jaw and temporomandibular joint stability are often included in the treatment plan. These exercises help in coordinating the muscles that control jaw movement, reducing the risk of joint misalignment, disc derangement, locked articular discs or further injury.
8. Relaxation Techniques:
   Since stress is a significant contributor to TMJ dysfunction, physiotherapists often incorporate relaxation techniques such as diaphragmatic breathing and progressive muscle relaxation to reduce overall muscle tension.

Dental TMJ Treatment Options:

1. Occlusion Splints or Bite Plates:
   Dentists often recommend occlusion splints or bite plates for patients who grind their teeth (bruxism) or clench their jaws, which can aggravate TMJ symptoms. These devices help to reduce the strain on the jaw muscles and protect the teeth from excessive wear.
2. Orthodontic Treatment:
   For patients with jaw misalignment, orthodontic treatment such as braces or Invisalign can correct the alignment and reduce TMJ-related issues. Correcting the bite can significantly alleviate the pressure on the TMJ, leading to a reduction in symptoms.
3. Dental Restorations:
   In cases where the bite is uneven due to worn teeth, dental restorations such as crowns or bridges may be necessary to restore proper alignment. This can help in redistributing the pressure on the TMJ and relieve discomfort.
4. Botox Injections:
   Botox injections can be used to relax the muscles around the jaw, reducing tension and pain. This is often recommended for patients who experience severe muscle spasms or chronic bruxism.
5. Surgical Interventions:
   In severe cases where conservative treatments do not provide relief, surgical options may be considered. These include arthrocentesis (joint washout), arthroscopy, or even open joint surgery to remove obstructions or correct structural abnormalities within the TMJ.

Post-Surgical TMJ Physiotherapy:

Studies focusing on post-operative care for TMJ surgery patients indicate that physiotherapy can enhance recovery outcomes. Specific techniques, such as muscle re-education and graded jaw exercises, were shown to reduce recovery time and improve functional outcomes. (Navarro-Fernández et al 2023)

Why Should You Consult a TMJ Physiotherapist or Dentist?

If you're experiencing jaw joint pain, clicking, or restricted movement, it's essential to consult a TMJ physiotherapist to improve your quality of life. Early intervention can prevent symptoms from worsening and progressing into TMJ osteoarthritis. For issues related to teeth clenching, a visit to your dentist may be necessary.

Interdisciplinary TMJ Treatment Approach:

An article by Brighenti et al 2023 emphasised the importance of an interdisciplinary approach combining physiotherapy with dental interventions for managing complex TMJ disorders. This integrated method showed better outcomes in terms of pain management and functional improvement.

What to Do?

Each case of TMJ dysfunction is unique, and seeking professional advice is crucial. Consulting a TMJ physiotherapist, dentist, or craniofacial specialist can help you receive a personalised treatment plan that addresses your specific needs.

Read More:

• TMD Explained
• Jaw Pain
• What Causes TMD?
• How to Improve Your Head, Neck, Jaw Posture
• Headaches & TMJ Connection

TMJ Treatment FAQs

1. What is TMJ treatment?
TMJ treatment addresses temporomandibular joint disorders affecting the jaw. It includes techniques like jaw muscle massages, dry needling, and joint mobilisation.

2. How does a TMJ physiotherapist help?
A TMJ physiotherapist assesses your condition and provides treatments to improve jaw movement, reduce pain, and address muscle and joint control issues.

3. When should I see a TMJ physiotherapist?
Consult a TMJ physiotherapist for jaw joint pain, clicking, or limited motion during mouth opening. For teeth clenching issues, see your dentist.

4. Can physiotherapy help with a locked jaw?
Yes, physiotherapy often helps with a locked jaw through gentle manipulation. If this is ineffective, an Oral Surgeon may be consulted for further treatment.

5. What exercises are recommended for TMJ?
TMJ exercises include posture enhancement, relaxation exercises, muscle lengthening, jaw muscle massages, joint mobilisation, and stabilisation exercises.

6. What should I avoid with TMJ dysfunction?
Avoid uncontrolled wide-opening actions, biting hard foods, gum-chewing, nail-biting, leaning on the jaw, and clenching pens or pencils until you see your TMJ physiotherapist.

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