TMJ

Question 1

Myalgia

Answer 1

History of orofacial pain
Pain in muscle region on…
1.	Active movements
2.	Muscle palpation
3.	Static > dynamic M tests

Treatment:

• Stretch, mobilisation
• Relaxation (TUTALC)
• Dental splint/oral appliance

Question 2

TMJ physical examination and general treatment

Answer 2

PE:

• Observation: posture (poke chin, head tilted)
• Active ROM (add OP): Upper Cx and TMJ (measure by middle of teeth)
• Resisted isometric movements
• Passive ROM of mandible (add OP) – opening, closed, protraction/retrusion, lateral/medial deviation
• Palpation
• Accessory joint movements
• Reflexes (jaw reflex test for cranial nerve V) and cutaneous distribution. Know the dermatomes
• Clicking sounds
• Functional activities

Treatment:

• Soft tissue massage (Masseter, temporalis)
• Electro-physical agents (Moist heat, Ultrasound, Mid or low level laser therapy)
• Acupuncture/dry needling
• Joint mobilisation
• Exercise programmes
• Mobilisations with movement – holding lateral deviation in place and opening
• AROM exercises

Question 3

Arthralgia

Answer 3

• History of orofacial pain
• Pain in joint region
  1. Active movements
  2. Joint palpation
  3. Dynamic > static M tests

Question 4

Hypomobility of TMJ

Answer 4

Causes

• Disc derangement
• Arthritis

Treatment

• Joint mobilisation
• Active exercise
• Passive stretching
• Posture correction

Question 5

Hypermobility of TMJ

Answer 5

Causes

• Lax capsule and ligaments
• Systemic hypermobility
• Disc displacement
• Parafunctional habits e.g. prolonged bottle feeding, thumb sucking, dummy use
• Habitual wide opening of mouth
• O/E click or jerky movement on open/close

Treatment

• Counselling
• Good prognosis

Question 6

TMJ disc derangement

Answer 6

Causes

• Malocclusion and/or trauma
• Excessive pressure – from clenching or trauma
• Incoordination of pterygoids
• Degeneration
• Stretching of ligaments, e.g. by frequent subluxation

Treatment

• Anterior disc displacement without reduced (closed lock)
• Only treat if limitation and/or pain

-Locked jaw (2-3 weeks):
• Distract mandible away from opposing joint surface, thumb inside mouth
• Exs to increase mouth opening and decrease pain
• Physio passive stretching, joint mobs, home exs
• Can splint

-Anterior disc replacement with reduction
• Counselling with good prognosis