Temporomandibular Joint Disorder (TMD)

Pain around the jaw can be synonymous with a condition effecting the temporomandibular joint (see Fig 1) which is often abbreviated as the TMJ. However, this simply refers to the location of the problem. Pain affecting the TMJ is termed temporomandibular dysfunction, abbreviated as TMD.

TMD can cause pain during every day activities that most of us take for granted such as talking, eating and yawning meaning it can have a significant impact upon someone’s quality of life.

The causative and contributing factors of TMD are not fully understood, they are likely to be complex and multifactorial, including:

• History of head and face trauma, this may require further investigation to screen for fractures.

• Previous dental work, for example braces can alter the way the mouth opens and closes.

• Individual habits such as gum chewing, lip biting, and pen chewing could be contributing to the dysfunction.

• Interestingly psychological factors may potentially be a cause or consequence of TMD (Slade et al., 2007).

It is beyond the scope of this piece to go into detail about the structures involved in TMD. However, the joint itself, the neck, specific muscles and tendons as well as other soft tissues structures specifically associated with the TMJ can all be generators of pain (some of these potential generators can be seen in figure 1).

Research surrounding TMD states that anywhere between 3-4% of the population suffer from this condition and that females may be affected up to twice as much as males in the general population (Slade et al., 2013).

Seeking advice from a specialist musculoskeletal clinician is recommended. At Pure Physiotherapy our clinicians complete a thorough assessment which facilitates in making an accurate working diagnosis and the subsequent development of an individualised condition specific rehabilitation protocol.

If you suffer from TMD be reassured that the condition is usually non-progressive, and whilst symptoms might fluctuate, they tend to improve. Your Physiotherapist will equip you with the skills and knowledge to effectively manage your symptoms.

If you experience an acute episode of TMD, your clinician may suggest eating a softer diet to rest the jaw. It is advised that you also try to avoid activities that may exacerbate symptoms, such as the aforementioned potential contributing or causative factors. After speaking with the appropriate healthcare professional, you might wish to consider simple analgesia such as paracetamol or a non-steroidal anti-inflammatory.

To finish with the good news is that symptoms resolve spontaneously in up to 40% of people, and in long-term follow-up studies up to 90% of people’s symptoms improve with conservative treatment (Gauer & Semidey., 2015).

If your symptoms do not improve to the point where you feel you are unable to self-manage, our clinicians are ideally positioned to treat TMD. Out Physios are skilled in muscle and joint assessment and can use hands-on manual therapy techniques to help reduce your pain levels and restore function. With regular re-assessment, your Physiotherapist will measure your progress in relation to your goals and will make adjustments to your treatment to ensure your recovery remains optimal.

Gauer, R. & Semidey, M.J. (2015). Diagnosis and treatment of temporomandibular disorders. American family physician. 91(6), 378-386.

Slade, G.D., Diatchenko, L., Bhalang, K., Sigurdsson, A., Fillingim, R.B., Belfer, I., Max, M.B., Goldman, D. & Maixner, W. (2007). Influence of Psychological Factors on Risk of Temporomandibular Disorders. Journal of Dental Research. 86(11), 1120-1125.

Slade, G.D., Bair, E., Greenspan, J.D., Dubner, R., Fillingim, R.B., Diatchenko, L., Maixner, W., Knott, C. & Ohrbach, R. (2013). Signs and Symptoms of First-Onset TMD and Sociodemographic Predictors of Its Development: The OPPERA Prospective Cohort Study. Journal of Pain. 14(12), pp. 20-32.