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TMJ disorders: One name two diagnoses

By Catherine Mormile, DPT OCS OTR/L
Mormile Physical Therapy

EditorÕs note: Due to an editing error, last weekÕs Health in Alaska article contained misinformation regarding the joint TMD condition. Contrary to what was printed, the condition can cause the jaw to lock so that two fingers cannot be inserted between the front teeth.

Disorders of the temporomandibular joint (TMJ), the joint that connects the lower jaw to the temporal bone at the side of the face are a source of distress for an estimated 10 million Americans. Demographically, four times more women report temporomandibular disfunction (TMD) than men.

Additional distress occurs when both patient and medical practitioner attempt to identify its parameters. Like the mythical, two-faced Roman god Janus, TMD is one name for two diagnoses.

One diagnosis, ÒjointÓ TMD, presents with measurable orthopaedic damage to the cartilage and ligaments located within the TMJ itself. The other, ÒmuscularÓ TMD, presents as a painful condition of the muscles involved in chewing and often involving the muscles of the scalp, base of the neck and shoulders. Sometimes both conditions occur simultaneously.

Patients experiencing joint TMD usually report that their jaw audibly clicks and sometimes locks in a posture such that more than two fingers can be inserted between the front teeth. The jaw may deflect to one side, thus changing tooth contacts. And once locked, the joint noises may cease. Radiological findings will be positive for TMJ derangement. Joint TMD usually involves only one side of the jaw often accompanied by headaches behind one eye, in front of the ear, in the temple, and the base and side of the neck.

Causes of joint TMD include trauma and over-use, tooth clenching and oral-facial habits, and dental abnormalities.

Muscular TMD involves the many muscles of the head, face, neck, shoulders, and one or sometimes both TMJs. In more complex presentations, this TMD may be considered a sub-classification of fibromyalgia. The primary clinical manifestations of muscular TMD are pain and headaches. Limitations in jaw range of motion and function may occur but are not as predictable as joint TMD and are dependent upon which muscle groups demonstrate the most pain-induced restrictions. Radiological findings are negative for TMJ derangement.

Causes of muscular TMD include: Traumatic and stressful life events, occupational multitasking under time constraints, sleep deprivation, imbalances of neurochemicals and hormones, and direct contusion to the muscles.

Treatment of both types of TMD involves identifying the aggravating factors, correcting the dysfunctional elements and teaching the patient health promotion and self-regulatory measures. Often, this is a multidisciplinary effort involving physical therapist, dentist, physician and surgeon.

Treatment for joint TMD include skilled, manual TMJ procedures administered by a physical therapy specialist that attempt to normalize deranged joint movements, provide comfort and restore function. Muscular TMD remedies include thermal modalities and soft tissue manual therapeutics. In addition to these passive treatments, the muscular TMD patient is taught to utilize self-affirming and self-empowering coping and motivational stress relieving strategies. An aerobic exercise program that includes goal setting and follow-through is developed with all patients.

At Mormile Physical Therapy we can work with you to identify your particular dysfunctional patterns and treatment strategies to fit your needs. We will also assist you to obtain knowledge from our TMD publications and other known experts in the field.

Catherine Mormile, DPT OCS OTR/L is a doctor of physical therapy, board certified orthopaedic specialist, occupational therapist and co-owner of Mormile Physical Therapy. She is a nationally published author and instructor in TMD evaluation and treatment topics. She is also a member of a local TMD dental expert consultation team. Appointments can be scheduled by calling (907) 561-1800.

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