What is temporo-mandibular joint dysfunction (TMD) and how to treat it
Temporo-mandibular joint dysfunction is a complex condition which is usually due to a combination of factors requiring expert clinical diagnosis.
What is TMD
The temporo-mandibular joint connects the jawbone to the skull and is the most frequently used joint in the body. It’s used for a wide range of movements involved in chewing, swallowing and speaking.
TMD is a common condition, but most people experience only mild symptoms. About 5 to 12% of the population will have symptoms requiring treatment. It’s most common in adults aged 20–40 years and women are at least four times as likely to suffer from TMD.
There’s usually more than one thing causing TMD
TMD is typically caused by a combination of factors which can be anatomical, pathophysiological or psychosocial. Clinical diagnosis will distinguish between ‘myofascial’ causes and intra-articular disorders of the joint itself. Myofascial disorders are the result of tension, fatigue or spasm of the masticatory muscles, whereas intra-articular (the joint rather than the muscles) disorders stem from mechanical or inflammatory disruption of the joint itself.
The most common cause is myofascial or musculoskeletal dysfunction causing muscle tension. Teeth grinding is a common cause, usually driven by stress or sleeping disorders like sleep apnoea, which put excessive stress on the joint. Cognitive and psychiatric disturbance, such as depression and anxiety, and autoimmune disorders, fibromyalgia and other chronic pain conditions are also frequently associated with TMD.
Intra-articular causes of TMD include internal joint derangement which could be due to a trauma or blow to the jaw or head, misaligned teeth, osteoarthritis, capsular inflammation, and hypermobility. Inflammatory conditions such as rheumatoid arthritis can also lead to internal joint derangement. Anatomical variations such as a displaced disc within the joint could be a contributing factor.
Do I need an x-ray or MRI
Although TMD is largely a clinical diagnosis, imaging can be useful if pain is intense or follows a trauma (blow or accident) to rule out fractures and dislocations and reveal any severe degenerative articular disease.
Physiotherapy and conservative treatment will successfully resolve most cases of TMD – the good news is that surgery is rarely needed.
How does physiotherapy help
Physiotherapy involves a careful clinical assessment to identify the different factors causing the jaw pain. Typically, a program of conservative (non-surgical) treatment involves a combination of manual therapy (soft tissue release, joint mobilisations and dry needling to ease tension on the surrounding muscles and the joint) and exercises to strengthen and improve jaw stability and flexibility.
Physiotherapy will help you with postural retraining to correct your head and neck alignment and reduce the load on the jaw. Your physio will also consider whether advice on activity modification is needed, such as sleep patterns or avoiding hard foods. We can work alongside your dentist or orthodontist to help with niche TMD exercises, and help you to implement self-management strategies
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