10% of the adult population experiences complaints of the jaw joint at some time. Temporomandibular dysfunction(TMD) is an umbrella term for complaints in the jaw region. TMDs are complaints of the jaw that manifest as pain, decreased jaw mobility and possibly a creaking sound of the jaw when talking, eating or swallowing.
Anatomy of the jaw joint
The joint of the jaw lies just in front of the ear, at this place the bone of the lower jaw meets the bone of the skull. Between these two pieces of bone lies a small cartilage disc. When the jaw moves, it slides with it to make the movement as smooth as possible.
Looking at the muscles, the jaw has 4 major muscles that perform two main movements, opening and closing the jaw. The two largest muscles are the m. Temporalis and the M. Masseter both ensure that the jaw can close in a powerful way. Of the two smaller muscles m. Pterygoideus medialis and lateralis, the pterygoideus medialis is also for closing the jaw. The m. pterygoideus lateralis is responsible for opening the jaw.
Complaints of the jaw joint
TMD is characterized by regional acute- or persistent pain at the ear or in the lower jaw or by reduced function of the jaw during, for example, eating or yawning. Headaches can also arise from these symptoms often radiating from the jaw to the side of the face/head. Because it is an umbrella term you can still distinguish between different types of TMD.
Muscle-related TMD - here the cause is in the jaw muscles
- Local pain in the jaw on the affected muscle
- Myofascial Pain on palpation spreading throughout the muscle
- Myofascial pain with radiation, this is pain that radiates beyond just into the muscle
Arthrogenic TMD here the cause is in the joint.
- Arthrogenic: Pain with jaw movements (even unloaded)
- TMJ disc disorder in which the disc does not move properly or when there is disc degeneration in which the disc is affected.
All images present complaints in or around the jaw joint though in a myogenic image the radiating areas may differ.
Physical testing of the jaw joint
Axis I temporomandibular diagnosis; in the first part of the examination the jaw itself is inspected, the mobility of the jaw is looked at how the function is at that moment. The therapist looks to see if he can possibly provoke the symptoms with further physical examination. Axis 2 we look at the severity of the complaints(psychosocial). This is designed to examine how a client deals with the complaints. Based on this, together we draw up a treatment plan.
- Age between 35-44
- Occurs more often in women than in men
- Smokers have increased risk of jaw problems
- Psychological complaints such as depression
- Clenching of the jaw or grinding of the teeth
- Over- or underbite
- Jaw surgery in the past
Treatment of TMD
Treatment depends on what kind of jaw problems the person has. However, there is a basis with which most complaints can be treated. The therapist may place more focus on a specific part versus the rest.
The following techniques are often used:
- Manual jaw region (mobilization).
- Manual Neck Region (mobilization).
- Massage therapy
- Exercises for the jaw and neck muscles