Temporomandibular Disorder (TMD)

It is a condition that causes pain in one’s jaw, especially during orofacial activities such as chewing, swallowing, speaking and facial expression. It is most commonly being characterized as dull aching, pulling pain or feeling of stiffness. TMD pain is more common in women than men, mainly due to female reproductive hormones – oestrogen. ^{[1] [2]}.

Causes:

Postural habits like forward head postures and bracing can also lead to headache, joint strain and poor bites. ^[3]. Besides that, there are other factors affecting the Temporomandibular joint (TMJ) such as unstable relationship between disc and condyle, pop or click sound will be heard during mouth opening and closing, particularly mouth opening. Disc instability of the TMJ due to reduced muscular control, stiffness of opposite TMJ, craniocervical posture changes can lead to subluxation of condylar out of the fossa. ^[4]

In addition, an unpredictable episodic sharp face pain can be triggered by changes in temperatures, emotional, mechanical stress and hormones. However, it can also be due to traumatic events and long term pressure on blood vessels, muscles or nerves. ^[5]

Management:

The prior treatment is to reduce local inflammation and reduce musculoskeletal pain felt by patient followed by restoring normal function of the specific area. Active exercises, manual therapy like mobilisation, postural correction, biofeedback training, low laser therapy and relaxation techniques are found to be possibly effective ^[6][7] According to Piekartz (2015, p.440), motor control test for orofacial region can be used as a basis for further treatment. Next, education on self-care practices is utmost important, applying ice or moist heat, performing a light jaw stretching exercise, consume soft foods, avoid extreme jaw movement and clenching teeth all the time (relax the masticatory muscles) ^{[8] [9] [10]}.

References

1. LeResche L, Saunders K, Von Korff M, et al. Use of exogenous hormones and risk of temporomandibular disorder pain. Pain 1997. 69 (1-2): 153-60.
2. The TMJ Association. 2016. Estrogen’s impact on TMD Pain your responses. [Online]. Available at: http://www.tmj.org/site/page?pageId=160. [Accessed on 20^th February 2017]
3. Salmeri J. 2012. Bad Posture can cause TMJ disorder. [Online]. Available at: http://www.dynamicdentalinc.com/blog/bid/75970/Bad-Posture-Can-Cause-TMJ-Disorder. [Accessed in 20^th February 2017]
4. Piekartz H. Temporomandibular Disorders: Neuromusculoskeletal Assessment and management in Jull G, Moore A, Falla D, et al. (2015, p. 435) 4^th Elsevier: United Kingdom.
5. Piekartz H. Temporomandibular Disorders: Neuromusculoskeletal Assessment and management in Jull G, Moore A, Falla D, et al. (2015, p. 436) 4^th Elsevier: United Kingdom
6. Medlicott MS, Harris SR. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. Phys Ther 2006. 86(7). 955-73.
7. McNeely ML, Armijo Olivo S, Magee D. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorder. Phys Ther 2006. 86(5). 710-25.
8. National Institute of Dental and Craniofacial Research. 2015. TMJ Disorders. [Online] Available at: https://www.nidcr.nih.gov/oralhealth/topics/tmj/tmjdisorders.htm#causes. [Accessed in 20^th February 2017]
9. Wright EF, North SL. Management and treatment of temporomandibular disorder: A Clinical Perspective. J Man Manip Ther 2009. 17(4). 247-254.
10. Piekartz H. Temporomandibular Disorders: Neuromusculoskeletal Assessment and management in Jull G, Moore A, Falla D, et al. (2015, p. 440) 4^th Elsevier: United Kingdom

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