What is TMD?

Temporomandibular Joint Dysfunction is a disorder of the muscles of mastication, the temporomandibular joints and associated structures. It is characterized by facial pain, mandibular dysfunction, clicking of the joint, limited range of motion of the jaw, and temporomandibular subluxation or dislocation.

Factors Contributing to TMD

imbalances in the muscles of mastication – trigger points, spasm, abnormal joint mechanics

muscle overuse – chewing gum, bruxism, occupation or activity where a mouthpiece or mouth guard is required, i.e. playing clarinet, scuba diving, hockey

malocclusion – loss of vertical dimension of bite (tooth loss – molar extraction) which increases compression on disc

postural dysfunction – head, neck and shoulder muscle imbalances increase activity in jaw muscles, forward head posture

increased stress – bruxism, apical breathing – increase activity of neck and shoulder muscles

trauma – blow to the jaw, whiplash, and prolonged dental work

sinus blockage or infection – mouth breathing, forward head posture to open airway and abnormal jaw positioning

joint pathology – hypermobility, capsulitis, synovitis, disc displacement, osteoarthritis, and rheumatoid arthritis

predisposition – genetic development of muscles, ligaments and bone

Symptoms of TMD

• unilateral or bilateral
• 15 to 45 years of age
• predominantly in women by a ratio of 5:1 (Cady, Fox, 1995)
• postural dysfunction
• joint sounds – clicking, popping
• jaw pain
• headaches
• spasm and trigger points in jaw muscles
• decreased range of motion of jaw

Assessment of TMD

postural assessment
palpation – heat, tenderness, clicking, crepitus, increased tone in jaw muscles
mandibular position at rest
range of motion of jaw, and follow course of movement
three knuckle test – how many knuckles of non-dominant hand can client stack in mouth

Massage Therapy Treatment of TMD

• address postural concerns
• decrease swelling and pain
• increase relaxation
• proper breathing techniques
• massage techniques to treat neck muscles – both posterior and anterior
• massage muscles of
  mastication extra-orally first, then move intra-orally
  address trigger points
• scalp massage
• hydrotherapy – heat to muscles with increased tone and cold where inflammation and swelling are present
• prescribe exercises,
  relaxation techniques and self massage techniques
• consult with a team – dentist, physiotherapist, kinesiologist

Treatment Frequency and Outcome

• two times a week for 4 to 6 weeks, followed by reassessment then
  once a week and wean off to a maintenance schedule
• prognosis good with patient cooperation