The Temporomandibular Disorder: A Guide for Evidence-Based Chiropractors
An Introduction to Temporomandibular Joint Disorders (TMD)
Temporomandibular Joint Disorder (TMD) encompasses a complex set of muscular and articular disorders affecting the TMJ, leading to pain, dysfunction, and potential degeneration. Understanding the etiology is crucial for effective assessment and treatment. For a comprehensive guide and research-backed assessment and treatment, refer back to ChiroUp.com in the condition reference section. New research for all conditions is added monthly.
What Causes TMD
TMD has two primary origins: myogenous (muscular) and arthrogenous (articular). Chiropractors treating TMD often focus on the systems affecting jaw motion. Acute presentations are often due to muscular dysfunction affecting the soft tissue of the surrounding area. Myogenous TMD is more prevalent and often stems from:
Muscular hypertonicity and trigger points
Fascial restrictions
Functional muscle imbalances, especially in the muscles of mastication (notably the masseter)
Factors such as bruxism, clenching, cervicocranial dysfunction, and poor posture (particularly forward head posture)
Trauma, including whiplash injuries
Conversely, arthrogenous TMD is often linked to structural issues such as disk displacement, osteoarthritis, and other conditions like trauma or malocclusion. This can be ruled out using the Centric Relation Provocation Test.
Causes of Jaw Pain
Several lifestyle and psychosocial factors contribute to the incidence of TMD:
Lifestyle: Nail biting, poor physical fitness, and inadequate sleep can increase risk.
Psychosocial: Stress, depression, and certain health conditions (e.g., PTSD, polycystic ovary syndrome) are significantly associated with TMD.
CRANIO (2024):
"These findings suggest that addressing psychological factors in general, and depression in particular, in the management of TMD is crucial, especially in those TMD groups with higher pain levels (I and III), and the TMD pain reduction is crucial in reducing depression levels." (1)
The prevalence of TMD varies, affecting 4-31% of the population, with a higher incidence in women and individuals aged 20-50.
Symptoms of TMD
Patients with TMD often present with:
Clicking or crepitus in the jaw.
Restricted mouth opening (less than 40mm is considered restricted).
Pain, typically anterior to the ear, may radiate to the face, neck, and shoulders.
Concurrent neck pain and headaches are common.
Chiropractic Evaluation of TMD
Clinical evaluation should include:
1. Visual and Palpatory Assessment: Observe opening patterns, lateral deviations, and audible joint sounds during jaw movement.
2. Palpation: Identify tenderness in associated muscles (e.g., masseter, temporalis) and assess cervical spine mobility.
3. Functional Tests: Use specific questionnaires (e.g., MFIQ, TSK/TMD) to understand the patient's condition comprehensively.
4. Orthopedic Evaluation: The Centric Relation Provocation Test helps rule out structural deformities of the TMJ leading to TMD.
5. Functional Evaluation: The Mouth Opening Test confirms a lack of mandibular depression and compensatory chin protrusion.
Centric Relation Provocation Test
Mouth Opening Test
*Advanced imaging, such as CT or MRI, may be necessary for more detailed analysis, especially in cases where structural abnormalities are suspected.
Chiropractic Treatment of TMD
Evidence suggests that non-surgical interventions can be highly effective for TMD. Here’s how you can approach treatment:
Manual Therapy
Cervical and TMJ Mobilization: Techniques such as non-thrust mobilization and intraoral myofascial therapy can significantly alleviate pain and improve function.
Upper Cervical Manipulation: Shows particular promise in reducing TMD symptoms.
Journal of Oral Rehabilitation (2024) found: "…cervical rehabilitation interventions, especially upper cervical manipulation therapy alone or in combination with a neck exercise program, are effective in improving multiple pain outcomes in adults with myogenic temporomandibular disorders." (2)
STM- Lateral Ptyergoid
TMJ Mobilization
Exercise
Postural and TMJ Function Exercises: Encourage patients to perform specific stretches and strengthening exercises (e.g., chin retractions, deep neck flexion) to enhance overall function and reduce muscle tension.
The Rocabado 6x6 Protocol: This program effectively restores jaw, neck, and shoulder coordination.
Chin Depression
Rocabodo
Lifestyle Modifications
Advise patients to avoid aggravating activities like chewing gum or eating tough foods.
Encourage stress management techniques and educate on maintaining a relaxed jaw position.
Psychosocial Considerations
Address any underlying biopsychosocial factors, as these can significantly impact treatment outcomes. Incorporating pain science education can improve patient understanding and coping mechanisms.
Managing TMD in chiropractic practice requires a comprehensive approach incorporating assessment, manual therapies, exercise, and psychosocial support. By staying informed about the latest evidence and tailoring interventions to individual patient needs, chiropractors can effectively alleviate symptoms and improve the quality of life for those suffering from TMD. For a full review of all the instructional videos and access to the patient education report for TMD, refer back to chiroup.com.
Empower your patients with the knowledge and skills to manage their condition effectively, ensuring a holistic approach to care.
-
de Almeida Hoff E, Grossi RK, Bozzetti Pigozzi L, Bueno CH, Pattussi MP, Rossi T, Quarti Irigaray T, Weber JB, Grossi ML. Depression and the risk of developing temporomandibular disorders in different diagnostic groups: A systematic review with meta-analysis. CRANIO®. 2024 Mar 7:1-3. Link
Bednarczyk V, Proulx F, Paez A. The effectiveness of cervical rehabilitation interventions for pain in adults with myogenic temporomandibular disorders: A systematic review and meta?analysis. Journal of Oral Rehabilitation. 2024 Mar 7. Link
