Temporomandibular

Purpose: The aim of perspective article is to suggest a practical traffic-light prognosis-based classification system to improve the management of patients with headache and/or orofacial pain in the musculoskeletal practice. This classification system is based on the best available scientific knowledge based on the unique set-up and clinical reasoning process of musculoskeletal practitioners.

This framework incorporates medical screening for dangerous medical conditions, and profiling the psychosocial aspects of each patient; thus, follows the biopsychosocial rehabilitation paradigm.

In accordance with TMJ complex aetiology, current evidence supports primarily conservative multidisciplinary treatment including self-management strategies, behavioural therapy, physical therapy and pharmacotherapy.

The aim of this review is to present an overview of most recent developments in aetiology, pathophysiology, diagnosis and management of TMD.

Educational Objectives

1. Understand the functional anatomy of the temporomandibular joint (TMJ).
2. Understand what makes the TMJ a unique joint.
3. Understand TMJ pathology.

Introduction

Up to 75 percent of the population has at least one sign or symptom of temporomandibular (TM) dysfunction at any given time, and 34 percent of the population reports having a temporomandibular disorder (TMD).  Understanding and treating TMDs is an opportunity to help up to one-third of patients.

Anatomy of the TMJ is complex and important in understanding the pathology and treatment of TMDs.  This article is intended as a refresher on TMJ anatomy and pathology.

There is a rising prevalence of temporomandibular disorders (TMD) and, therefore a need to improve the management of these conditions. No studies have been done to assess the possible associations between the shoulder girdle and the temporomandibular joint (TMJ) in participants with TMD.

The associations found between the pain and disability of the shoulder girdle and TMJ give insight into the relationship between the two areas in participants with TMD.

This 2-part course on paediatric otolaryngology, you will recap basic anatomy of the ear, nose and throat. You will learn about presentations and management of common ENT conditions affecting children, such as acute and chronic otitis media and externa, acute and chronic upper respiratory tract infection, sinusitis and many more; how to complete a thorough assessment and what home care advice to offer.

This course will help you gain clarity and confidence when treating ENT conditions in children.

This 2-part course on paediatric otolaryngology, you will recap basic anatomy of the ear, nose and throat. You will learn about presentations and management of common ENT conditions affecting children, such as acute and chronic otitis media and externa, acute and chronic upper respiratory tract infection, sinusitis and many more; how to complete a thorough assessment and what home care advice to offer.

This course will help you gain clarity and confidence when treating ENT conditions in children.

This course will concentrate on examination of the TMJ and also briefly cover examination of other structures for dysfunction related to the TMJ. Examination is discussed under two main sections:

Subjective examination, in which patients are questioned about their symptoms, how they interfere with daily activities and the history of the symptoms; Objective examination, the physical examination of musculoskeletal structures.

Examination of the TMJ should include the examination of dental occlusion, masticatory muscles, suprahyoid muscles, the upper cervical spine and the cervical musculature, as all these structures are functionally interdependent.

The functional interdependence of the TMJs with dental occlusion and with the upper cervical spine is outlined. Due to this interdependence and to overlapping presentation of pain referral from the TMJs and from the upper cervical spine, it is essential that the clinician examine in details these structures as possible sources of symptoms in patients with facial pain and headache.

This course will concentrate on examination of the TMJ and also briefly cover examination of other structures for dysfunction related to the TMJ. Examination is discussed under two main sections:

Subjective examination, in which patients are questioned about their symptoms, how they interfere with daily activities and the history of the symptoms; Objective examination, the physical examination of musculoskeletal structures.

Examination of the TMJ should include the examination of dental occlusion, masticatory muscles, suprahyoid muscles, the upper cervical spine and the cervical musculature, as all these structures are functionally interdependent.

The functional interdependence of the TMJs with dental occlusion and with the upper cervical spine is outlined. Due to this interdependence and to overlapping presentation of pain referral from the TMJs and from the upper cervical spine, it is essential that the clinician examine in details these structures as possible sources of symptoms in patients with facial pain and headache.

The management of the common clinical syndromes presented in this course are:

1. Myofascial pain dysfunction (MPD) syndrome
2. Post-fracture of the mandible and/or maxilla
3. Post-extraction of wisdom teeth
4. TMJ osteoarthritis
5. TMJ clicking
6. Pain secondary to new or remodelled dentures
7. TMJ locking
8. Headache, earache, facial pain.

Presentation of these clinical symptoms will serve to emphasise that in many cases, the symptoms are multifactorial in aetiology and may require diagnostic and treatment skills of dentists, doctors and physiotherapists.

This multidisciplinary approach has been found to offer solutions to complex problems

The management of the common clinical syndromes presented in this course are:

1. Myofascial pain dysfunction (MPD) syndrome
2. Post-fracture of the mandible and/or maxilla
3. Post-extraction of wisdom teeth
4. TMJ osteoarthritis
5. TMJ clicking
6. Pain secondary to new or remodelled dentures
7. TMJ locking
8. Headache, earache, facial pain.

Presentation of these clinical symptoms will serve to emphasise that in many cases, the symptoms are multifactorial in aetiology and may require diagnostic and treatment skills of dentists, doctors and physiotherapists.

This multidisciplinary approach has been found to offer solutions to complex problems.

TMJ affects millions of people around the world, most of whom are young women. Because the condition is multifactorial in nature (articular, myofascial, intra articular disc, cervical spine and stress) it is a challenging disorder to treat.

This on-line course will demonstrate how manual therapy techniques can be applied in order to render the movement painless as well as help to maintain correct anatomical relationships between the affected components while normal movement patterns are re-established.