Information to Collect
Jaw opening and closing
- Look for deflection or S-curves in jaw tracking.
- Are there joint sounds? Describe the quality and where they occur.
TMJ synovial and ligament pain
- Pain with palpation of the lateral upper and lower TMJ suggests inflammation.
- Is there swelling of the joint? Check the skinfolds!
Bite orientation and teeth
- Are there any missing teeth? The most common bite change that was related to TMD was an anterior open bite.
(Loss of molars on one side increases the strain on the TMJ's over time and can lead to accelerated degenerative changes on one or both TMJ's.)
- We are looking for muscle trigger points, pain and pain referral.
- Common referral patterns of the masseters and temporalis are to the teeth.
Trigeminal Neuritis and nerve entrapment symptoms of the mandibular branch of the trigeminal nerve.
Tooth related problems that cause changes in TMJ function and facial pain.
Pain referral patterns of temporalis and masseters.
Dental work and TMD
So you think your patient has TMD?
What do you do?
Home Program for TMD
This is a program that can be started for any type of acute or painful TMJ problem.
Resting tongue position
Just say "no". The "N" sound we make when our tongue goes to the roof of our mouth behind the upper front teeth is the resting position of the tongue. When our tongue is in this position it seals our mouth and allows us to breathe through our nose. It also drops your jaw, separating your teeth, and relaxing your clenching muscles.
This is probably the most important home program activity you can do!
Jaw traction and masseter massage
Traction to the jaw including a stretch to the masseters and temporalis muscles can be done by using your finger tips to hold onto the sides of your jaw, dropping your arms downward, pulling your mouth open. Hold for 5 to 6 seconds.
(Best to do this when no one is looking.)
Firm pressure to your masseter on the inside of your mouth with outside pressure deep into your cheek can be painful but steady pressure, pulling downward, can help relax this muscle.
TMJ synovial pain? Soft diet
Liquid or softer diet. Salad, steak, apples and sub sandwiches are going to be tough with a swollen and painful TMJ.
Stop chewing gum or tough candy.
If you need to chew gum then chew on the painful side. This will reduce pressure to the joint on the same side but increases the load on the opposite joint.