The temporomandibular joint syndrome is also known as temporomandibular disorder (TMD) is a common type of musculoskeletal disorder in the orofacial region involving the masticatory muscles, temporomandibular joint (TMJ), and associated structures. The typical features include pain in TMJ, restriction of mandibular movement, TMJ sound, and facial deformities.
Epidemiology reports state temporomandibular joint disorders (TMD) affect up to 25% of the population and may experience symptoms of TMD. TMD symptoms occur disproportionately between the sexes with a much higher incidence reported in females. Female to male ratios range between 2:1–8:1. Most patients presenting symptoms are between 20 to 50 years of age.
Types of temporomandibular joint disorders
Structural incompatibility with articular surfaces:
This is resulted due to the changes in the smooth sliding surfaces of the TMJ. The alteration causes friction, stickiness, and inhibits joint function. The structural incompatibility are of four types:
i. The physiological, aging or minor degenerative alterations in the condyle, disc, and fossa can cause deviations and dysfunction, which significantly affects the mandibular movements.
ii. Adhesion can happen between the condyle- disc or amidst the disc or between the disc-fossa. Adhesions are created by the development of fibrous connective tissue or due to loss of lubrication between the structures.
iii.It is a non-pathologic condition where a sudden forward movement of the condyle past the crest of the articular eminence can be seen during the final stages of mouth opening.
iv. In dislocations, the patient shall find difficulty in closing the mouth, and pain is associated with it.
Inflammatory disorders of the TMJ:
This presents with a deep continuous pain that commonly gets emphasized on functional movement. The continuous pain can trigger secondary effects. Inflammatory joints also get classified according to the structures involved such as,
i. Synovitis/capsulitis -Trauma can cause inflammation of the synovial tissues (synovitis) and the capsular ligament (capsulitis). It presents as a continuous pain.
ii. Retrodiscitis- It is caused due to trauma or due to progressive disc displacement and dislocation. The patient complains of pain, which increases with clenching.
iii. Arthralgia - Pain originating in the joint that is affected by jaw movement, function or para-function.
iv. Arthritis- Pain originating in the joint with clinical characteristics of inflammation or infection over the affected joint that is edema, erythema, and/or increased temperature.
Signs and symptoms of temporomandibular joint syndrome
️Pain:
Pain from the TMJ and muscles of mastication is a common symptom. It can be a constant or periodic dull ache over the joint, the ear, and the temporal fossa. The pain can be myogenic caused due to mechanical trauma and muscle fatigue.
️Joint sounds
️Limitation of mandibular movements
️Dislocation:
It is the displacement of the condyle from the fossa, and the patient may be unable to close the mouth.
️Dental symptoms
Tooth mobility, pulpitis, tooth wear are the commonest dental symptoms elicited in TMD patients.
️Otologic symptoms
TMJ pain in the auricular regions is more noticeable posteriorly. Tinnitus, itching in the ear, and vertigo are other symptoms associated with auricular pain.◻️ Recurrent headaches
Patients perceive the pain and tenderness of masticatory muscles along the temporal region as headaches. Additionally, it can correlate with other headaches, such as migraine pain.
The goals of physiotherapy treatment in the temporomandibular joint syndrome are,
To increase mandibular range of motion and to restore normal function and mobility
To decrease joint and masticatory muscle pain and inflammation
To minimize stiffness
To prevent further degenerative changes in articulating tissues, including direct or indirect joint damage
With appropriate physiotherapy most patients will see a significant improvement in their symptoms within 3 to 6 weeks.
References:-
https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.nidcr.nih.gov/sites/default/files/2017-12/tmj-disorders.pdf&ved=2ahUKEwiBwpHr3v7yAhWOb30KHSEgCa0QFnoECBYQAQ&usg=AOvVaw0Y3jXj1MtmcZ6dJCYNm94n
https://www.nhs.uk/conditions/temporomandibular-disorder-tmd/
https://www.webmd.com/oral-health/guide/temporomandibular-disorders-tmd
https://www.ncbi.nlm.nih.gov/books/NBK551612/
Fazrina Faizer
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