Physical therapy as an adjunct to temporomandibular joint therapy

Orofacial pain management: current perspectives

Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities.

Temporomandibular disorders seen in rheumatology practices: A review

Temporomandibular disorders are recognized as the most common nontooth-related chronic orofacial pain conditions. This article reviews the recent temporomandibular disorders literature and summarizes the temporomandibular disorders seen in rheumatology practices. Arthritis is a common condition affecting the temporomandibular joint. Although degenerative and rheumatoid arthritis are the most frequently encountered infectious arthritis, metabolic arthritis, spondyloarthropathies and the traumatic arthritis have also been reported. Distinguishing between different temporomandibular disorders is as important as the clinical course, long-term prognosis, and therapy. Diagnostic criteria are generally based on signs and symptoms of the patient. The American Academy of Orofacial Pain established the first well-defined diagnostic classification. In addition, Research Diagnostic Criteria for Temporomandibular Disorders have been developed using similar classification. In the treatment of temporomandibular disorders, conservative and noninvasive treatments are endorsed for the initial care of nearly all TMD patients because the majority of patients with TMD achieve good relief of symptoms with conservative treatment.

Management of temporomandibular disorders: concepts and controversies

STATEMENT OF PROBLEM

Controversy continues in the area of epidemiology, etiology, diagnosis, and management of temporomandibular disorders (TMD). The field is replete with testimonials and clinical opinion, but it has been lacking in scientific foundation.

PURPOSE

This article reviews the recent temporomandibular disorder and orofacial pain literature and summarizes the concepts published in the 1993 and 1996 American Academy of Orofacial Pain guidelines. Temporomandibular disorders rarely occur as single entities but rather as multiple problems with overlapping symptoms.

CLINICAL SIGNIFICANCE

The multicausal nature of these problems and the number of conditions with similar signs and symptoms demand an effective differential diagnostic process. Diagnostic criteria are used from an operational standpoint to establish specific diagnoses based on a multiaxial diagnostic model.

CONCLUSION

Because little is known about the natural course of the various classifications of temporomandibular disorders, and because most treatment approaches are reported to be equally effective, a conservative, noninvasive management program is endorsed. The emphasis is on a medical multidisciplinary model similar to ones used for other musculoskeletal disorders that involve the patient in the physical and behavioral management of his or her own problem. This article concludes that a majority of temporomandibular disorder patients achieve good relief of symptoms with noninvasive reversible therapy.

The role of physical therapy in recovery after temporomandibular joint surgery

The purpose of this study was to investigate the effect of aggressive physical therapy on the rehabilitation of patients who have had temporomandibular joint (TMJ) surgery. The control group consisted of 26 postsurgical patients who had no physical therapy, and the treatment group consisted of 24 postsurgical patients who were treated with aggressive therapy for 8 weeks. Patients in both groups had range of motion measurements taken at 1 and 8 weeks. The ratio of patients in the treatment group who achieved normal range of motion was compared with the ratio of patients in the control group who achieved it. The results showed a significantly greater range of opening in experimental than in control subjects at 8 weeks but not for lateral excursions. These results suggest that aggressive physical therapy is an important adjunct to postsurgical care for patients with TMJ.

Parotid gland carcinoma simulating signs and symptoms of craniomandibular disorders--a case report

The following case involves a 33-year-old woman who received two accidental blows to her left temporomandibular joint (TMJ) region six months before her first visit to the Institute of Dentistry, University of Oulu. Both clinical and computed tomography (CT) examinations of this left TMJ strongly favored a diagnosis of craniomandibular disorders (CMD). However, a fine needle biopsy and an histopathological examination of the parotid gland established the final diagnosis as poorly differentiated adenocarcinoma of the parotid gland. The course of the disease was very aggressive developing several metastases, and the patient died 24 months after the diagnosis. The presence of facial nerve paralysis, especially in combination with cheek numbness in the parotid region, should have strongly suggested the possibility of such a malignancy.

Head posture and cervicovertebral and craniofacial morphology in patients with craniomandibular dysfunction

A relationship between particular characteristics of dental occlusion and craniomandibular disorders (CMD) has been reported, while less attention has been focused on the possible effect of dysfunction of the masticatory system on head posture or cervicovertebral and craniofacial morphology. Natural head position roentgen-cephalograms of 16 young adults with complete dentition taken before and after stomatognathic treatment displayed an extended head posture, smaller size of the uppermost cervical vertebrae, decreased posterior to anterior face height ratio, and a flattened cranial base as compared with age- and sex-matched healthy controls. The lordosis of the cervical spine straightened after stomatognathic treatment. The results are an indication of the close interrelationship between the masticatory muscle system and the muscles supporting the head, and lead to speculation on the principles of treating craniomandibular disorders.

Physical medicine procedures affect temporomandibular disorders: a review

This article reviews the literature on the effectiveness of physical medicine procedures for treatment of temporomandibular disorders (TMD). Brief descriptions of some commonly used dental appliances, and pharmacological and surgical treatment methods are provided.

Acupuncture compared with stomatognathic treatment for TMJ dysfunction. Part III: Effect of treatment on mobility

The purpose of this study was to compare the effects of acupuncture and stomatognathic treatment on the mobility of the mandible in random samples of patients with TMJ dysfunction. One group of 25 patients was treated with acupuncture performed by a specialist in physical medicine and rehabilitation and a second similar group received standard stomatognathic treatment. All of the patients were evaluated in terms of the Helkimo dysfunction index by a dentist before treatment, within 1 week of treatment, and 3 months after treatment. No significant differences could be detected in painful movement of the mandible except in retrusive movement, wherein stomatognathic treatment was clearly superior immediately afterward. Acupuncture seems to be a useful early form of therapy in patients with TMJ disorders that are expected to be largely functional and reversible and with evidence of psychophysiologic or neuromuscular disturbances but not of any marked occlusal interference or joint damage. Acupuncture could well be complementary to stomatognathic treatment, either preceding or following it, to achieve full neuromuscular rehabilitation, to ease the treatment (for example, occlusal splints), or to eliminate other possible contributory factors.

Factors influencing the outcome of treatment in patients referred to a temporomandibular joint clinic

A retrospective review was performed in 350 consecutive patients referred for functional disturbances of the masticatory system. Two and one-half years after the first visit, the records of all patients were examined for clinical findings, diagnosis, and observations related to treatment. Number of visits, length of the treatment period, and evaluation of signs and symptoms at last visit (factors which showed a wide variation) were analyzed for correlation with signs and symptoms at first visit and some background factors. A total of 50 variables were considered. The number of visits and length of treatment indicated the severity of signs and symptoms at the first visit. Multiple regression analysis showed that tenderness on muscle palpation at first visit was the most important of the independent variables. About one-fourth of the variance of number of visits and length of treatment could be explained (R2 = 0.28 and 0.27, respectively), while the corresponding value for the variance of the evaluation at last visit was 15% (R2 = 0.15). The results tend to emphasize the heterogeneity of patients with functional disturbances of the masticatory system and the difficulty of prognosticating the outcome of treatment in such patients, even when attempts are made to divide them into subgroups.