Chapter 11: Musculoskeletal Medicine

TEMPOROMANDIBULAR JOINT: TEMPOROMANDIBULAR DYSFUNCTION

A tender and perhaps clicking temporomandibular joint (TMJ) is a relatively common problem presenting to the general practitioner. In the absence of obvious malocclusion and organic disease, such as rheumatoid arthritis, simple exercises can alleviate the annoying problem in about 2 weeks. Three methods are described as alternatives to splint therapy.

Method 1

1. Obtain a cylindrical (or similar-shaped) rod of soft wooden or plastic material, approximately 15 cm long and 1.5 cm wide. An ideal object is a large carpenter’s pencil or piece of soft wood.

2. Instruct the patient to position this at the back of the mouth so that the molars grasp the object with the mandible thrust forward.

3. The patient then rhythmically bites on the object with a grinding movement (Fig. 11.1) for 2 to 3 minutes at least 3 times a day.

Method 2

1. Instruct the patient to rhythmically thrust the lower jaw forward and backward in an anterior–posterior direction with the mouth slightly open, rather like a cheeky schoolchild exposing the bottom lip (Fig. 11.2).

2. This exercise hurts initially but should soon lead to relief of the uncomplicated TMJ syndrome.

Method 3: The ‘six-by-six’ program

This is a specific program (separate from the previous exercises) recommended by some dental surgeons. The six exercises should be done 6 times each time, 6 times a day. It takes 1 minute to do them. Instruct the patient as follows:

1. Hold the front one-third of your tongue to the roof of your mouth and take six deep breaths.

2. Hold the tongue to the roof of your mouth and open your mouth 6 times. Your jaw should not click.

3. With your mouth slightly open, hold your chin with both hands, keeping the chin still for these resistance exercises. Without letting your chin move, push it with your hands; up, down and to each side.

4. Hold both hands behind your neck and use your jaw muscles to pull the chin in.

5. Push on the upper lip so as to push the head straight back.

6. Pull your shoulders back as if to touch the shoulder blades together.

Repeat each exercise 6 times, 6 times a day.

Note: Patients should use a visual cue to remind them to do the exercises.

These exercises should be pain-free. If they hurt, do not push patients to the limit until the pain eases.

Method 4: Resisted ‘jaw’ opening

For this isometric contraction method the patient grasps the jaw mainly ...