A Proposed Diagnostic Classification of Patients With Temporomandibular Disorders: Implications for Physical Therapists

Abstract

Researchers and expert clinicians in orofacial pain have long acknowledged the Differential DiagnosisIn addition to the musculoskeletal structures (TMJ and the masticatory muscles) and the psychological factors discussed, orofacial pain may result from or be exacerbated by (1) primary HAs (migraine, cluster, tension type, other primary); (2) secondary HAs related to systemic problems such as cardiovascular and rheumatoid disorders and disorders related to the cervical spine, ears, sinuses, eyes, medications, and dental structures; and (3) cranial and peripheral neuralgias and central nervous system disorders.The following provides an overview of the physical therapy examination for people presenting with HAs and/or orofacial pain. The examination will consist of the history, screens for contributing psychological factors, a systems screen, cervical spine screen, and specific examination of the TMJ and masticatory muscles. PHYSICAL THERAPY EXAMINATION HistoryA thorough history will help identify the possible source(s) of the orofacial pain and provide a screen for other causative or contributing factors. 17,22,61,74,75 Red flags related to cardiac history (eg, angina or history of myocardial infarction) and brain function (eg, sudden-onset severe HAs, weakness, or slurred speech) must be investigated early in the history taking. Information about the nature of the pain will be critical in determining the possibility of primary HAs (migraine, cluster) (TABLE 3) and secondary HAs related to the eyes, ears, sinus, dental structures, medication complications, and/or neurologic types of pain. Unrelenting pain unrelated to musculoskeletal function is an indication for referral. Information about cervical dysfunction is essential to determine whether the cervical spine is causing or exacerbating the HA/facial pain. Medication history is important to determine potential negative interactions, rebound HAs from overuse (as occurs with nonsteroidal anti-inflammatory drugs), or withdrawal.Key questions have been examined and determined to have strong sensitivity and specificity in incriminating TMDs as the source of pain. 22,29 The initiating question is, "Have you had pain or stiffness in the face, jaw, temple, in front of the ear, or in the ear in the past month?" A positive response should be followed with a question about whether the symptoms are altered by any of the following jaw activities: chewing, talking, singing, yawning, kissing, moving the jaw. 22,29,74,75 The other key inquiry is directed toward identifying the presence of a disc displacement 22,74 : "Have you ever had your jaw lock or catch so that it would not open all the way? If so, was this limitation in jaw opening severe enough to interfere with your ability to eat? Have you ever noticed clicking, popping, or other sounds in your joint?" 74 importance of the psychological domain in causing and/or maintaining pain, and in upregulating peripheral and central neural structures involved in nociception. 22,32,74,75 Central nervous system differences in the t...

Effects of 8 weeks of masticatory muscles focused endurance exercises on women with oro‐facial pain and temporomandibular disorders: A placebo randomised controlled trial

“…The same study suggested spinal and central hyperexcitability in TMD subjects. The central sensitisation process may amplify the pain information in the brain, resulting in a reduction in the normal central inhibitory mechanisms that help to balance activation of pain centres . The TMJ pain is an usual complaint in subjects with TMD, and it can be a referred pain from the myalgia due to central or even peripheral sensitisation .…”

“…The central sensitisation process may amplify the pain information in the brain, resulting in a reduction in the normal central inhibitory mechanisms that help to balance activation of pain centres. 40 The TMJ pain is an usual complaint in subjects with TMD, and it can be a referred pain from the myalgia due to central or even peripheral sensitisation. 23,41,42 The PPT increased overtime for both groups, but no differences were observed within or between groups anytime.…”

Thoracic spine manipulation did not improve maximal mouth opening in participants with temporomandibular dysfunction

“…The current medical approach for treating people with TMD is to provide the least invasive medical care (Harrison et al, ; Okeson & de Leeuw, ). Physical therapy, including thoracic TJM, has been considered less invasive when compared with other interventions (Magoun, ).…”

“…The current medical approach for treating people with TMD is to provide the least invasive medical care (Harrison et al, 2014;Okeson & de Leeuw, 2011). Physical therapy, including thoracic TJM, has been considered less invasive when compared with other interventions (Magoun, 1976 Participants with TMD generally demonstrated reduced MMO, but the authors found no difference in MMO improvement between groups following TJM.…”

Relación entre los hábitos parafuncionales y las características clínicas de la articulación temporomandibular

“…La ATM se caracteriza por ser una de las articulaciones más complejas del organismo; está clasificada como una diartrosis bicondílea, y es la única en todo el organismo constituida por dos articulaciones situadas entre el hueso mandibular y el temporal. Se caracteriza por ser una articulación sinovial, la cual contiene dos espacios articulares aislados por un disco fibrocartilaginoso 2,3 . Se especializa por trabajar conjuntamente con el lado opuesto, en forma sincrónica, se encuentra relacionada con la oclusión y el sistema neuromuscular, que actualmente se consideran contribuyentes en la remodelación y la adaptación de la ATM.…”