Archive for December, 2009


According to an article by The Dynamic Neuromuscular Rehablilitation Center in New York;
Temporo-Mandibular system is one of the most active and powerful structures of human body. It works during the day and while we are asleep. Due to the massive continuous workload and considerable forces exerted by its components it is a subject to breakdowns. Fortunately for the patient the Temporo-Mandibular system is very resilient and capable of self-repair when a proper treatment is administered.

Causes of Orofacial pain arising from within the Temporo-Mandibular system:
Repetitive overload of masticatory muscles and TMJs.
Acute overload of the Temporo-Mandibular structures.
Parafunctional habits (lip biting, teeth clenching and grinding and etc)
Direct trauma to TMJ
Cervical spine dysfunction forward head position and poor scapular stability
Structural deformity of the craniofacial bones (growth disorders)
Arthritic disease of TM joints

Dysfunctions and pathologies outside the Orofacial system contributing to the breakdown of Temporo-Mandibular complex:
Emotional disturbances (depression, anxiety, etc.)
Mouth breathing and faulty respiration
Chronic nasal airway obstruction (Sinusitis, Adenoidal hypertrophy and others)
Swallowing disorders
Neurological disease affecting Nervous system (MS, Stroke and etc.)
Central coordination disorder
General hypermobility

Other diseases and dysfunctions, which could mimic Orofacial pain:
Dental disease infection in the oral cavity, atypical odontalgia
Neurological lesions Atypical facial pain and Trigeminal neuralgia
Oral lesions tumors in the oral cavity.
Vascular lesions Temporal arthritis and facial migraine
Ear disorders otalgia of various etiology
Eye disorders

Major categories of TMD
Myofascial disorders
Temporo-Mandibular joint disorders
Mandibular mobility disorders
Degenerative/inflammatory disorders

Diagnostics of TMD
Diagnosed TMDs fall into three basic etiological categories:

Pure myofascial etiology. Resulting strictly from hypertonicity of masticator musculature, but may also involve muscles of the cervical spine.
Mixed etiology. Masticatory muscle hypertonicity in conjunction with some degree of intra-articular TMJ dysfunction (hypo- or hypermobility in one or both joints, with or without periarticular adhesions).
Resulting from true intra-articular pathology with locking of the jaw.

TMDs of any etiology in general seldom require a surgical intervention. Historical research data has shown that jaw repositioning (one of the common measures taken in combating TMDs in adults) has failed to yield any significant improvement in the recovery ratio. It is a risky and expensive procedure that seems to have been developed by creative dental specialists out of desperation due to the lack of better, scientifically proven alternatives. Such dental measures like occlusal grinding, expensive crowns and bridges, and full mouth restorative procedures also lack sufficient statistical evidence proving them to be effective as cure of TMDs.

Conditions from Categories 1 and 2 (see above) should be treated by a neuromuscular therapist (chiropractor or physical therapist) specializing in TMD. Special attention has to be devoted to dysfunction in the Locomotor system as a whole because the local manual approach alone may not be sufficient. Treatment of the entire Locomotor system is necessary to avoid recovery delay and subsequent chronicity. This is especially the reason why intraoral appliances, such as dental splints, should only be used in conjunction with neuromuscular physiotherapy or as a supplemental home therapy to consolidate the recovery achieved by the neuromuscular treatment.

TMDs caused by infrarticular pathology (category 3) require close cooperation between orthodontist or maxillofacial surgeon and neuromuscular specialist. The worlds scientific authority recommends treating these cases conservatively until maximum improvement is achieved before committing to surgery. At present about fifty percent of such cases are managed without any orthodontic or orthoghnathic intervention. It must be up to the neuromuscular specialist to make a sound judgment, based on good clinical skills and clear understanding of structural pathology of the TMJ, whether the conservative care is no longer effective and refer the patient for surgical consultation.

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