Chronic Pain and Temporal Mandibular Dysfunction

When people get whiplashes their jaw can be involved. This can lead to chronic pain in face and neck or complicate whiplash pain. Dentists and othodontists have noted this.  Today at the Trial Lawyer's Association of BC Essential Soft Tissue Injury conference a physiotherapist presented on this covering the topic neatly and succinctly with relevant and useful slides.  These are the notes I took and of course they don't cover all the material. The conference offered a CD with the various lecturers notes on that my own notes tend to remind me of what I thought was useful clinically and give a glimpse of what kind of information this conference covered clinically.

Essential Soft Tissue Injury Conference

March 31, 2012

Physical Therapy Treatments for TMD: Giving Hope to your Patients and Clients, Angelica Reeve, MSc,PT, BSc PT MACP

19th Street Physiotherapy Clinica

TMD - Temporalmandibular Dysfunction

TMJ is the jaw joint

connect mandible to temporal bone of skull by articular disc

Opening mouth requires mandible to slide forward and rotate - makes the disc very vulnerable

Muscles of mastication

masseter

temporalis - one of the reasons people complain of headaches

lateral and medial pterygoid

Temporal mandibular dysfunction

-collective term

-muscular

• intra-articular (inside joint)
• Combination

5 categories of very minimal to very severe

Causes

trauma -direct trauma, derangement, adhesions

micro trauma -indirect blow, whiplash, bruxism, adhesion

Mechanical dysfunction - trauma, bruxism, muscle imbalance, posture

Osteoarthritis - any of the above

Signs and symptons

loss of range of movement or locking

joint noises

pain - tmj, fascial,earache

pain ful neck

sudden change in bite

decreased hearing, blocked ear

Whiplash - hyperextension and hyperflexion

High incidence of TMD with cervical spine disorders

Five times more likely to develop TMD

20% of recorded cases TMD main complaint

Deep cervical spine muscles can be involved  in whiplash and contribute type i fibers versus type ii more common in superficial muscles

Muscle imbalance

-loss of spatial awareness

posture changes

forward head posture has been found to be correlated to TMD

Treatment

involves positive retraining

deep neck re posturing

Need to taught how to sit upright

Chronic pain

-provides more of a challenge

-change in hard wiring of brain

-increased sensitization

-anxiety and depression

Homunculus in Somatosensory Cortex

Homuncular Man = more face and hand

Chronic TMJ Pain can be associated with problems

• fascial expression recognition

-two point discrimination

-loss of expression

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