TEMPOROMANDIBULAR JOINT

The temporomandibular joint (TMJ) is composed of the upper part of the jaw (condyle) and
the temporal bone. Between these two bones is the disc which is essential in TMJ function,
because the bone surfaces are convex and the disc allows rotational movements.
This joint has the function of talking, breathing, chewing, biting, breathing, etc.

There is evidence that shows us that there isn’t an association between the angle
asymmetry and the temporomandibular (TM) disorders, so TM signs and symptoms, such as
pain, are not related to occluso-postural abnormalities.

The musculoskeletal temporomandibular disorders (TMD) are characterised by pain and

tenderness, or also with joint noises and functional limitations.

Research diagnosis criteria (RDC) for TMD

- Group I: Muscular disorders
- Myofascial pain (Ia)
- Myofascial pain with limited jaw opening (Ib)
- Group II: Disc displacement
- Disc displacement with reduction (IIa)
- Stop sensation during the opening
- There’s an anterior displacement of the disc so the condyle articulates
with the retrodiscal tissues
- The ipsilateral deflexion recovers when the disc displacement is
reduced
- Disc displacement without reduction
- There isn’t a reduction of the disc in the opening
 - With aperture limitation (IIb)
- Without aperture limitation (IIc)
- Group III: Other articular conditions
- Arthralgia (IIIa)
- Arthritis (IIIb)
- Osteoarthritis (IIIc)

Assessment
1. Visual assessment of the mouth to identify any deformity
2. Mandibular dynamics
3. Joint noise evaluation
4. Palpation
5. Joint test
6. Muscle evaluation
7. Rule out other nociceptive sources
8. Signs of sensory hypersensitivity

Firstly, the examiner will ask the patient where’s his pain, to do the pain map and know if it's
localized, fascial or hearing.
When the pain comes from the joint (arthrogenic) it is localized and referred to the fascial
area.
In the acute phase there is also a secondary pain in the muscles (miogenic).

1. Visual assessment
The examiner asks the patient to open his lips to assess the morphology. Then, he does the
same but with the mouth open.

2. Mandibular dynamic
The examiner asks the patient to do TM active movements. After each movement and
before the next one the patient must close its teeth (not the lips).
- Normal opening
- Maximum opening
- Laterality (right-left)
 - Protrusion
With this assessment we will see if there’s a deviation of the middle line. Therefore, it is
identified if the movements are normal or pathological.

3. Assess the joint noises

The noisses can be: clicking or popping, and crepitus.
To assess the noises, the examiner puts its fingers on the mandibular angle and asks the
patient to do the movements (opening, laterality, protrusion). The examiner registers the
degree in which the noises are noticed. It is important to differentiate both noises.

4. Palpation
1. Static palpation of the condyle → assess pain and sensibility
a. Lateral
b. Anterior
c. Posterior
2. Dynamic palpation → assess mobility (rotation and translation), pain and noises
a. Lateral
i. Opening
ii. Protrusion
iii. Laterality

5. Joint test
Mandibular mobility in load.
The examiner resists the movements in this order:
1. Protrusion
2. Laterality (right and left)
3. Opening
4. Retrusion

Treatment
Objectives
- Education
 - Promote tissue repair
- Reduce the load
- Restore the function
- Treat the pain
The objectives of the articular treatment in the TMJ are mechanics and neuromodulators.

Principles
1. Diagnosis
2. Pain mechanisms
3. Clinical situation: dominant pain or function
4. Patient preferences

A technique to improve mouth opening, modulating pain and stretching the articular
capsule is done with the patient in supine position. The examiner puts its thumb in the
mouth, palpating the condyle. From this position, the examiner does a distraction, to stretch
the articular capsule. Then he does a gliding move (anterior and posterior), and medial and
lateral movements. In the last ones the thumb must be in the lingual aspect.
Furthermore, it can be used the therabite.