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Jaw Pain or TMD

Evaluation and Treatment of Temporomandibular Disorder and Craniofacial Pain (TMD)

TMD patients with limited mouth-opening, we use a cluster of seven tests (dentalstick test, isometric test, joint provocation test, joint sound test, de-viation test, laterotrusion test and joint mobility test) were five tests have to be positive. The tests require no advanced equipment, they are easy to perform and suitable in clinical settings to provide basis for therapists in choosing treatment techniques. The treatment can start earlier and reduce the time with pain.

A patient with a high level of jaw disability has also a higher level of neck disability as compared to other patients with just joint pain or muscle pain. In addition, patients with mixed chronic pain diagnosis show greater craniomandibular and neck disability than patients with a diagnosis of chronic joint pain or muscle pain. As well, patients with mixed chronic pain show greater headache impact than the chronic joint pain or muscle pain.

The presence of pain cause changes in the mandibular kinematics which, in turn, affect the neuromuscular mechanism, and which enroll differently the muscles and other structures associated with the TMJ. Patients sometimes report that they have to limit the mouth movements or perform them slowly when compared with other healthy people. They also explain that slowing down of jaw movements is aimed to avoid the exacerbation of the pain, which took higher chewing time and the higher number of chewing strokes for them

It can be assumed that a higher difficulty and a lower ability to chew, besides a higher chewing time, may be considered as a factor in evaluating functionality of the masticatory muscles, failure of neuromuscular system that has to be in equilibrium, failure of muscle coordination during the dynamic activities. Due to the complex mechanism of the system (the masticatory function involves complex movements of different muscle groups activated at different times and based on food consistency along with the presence or absence of pain), a healthy neuromuscular system and muscle coordination of masticatory of stomatognathic system is very important for healthy living.

Temporal muscles are generally activated more when compared with the masseter in patients with TMD that can also cause changes in the mandibular kinematics, which could change the intermaxillary relationship, and hence the chewing pattern.

These factors can lead to conclusion that there is probably an imbalance in the structures of the stomatognathic system.

Disability associated with jaw and neck pain interferes greatly with daily activities and affects the patient’s lifestyle which negatively impacts the individual’s ability to work and interact in a social environment.

Headaches can be influenced by cervical muscle strength. Weak musculature of cervical spine causes excessive stress on upper cervical facets that, in turn, may lead to more headaches, neck pain, and cervical spondylosis.

Faizal (Physiotherapist)

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