TMDs are basically locomotor disorders, and like other locomotor organs, exercise therapy is effective. When performing exercise therapy for TMDs, it is necessary to consider the peculiarities of the TMJ while referring to the concept of exercise therapy for other locomotor organs. The basics of exercise therapy for TMJ disc derangement without reduction and osteoarthritis of the TMJ are to expand the range of motion of the joints and improve fluid circulation by improving joint and masticatory muscle contractions and internal joint disorders. Static stretching of the TMJ is important in exercise therapy to encourage functional recovery and alleviate associated pain. In stretching for the TMJ, it is necessary to consider the stretching direction and improvement with resting for 10 to 60 seconds in the maximum range of motion due to the sliding motion of the mandibular condyle, compression of the posterior tissue of the articular disc, and compression. In addition, as exercise therapy, it is more effective to perform "manual therapy" in combination with "manual therapy" after the patient has received full instruction and practiced "exercise therapy (self-care) performed by the patient himself according to the instructions of the surgeon". It seems to be. As the range of motion of the joint improves, the TMJ including the mandibular condyle morphology may change and the jaw position and occlusal state may change. Therefore, it is also possible to grasp the change in the occlusal state from the first examination. It becomes important. In the future, in order to establish exercise therapy for TMDs, it is necessary to collaborate among multiple disciplines such as physiotherapists and dental hygienists, and to unify terms and procedures.
Reversible conservative treatment, especially therapeutic exercise, has attracted attention as a first-line initial treatment for temporomandibular disorders. In the field of orthopedics, therapeutic exercise has been established as an important conservative treatment, but further examination regarding its use for the treatment of temporomandibular disorders is needed.
Here, we explain the approach and techniques of therapeutic exercise (i.e., temporomandibular joint mobilization therapy) performed by a specialist according to the pathological condition of patients with articular disc disorder/degenerative joint disease (DJD). Furthermore, based on the degree of joint dysfunction classification, temporomandibular joint motion exercise (TMJROME) and self-traction therapy (STT) as self-care at the initial visit and at the first return visit were provided for patients with moderate or severe disability as a single exercise program, and when they were administered, the clinical symptoms (the five items of maximal mouth opening, pain at rest, pain upon opening and closing, pain upon mastication, and degree of difficulty in daily life) were evaluated.
The results revealed a significant improvement for maximal mouth opening, pain upon opening and closing, pain upon mastication, and degree of difficulty in performing activities of daily living (p<0.05).
It appears that these therapeutic exercises circulate the synovial fluid, expand the joint cavity, and ameliorate the range of motion of the joint. Thus, the results suggest that these therapeutic exercises may be effective conservative treatments that reduce symptoms associated with articular disc disorder, especially cases of anterior temporomandibular joint disc displacement without reduction (ADDwoR) and DJD, in a relatively short period of time.
Recently, mouth-opening exercises have been recognized as an effective treatment for limited mouth-opening in cases of temporomandibular disorder (TMD), but have not become universal. This is because some problems remain, for example, a standard protocol for mouth-opening exercises has not yet been established in Japan. In addition, it is relatively difficult to manage the treatment as patients should do it by themselves.
Protrusive sliding movement of the mandibular condyle is often inhibited in patients with limited mouth-opening, so it is considered important to restore this condylar movement to increase the mouth-opening. Therefore, it is thought that inducing sliding movement of the mandibular condyle is essential for effective rehabilitation of the jaw.
Here we describe the concept of effective mouth-opening exercises to restore joint mobility for treating limited mouth-opening of TMD.
Masticatory muscle pain of temporomandibular disorders was considered in the past as non-inflammatory myalgia caused by muscle damage and fatigue substances derived from overloading. However, several studies on tissue fibrosis due to immobility and rest began to be reported around 2000, and some studies reported that pain and dysfunction were evoked by interstitial tissue such as connective tissue adjacent to muscle. Traditional treatments have been based on rest to allow the muscle damage and fatigue to heal. However, the treatment favored by many clinical researchers at present is exercise, which is the opposite of resting. This paper introduces the pathophysiology and treatments of local myalgia and myofascial pain as the most frequently seen in masticatory muscle disorders of TMD adopted in the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).
The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) have been widely used since they were established in 2014 as internationally standardized diagnostic criteria for TMD. In Japan, the DC/TMD was modified by the Japanese Society for the Temporomandibular Joint to fit the Japanese medical system and make the diagnostic process of TMD clearer.
Physical therapy, medication, and appliance therapy have all been shown to be effective treatment options for TMD. However, it can be difficult to select the correct treatment plan due to the lack of standardized guidelines for such selection. This paper details treatment options currently recommended for the management of myalgia in the orofacial region, as well as the effectiveness of exercise therapy for pain in the masticatory muscles. Furthermore, an RCT study that investigated the effect of diet, as a possible lifestyle-related risk factor for TMD myalgia, on pain in the masticatory muscles is also introduced.
Masticatory muscle pain is a chronic myalgia, and the main pathological condition is myofascial pain involving a nociceptive mechanism in the peripheral muscles, a pain perception mechanism in the central nervous system, and pain emotion/cognition. Since masticatory myalgia is presumed to include pathological conditions similar to other chronic myalgias and musculoskeletal pain, it is necessary to deal with not only local peripheral muscles, but also peripheral and central sensitization. Currently, exercise therapy, along with patient education, is positioned as the first-line treatment for chronic pain and is expected to bring about a high analgesic effect through the anti-nociceptive mechanism and central pain inhibitory system by various endogenous analgesic substances. The initial exercises prescribed are painless, short-term, and with low intensity and high frequency. Since exercise therapy has the potential to enhance the patient's own endogenous analgesic ability, it can be one of the fundamental treatments that can be introduced and actively utilized in the dental field.
The number of adult patients with Down's syndrome is increasing due to significant advancements in medical management. In this paper, we report a case of recurrent condylar dislocation in a middle-aged patient with Down's syndrome. A 47-year-old man with Down's syndrome visited our hospital complaining of occasional difficulty in closing his mouth. After examination, he was clinically diagnosed with bilateral recurrent condylar dislocation and was treated with conservative therapy. Unfortunately, the symptoms recurred. Therefore, we performed an eminectomy, and a headgear device specialized for condylar dislocation was applied after the surgery. After 18 months of treatment, the patient reported no recurrence of condylar dislocation and had a good outcome.