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Because of generic use of this term to describe disorders of the joints and surrounding musculature that connect the lower jaw to the temporal region at the sides of the skull, confusion and lack of understanding have been the norm for patients and medical practitioners alike.

The article, written by Catherine Mormile, DPT, a private-practice, doctor of physical therapy practicing in Anchorage, Alaska, describes that TMD, a source of pain and dysfunction for nearly 10 million Americans and four times more women than men has a distinct muscular and joint presentation.

One diagnosis, “joint” TMD presents itself with measurable orthopaedic damage to the cartilage and ligaments located within the TMJ itself. The other, “muscular” TMD, presents as a painful condition of the muscles involved in chewing and often involving the muscles of the scalp, base of the neck, and shoulders. Sometimes, both conditions occur simultaneously.

Patients experiencing joint TMD usually report that their jaw audibly clicks and sometimes locks in a posture such that more than two fingers cannot be inserted between the front teeth. The jaw may deflect to one side, thus changing tooth contacts. And once locked, the joint noises may cease. Radiological findings will be positive for TMJ derangement. Joint TMD usually involves only one side of the jaw often accompanied by headaches behind one eye, in front of the ear, in the temple, and the base and side of the neck.

Causes of Joint TMD include trauma and over-use, tooth clenching and oral-facial habits, and dental abnormalities.

Muscular TMD involves the many muscles of the head, face, neck, shoulders, and one, sometimes both TMJs. In more complex presentations, this TMD may be considered a sub-classification of fibromyalgia. The primary clinical manifestations of muscular TMD are pain and headaches. Limitations in jaw range of motion and function may occur but are not as predictable as joint TMD and are dependent upon which muscle groups demonstrate the most pain-induced restrictions. Radiological findings are negative for TMJ derangement.

Causes of Muscular TMD include traumatic and stressful life events, occupational multitasking under time constraints, sleep deprivation, imbalances of neurochemicals and hormones, and direct contusion to the muscles.

Treatment of both types of TMD involves identifying the aggravating factors, correcting the dysfunctional elements and teaching the patient health promotion and self-regulatory measures. Often, this is a multidisciplinary effort involving physical therapist, dentist, physician, and surgeon.

Dr. Mormile believes that it is essential that the public understand that like the mythical, two-faced Roman god Janus, TMD is one name for two diagnoses. Understanding of both diagnoses will assist the health care provider to deliver appropriate care and the patient to seek appropriate care and providers.

Catherine Mormile, DPT OCS OTR/L is a doctor of physical therapy; board certified orthopaedic specialist, occupational therapist, and co-owner of Mormile Physical Therapy in Anchorage, Alaska. She is a nationally published author and instructor in TMD evaluation and treatment topics. She is also a member of a TMD dental expert consultation team.

For addition information, please contact:

Dr. Catherine Mormile
Mormile Physical Therapy
1600 A Street, Suite 215
Anchorage, Alaska 99501
(907) 561-1800
Fax: (907) 562-4705