TMJ (Temporomandibular) Dysfunction
Philosophy of Care
At Braintree Rehabilitation Hospital, we promote a variety of treatments for Temporomandibular Dysfunction (TMJ). The centerpiece of care is education of the patient on self-management techniques; from inflammation control to posture and exercise. The focus is on rapid reduction of symptoms in the clinical setting, followed by a progressive development of home exercises, all of which are designed to normalize functional opening and masticatory control. The physical therapist consults closely with the referring practitioner to achieve a clear understanding of the patient's case, and to modify programs as necessary.
The most common TMJ disorder is the internal derangement, Type I and II. It is often associated with a capsulitis, making pain a common feature. On physical exam, a popping is felt and heard, with associated pain. Early treatment of the internal derangement is imperative, as progression of the disorder often leads to a less favorable outcome. Treatment for derangements is similar to that for myofascial disorders. Physical Therapy (including the use of ultrasound, heat/cold, manual techniques, and exercise), NSAIDs and muscle relaxers, a soft diet and resting the TM joint. The addition of a splint to attempt repositioning of the condyle may be required. Eventual surgical intervention may be needed.
Myofascial Pain Dysfunction
The most common non-surgical diagnosis we see is myofascial pain dysfunction. Typically, these are patients for whom other intervention including splinting and medication has not achieved maximum benefit. Patients generally respond quite well to a short course of Physical Therapy including modalities such as ultrasound, iontophoresis, myofascial release, and ice. Then, they are trained in a home exercise program of controlled opening and strengthening of the muscles of mastication. Stress reduction techniques, including surface EMG Biofeedback are utilized where appropriate.
Post Surgical Rehabilitation
Arthrocentesis and Disk Plication are two common interventions after which the patient may benefit from Physical Therapy. The focus is on early reduction of inflammation; patient education and training regarding controlled opening, and eventual strengthening of the muscles of mastication when appropriate.
Insurance Coverage for Services
Services provided by a Physical Therapist are generally covered under the physical therapy benefit of the patient's health insurance. In many cases, after an evaluation there are other musculoskeletal issues (cervical / thoracic) problems that contribute to the patients TMJ. However, some carriers itemize the TMJ benefit separately, which may require a letter of medical necessity from the referring practitioner. In all cases, coverage is verified in advance on the patient's behalf.