The treatment of the temporomandibular joints dysfunctions shall be complex due to several possible causes that trigger the disorders. Rehabilitation is based on adopting the techniques that originate from manual therapy, applying physiotherapy, classical and transverse massage, as well as autotherapy. Moreover, in the course of the therapy, Kinesio taping, post-isometric relaxation, positional release, release and rolling of the skin are also applied. Cooperating with an orthodontist, a stomatologist, a physiotherapist and a psychologist, as well as the commitment to the treatment on the part of the patient shall allow the cure to take effect in the joint itself and the muscles surrounding it

Biernacki, Maciej

Dąbrowska, Maria

Lisiecki, Jakub

Paruszewska-Achtel, Monika

Ulenberg, Agata

Ulenberg, Grzegorz

Journal of Education Health and Sport

English

Dąbrowska Maria, Biernacki Maciej, Lisiecki Jakub, Paruszewska–Achtel Monika, Ulenberg Agata, Ulenberg Grzegorz. Rehabilitation in dysfunctions of temporomandibular joints. Journal of Education, Health and Sport. 2019;9(5):410-415. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.3229464

http://ojs.ukw.edu.pl/index.php/johs/article/view/6946

https://pbn.nauka.gov.pl/sedno-webapp/works/914392

 

 

 

 

 

The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26/01/2017).

1223 Journal of Education, Health and Sport eISSN 2391-8306 7

 

© The Authors 2019;

This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland

Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike.

(http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.

 

The authors declare that there is no conflict of interests regarding the publication of this paper.

 

Received: 02.05.2019. Revised: 20.05.2019. Accepted: 26.05.2019.


 


 


 


 

Rehabilitation in dysfunctions of temporomandibular joints


 


 

Dąbrowska Maria¹, Biernacki Maciej¹, Lisiecki Jakub¹, Paruszewska–Achtel Monika¹, Ulenberg Agata², Ulenberg Grzegorz³


 

1 Department of Anatomy, Nicolaus Copernicus University in Torun, Collegium Medicum

2 Fundamentals of Clinical Skills Laboratory and Medical Simulation, Nicolaus Copernicus University in Torun, Collegium Medicum

3 Cathedral treatment of Nursing, Department of Nursing in Intensive Care Medicine,


 


 


 

Abstract

The treatment of the temporomandibular joints dysfunctions shall be complex due to several possible causes that trigger the disorders. Rehabilitation is based on adopting the techniques that originate from manual therapy, applying physiotherapy, classical and transverse massage, as well as autotherapy. Moreover, in the course of the therapy, Kinesio taping, post-isometric relaxation, positional release, release and rolling of the skin are also applied. Cooperating with an orthodontist, a stomatologist, a physiotherapist and a psychologist, as well as the commitment to the treatment on the part of the patient shall allow the cure to take effect in the joint itself and the muscles surrounding it.


 

Key words: Temporomandibular joint, biomehanics, manual therap

Paruszewska–Achtel, Monika

ZENODO

Rehabilitation in dysfunctions of temporomandibular joints

Repository of Nicolaus Copernicus University

Dąbrowska Maria, Biernacki Maciej, Lisiecki Jakub, Paruszewska–Achtel Monika, Ulenberg Agata, Ulenberg Grzegorz.  Rehabilitation indysfunctions  of  temporomandibular  joints.  Journal  of  Education,  Health  and  Sport.  2019;9(5):410-415.  eISSN  2391-8306.  DOIhttp://dx.doi.org/10.5281/zenodo.3229464http://ojs.ukw.edu.pl/index.php/johs/article/view/694  6  The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26/01/2017).1223 Journal of Education, Health and Sport eISSN 2391-8306 7© The Authors 2019;This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, PolandOpen Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the originalauthor (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike.(http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.The authors declare that there is no conflict of interests regarding the publication of this paper.Received: 02.05.2019. Revised: 20.05.2019. Accepted: 26.05.2019.Rehabilitation in dysfunctions of temporomandibular jointsDąbrowska Maria¹, Biernacki Maciej¹, Lisiecki Jakub¹, Paruszewska–Achtel Monika¹,Ulenberg Agata², Ulenberg Grzegorz³1 Department of Anatomy, Nicolaus Copernicus University in Torun, Collegium Medicum 2  Fundamentals  of  Clinical  Skills  Laboratory  and  Medical  Simulation,  Nicolaus  CopernicusUniversity in Torun, Collegium Medicum 3 Cathedral treatment of Nursing, Department of Nursing in Intensive Care Medicine,AbstractThe treatment of the temporomandibular joints dysfunctions shall be complex due to several possiblecauses that trigger the disorders. Rehabilitation is based on adopting the techniques that originatefrom  manual  therapy,  applying  physiotherapy,  classical  and  transverse  massage,  as  well  asautotherapy.  Moreover,  in  the  course  of  the  therapy,  Kinesio  taping,  post-isometric  relaxation,410positional release, release and rolling of the skin are also applied. Cooperating with an orthodontist, astomatologist, a physiotherapist and a psychologist, as well as the commitment to the treatment onthe  part  of  the  patient  shall  allow  the  cure  to  take  effect  in  the  joint  itself  and  the  musclessurrounding it.Key words: Temporomandibular joint, biomehanics, manual therapyIntroductionThe  temporomandibular  joint  is  built  of  the  head  of  the  mandible  and  the  anterior  part  of  themandibular fossa – the dimple and the joint lump of the temporal bone [1]. There is a disc located inthe joint, which divides the joint into two halves. The role of the disc is to reduce the friction forcesand  to  decrease  the  stresses.  The  joint  is  stabilized  by  the  ligaments:  the  lateral,  thesphenomandibular and the stylomandibular. It is possible to make the following movements in thejoint: ejecting and reversing, lowering and lifting, as well as lateral movements [2]. The temporalmuscle, the masseter muscle, and the medial pterygoid muscle are responsible for clenching the jaws.The  lateral  pterygoid  muscle  ejects  the  mandible  forward  and  slightly  opens  the  jaws  [4].  Itsmass, the muscle of the floor of the mouth,  the digastric  muscle,  and the mylohyoid muscle areresponsible for opening the jaw [2, 3]. The strength of the masseter muscles is significant. Despite clenching the jaws, the muscles may stillcontract, which makes it possible to chew. Once the clench of the jaws has been reached, musclework results in excessive pressure on the joint, which causes periosteum soreness [4].The movements in the temporomandibular joint depend on both rows of teeth, the cooperation of themuscles and the joint structure. Both joints cooperate with each other at every movement, makingthus  the  movement  in  only  one  of  the  joints  impossible.  In  the  case  of  missing  teeth,  due  tocompensation, we may expect a joint conversion [2]. The rows of teeth, the mandible, the jaw, andthe masseter muscles create a coherent system, referred to as the stomatognathic system [4].During sleep,  in physiological  conditions,  a slight opening of the mandible  takes place [2]. In apathologic situation, we witness an excessive masseter muscle tension during sleep, often coupled411with  grinding the  teeth.  The  external  grounds  for  bruxism (the  aetiology  whereof  has  not  beenentirely elucidated) include a high level of stress and depression. Whereas malocclusion, pathologiesof the temporomandibular joint, dysfunctions of neurotransmitter secretion - mainly dopamine [5] –constitute the internal grounds.Dysfunctions in formations of the joint and - mostly masseter andtemporal  –  muscles  have  been  observed  in  patients.  Moreover,  patients  display  teeth  grinding,soreness  and limited  movability.  If  left  untreated,  bruxism gives  rise  to  further  disorders.  Theyinclude  headaches,  neck  pains,  earaches,  hearing  and  sleep  disorders,  excessive  tension  in  theshoulder and backaches [6]. Present dysfunctions induce further ones. The treatment of bruxism is acomplex process.  It  involves the application  of relief  braces,  malocclusion is  corrected,  physicalexercise, physiotherapy, therapeutic massage, psychotherapy, pharmacotherapy, manual therapy andautotherapy are adopted into the treatment [5, 7, 8]. Aim of the dissertationA literature review has been conducted and the types of modern therapy employed in the treatment oftemporomandibular joints dysfunctions have been identified.Temporomandibular joints disordersA diagnosis of temporomandibular joints disorders consists of conducting examinations and runningfunctional tests. The inquired patients report pain in the joint area, a “clicking” noise while openingthe mandible, a toothache after waking up – caused by clenching them tightly in sleep. Headaches,pains in the neck, shoulders, and saliva secretion disorders and gingivitis while brushing the teethmay also be present. Some patients also report they wake up because of grinding their teeth [5, 7, 9].In the course of visual examination, wearing the tooth surface, biting down on a cheek on the inside– usually to a greater extent on one side – and gum line recession are visible in the oral cavity.Hypertrophies of the masseter muscle and the temporal muscle are visible from the outside. In thecourse of palpation examination, there are tissue texture abnormalities or trigger points located onthe masseter muscle and the temporal muscle. During the examination, the muscles are evidentlypainful and excessively tightened. The next stage in the diagnosis of temporomandibular joints is anexamination of active and passive movability. A therapist assesses and compares the range and thephysiological track of the movements in both joints checks the present deviations or the poppingaudible during the movement. All the movements possible to make, as well as the working of the412joint itself, are subject to examination. The examination may be performed in either a sitting or lyingposition [6]. Treatment of temporomandibular joints dysfunctionIt is possible to treat temporomandibular joints dysfunction in several ways. Dental and orthodontic-prosthetic treatment is the first step in the therapy. After the working order inside of the mouth hasbeen restored, physiotherapeutic treatment begins [10]. Untreated stomatognathic system disorderswith  time shall  affect  disorders  and pains  in  other  parts  of  the body [11].  The selection  of  theappropriate  therapeutic  conduct  should  allow  for  an  individual  approach  to  all  the  existingdysfunctions. For the cause of these disorders may be compound [4, 10]. One method to rehabilitatetemporomandibular joints is relaxing the skin by stretching and rolling it. The therapist locates theirregularities in skin tension above the joint, subsequently stretches it to the limits of elasticity andupholds this stretch without increasing force for about 10 to 15 seconds, until the place being workedon relaxes. Then the therapist searches for another dysfunction works on it and proceeds to do sountil all the irregularities in skin elasticity have been removed. The tissue prepared in this way maybe subsequently subject to rolling [6]. In the course of the therapy, grips like those applied to testjoint play are used.Further components that are worth taking advantage of in in the treatment include classical massageand deep massage of transverse muscles affected by dystrophies. Physiological inflammation that isinduced in the massaged tissues causes the tissues to come apart, thereby enabling them to regenerateproperly [6]. The patient needs to be taught self-massage. The therapy is performed in a rest positionof the mandible for about 3 to 5 minutes. All the masseter muscles undergo massaging.The therapy of the temporomandibular joints also includes removing trigger points in all the muscleslocated in the joint area, as well as the in the neck muscles [4].Availing oneself  of muscle  energy technique,  e.g.,  post-isometric  relaxation  of excessively tensemuscles represents another therapeutic alternative. It is worth ordering the technique to patients inthe form of autotherapy. Relaxation exercises of excessively tense muscles shall be done severaltimes during the day [12]. The joint hypermobility is corrected, among others, by applying Kinesiotaping. The plasters are also used to reduce excessive muscle tension [13]. In order to achieve apermanent  improvement  of  the  patient’s  condition,  it  is  important  that  the  therapist  teaches  themuscle  relaxation  techniques  to  them.  They  may  also  benefit  from ischemic  compression.  It  isessential to develop a habit of conscious muscle relaxation. Some simple exercises shall be helpful in413order to do it: upholding the tip of the tongue in the front part of the palate, right behind the frontupper teeth, holding the tongue between the teeth – with the mouth shut, holding the tip of the tongueon the palate, attempting to yawn with one’s mouth shut. It is also essential that the patient developsa habit of constantly controlling the level of the masseter muscles tension [12, 13].Another element useful in the treatment of bruxism is the application of dry needling techniques.Pricking  muscle-slings  trigger  points  is  used  the  most  often.  The  best  result  of  the  therapy  isattributable to evoking a local muscle twitch as a result of the prick [14, 15].It is worth including physiotherapy in the therapy of the temporomandibular joints. Among others,the ultrasounds, laser therapy, electrotherapy, magnetic field, infrared light exposure are utilized inthe treatment. Electrotherapy is used in order to alleviate pain and reduce muscular tension, usually,TENS  currents  and  interference  currents  are  applied.  Ultrasounds  have  pain-relief,  anti-inflammatory, and relaxing effect. It is worth combining point-based laser therapy with a low-powerand a high-power laser with developing trigger points on the masseter and the temporal muscle. Amagnetic field is deployed to improve exacerbating symptoms and in chronic conditions. It is worthapplying infrared lamps as a form of preparation preceding relaxation [16, 17].There are several different methods and ways applied in rehabilitation of the temporomandibularjoints.  An  individual  approach,  appropriately  selected  and  integrated  therapy,  autotherapy,developing new habits and patient re-education shall influence the effectiveness of the therapy. Bibliography1.Gorzałek  J.  Biomechanics  of  the  temporomandibular  joint  (TMJ)  in  the  aspect  of  the  manualtherapy. Medycyna Manualna 2009; 4(12) 7-12.2. Bochenek A, Raicher M. Anatomia Człowieka.  PZWL Warszawa 2009; 401-406.3.  Plato  G,  Holtenstraβe  M:  Droga  do  chroniczności  zaburzeń  czaszkowo -żuchwowych  (ZCŻ).Manuelle Medizin. 2008; 6(46) 384–385.4. Jagucka-Mętel W, Brzeska P, Sobolewska E et all. Motor system physiotherapy of the masticatoryorgan.  Annales  Academiae  Medicae  Steinensis,  Roczniki  Pomorskiej  Akademii  Medycznej  wSzczecinie 2013, 59, 2, 71–75.5.  Shetty S,  Pitti  V,  Babu S et  all.  Bruxism: A Literature  Review .  J   Indian Prosthodont  Soc.2010(10): 141-148.6. Zaworski K, Latosiewicz R, Majcher P et all. Zastosowanie terapii manualnej w leczeniu zaburzeństawu skroniowo-żuchwowego. Rehabilitacja w Praktyce. 2016; 1, 7-14.4147 . Büttner P, Czarnecka B, Shaw H: Zastosowanie terapii manualnej w leczeniu dysfunkcji stawuskroniowo żuchwowego. Czas Stomatol. 2008; 61: 807-814. 8. Czajkowska D, Lisiński P, Samborski W. Terapia manualna w leczeniu zespołu bólu mięśniowo-powięziowego w przebiegu bruksizmu. Dent Forum. 2013; 1: 57-64.9. Ziółkowska-Kochan M., Kochan J., Pracka D., Dróżdż W., Borkowska A.: Bruksizm – probleminterdyscyplinarny.„Czasopismo Stomatologiczne”, 2007; 6: 391-397.10.  Kogut  G.,  Kwolek  A.:  Functional  disturbances  of  the  masticatory  apparatus -diagnosis  andtreatment. Med Rehab. 2006, 10 (1), 44–56.11. Plato G., Holtenstraβe M.: Droga do chroniczności zaburzeń czaszkowo -żuchwowych (ZCŻ).Manuelle Medizin. 2008, 6, 46, 384–385.12.  Chaitow L.: Techniki energii mięśniowej. Wyd. Elsevier Urban & Partner, Wrocław 2011.13.  Ey-Chmielewska H., Frączak B., Sobolewska E., Polak-Majcher D., Hamerlak Z., Serewa J.:Metoda  kinesiotapingu  i  jej  zastosowanie  w  leczeniu  zaburzeń  narządu  żucia  –  przeglądpiśmiennictwa. Dent Forum. 2009, 1 (37), 69–72.14. Kietrys D, Palombaro K, Mannheimer J. Dry needling for management of pain in the upperquarter and craniofacial region. Curr Pain Headache Rep 2014;18:437. 15. Liu L, Huang Q, et al. Effectiveness of dry needling for myofascial trigger points associated withneck  and  shoulder  pain:  a  systematic  review  and  meta-analysis.  Arch  Phys  Med  Rehabil2015;96:944-55. 16. Gawda P, Suwała M, Gawda J et all. Functional temporomandibular joint disorders, and the needfor co-operation between physiotherapy and dentistry professionals. Zdrowie I Dobrostan 2013;1,95-102.17. Wałach A., Pihut M., Loster J.: Physiotherapeutic interventions in the treatment of patients  withtemporo-mandibular disfunction. Prot. Stom., 2006, 56, 4, 274-281.415

Rehabilitation in dysfunctions of temporomandibular joints

Abstract

Similar works

Full text

Available Versions

ZENODO

Repository of Nicolaus Copernicus University

Akademicka Platforma Czasopism

Directory of Open Access Journals