Learning Objectives:

After completing this course participants will:

• Have a working knowledge of the TMJ and surrounding tissue anatomy.
• Skillfully and thoroughly complete an evaluation with a client who has TMD.
• Evaluate and educate clients around the mindset and habit issues related to TMD.
• Apply and educate occupation based and manual therapy techniques with client with TMD.
• Competently document, bill and promote occupational therapy services for TMD.

Introduction to the Topic of TMD

Thank you for taking the time to learn more about Occupational Therapy's role in evaluating and treating TMD!

TMD affects over 80 million adults and 8 million children/adolescents in the United States (The TMJ Association, 2022). More times than not, a person may be experiencing the symptoms of TMD but not know what it is, let alone know where to seek treatment to address the issue. Not enough is being done to address the root cause of this epidemic.

Begin by thinking about the jaw as just another joint in the body. Muscles, fascia, nerves, and blood supply surround it. The tissues around the jaw must be flexible and strong, just like all your other joints. They are also susceptible to tension and injury just like all your other joints. So, just like any joint and surrounding tissues, they can heal.

The jaw is unique because it is used in many critical aspects of life, such as communication, eating, intimacy, singing, facial expressions, yawning, smiling, laughing, sneezing, breathing, and more. So many small muscles and layers of fascia in the jaw area can make the jaw more susceptible to tension.

When people have jaw problems, they often think about visiting the dentist because the jaw is part of your mouth, and you often rely on your dentist to help you with problems in the mouth. We are taking a rehabilitation and myofascial approach since the jaw is a joint surrounded by muscles and fascia. Rehabilitation specialists, including occupational therapists, specialize in healing joints and returning you to the activities you need and want to do each day. The Healthy TMJ Protocol is about creating a healthy TMJ that will enable you to participate in all the activities and movements your jaw can make without tension or pain.

How do Occupational Therapy practitioners fit into this picture when treating TMD? 

Currently, invasive and non-reversible treatments are being utilized without strong evidence to actually “fix” the issues related to TMD. The TMJ Association recognizes over 50 treatments. However, the evidence for most treatments is lacking. In 2019, Aggarwal et al. reported that conservative treatment options, including physical and psychosocial interventions, are effective and should be started early in the case of TMD and be chosen over invasive, irreversible, and expensive interventions. The conservative options for treatment fit very nicely into the occupational therapy scope of practice as we naturally treat patients holistically!

The occupation of eating and other occupations TMD directly affects are some of our most valued and repetitive activities of daily living and, when limited from TMD, can result in a decline in both physical and mental health for all ages. The cause of TMD is often considered multifactorial, including biological, behavioral, environmental, social, emotional, and cognitive components. Thus, it is imperative that occupational therapists become involved in treating those affected by TMD, as occupational therapists have in-depth training within the biopsychosocial foundations of practice.

Occupational therapy practitioners are well suited to deliver conservative treatments for the multifactorial components of TMD and educate clients on the components to help them heal from pain and dysfunction, ultimately improving their quality of life. In the section below, you will hear directly from individuals who live with TMD and how difficult living with TMD can be.

The Burden of TMD

In 2020, the National Academies Press released Temporomandibular Disorders: Priorities for Research and Care. The multidisciplinary committee who authored this paper invited individuals with TMD to speak so they could hear firsthand the experiences of these individuals. The committee noted both the financial and emotional cost of living with TMD. The following bullet points are taken directly from the report on pages 96 and 97. Summarizing these details felt minimizing to the people who shared with the committee.

• Women treated in a male-dominated environment;
• Failure of health professionals to acknowledge or explain the severity and complexity of TMD in marketing to the public;
• Chaos and controversy that abounds in the TMD treatment arena where patients receive different diagnoses and treatment plans from different practitioners, risking patient healthcare decisions in the face of sometimes conflicting information;
• Patient abandonment when the treatments prescribed by the provider doesn’t alleviate their condition or worsen it;
• Patients blamed when the treatments fail;
• Financial loss and bankruptcy due to the costs of TMD health care, unpredictable insurance coverage for TMD treatments, requirement by practitioners for patients to pay for services in cash in advance, encouraging patients to take personal loans, and sign contracts with financial companies affiliated with the dental practice;
• Harm from treatments that received FDA approval; • Betrayal by and loss of trust in dentists and other practitioners with whom they have entrusted their well-being;
• Desperation to get relief trying any treatment, regardless of its scientific validity;
• The stigma of a condition that isn’t readily obvious to friends, family, and the general public;
• Social isolation from friends and family leading to loneliness, anxiety, and depression;
• Dramatic changes in physical appearance resulting from the disorder, treatment, nutritional problems, and severe weight gain/loss. Facial deformities causing diminished self-esteem, shame and revulsion, the shock of no longer recognizing themselves when looking in the mirror, and the ultimate shame of being stared at in public;
• Social consequences such as: job loss; divorce; abandonment of career, educational, and personal ambitions; abandoning the idea of having children; inability to assume household and child-rearing responsibilities; and changed family roles;
• Physical inability for restaurant dining—society’s way of interacting in a social or business setting. Those who feel like going out suffer the embarrassment imposed by the masticatory inadequacy, such as having food fall out of their mouths or choking;
• Loss of valuable friendships and inability to participate in daily experiences and pleasures normal people take for granted;
• The effect TMD on the sex lives of both the patient and partner—the once pleasurable sensations of being touched, hugged, kissed, having one’s face stroked, and all the things that are an integral part of lovemaking and affection sharing, are, for many, excruciatingly painful;
• Thoughts and attempts of ending one’s life/suicide.

References:

Aggarwal, V. R., Fu, Y., Main, C. J., & Wu, J. (2019). The effectiveness of self-management interventions in adults with chronic orofacial pain: A systematic review, meta-analysis, and meta-regression. European journal of pain (London, England), 23(5), 849–865. https://doi.org/10.1002/ejp.1358

Empowering you with the truth. The TMJ Association. (2022, December 2). Retrieved February 16, 2023, from https://tmj.org/

Lee, Y. H., Auh, Q. S., An, J. S., & Kim, T. (2022). Poorer sleep quality in patients with chronic temporomandibular disorders compared to healthy controls. BMC musculoskeletal disorders, 23(1), 246. https://doi.org/10.1186/s12891-022-05195-y

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Board on Health Sciences Policy; Committee on Temporomandibular Disorders (TMDs): From Research Discoveries to Clinical Treatment, Yost, O., Liverman, C. T., English, R., Mackey, S., & Bond, E. C. (Eds.). (2020). Temporomandibular Disorders: Priorities for Research and Care. National Academies Press (US).

Valesan, L. F., Da-Cas, C. D., Réus, J. C., Denardin, A. C. S., Garanhani, R. R., Bonotto, D., Januzzi, E., & de Souza, B. D. M. (2021). Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clinical oral investigations, 25(2), 441–453. https://doi.org/10.1007/s00784-020-03710-w