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At the completion of this chapter, the reader will be able to:

  1. Describe the anatomy of the temporomandibular joint (TMJ), including the bones, ligaments, muscles, and blood and nerve supply.

  2. Describe the biomechanics of the TMJ, including the movements, normal and abnormal joint barriers, kinesiology, and reactions to various stresses.

  3. Summarize the various causes of temporomandibular joint dysfunction (TMD).

  4. Describe the close association between the TMJ, the middle ear, and the cervical spine.

  5. Perform a comprehensive examination of the temporomandibular musculoskeletal system, including palpation of the articular and soft-tissue structures, specific passive mobility tests, passive articular mobility tests, and stability tests.

  6. Evaluate the total examination data to establish a diagnosis.

  7. Recognize the manifestations of abnormal TMJ function and develop strategies to correct these abnormalities.

  8. Apply active and passive mobilization techniques to the TMJ, using the correct grade, direction, and duration.

  9. Describe and demonstrate intervention strategies and techniques based on clinical findings and established goals.

  10. Evaluate the intervention’s effectiveness to progress or modify an intervention.

  11. Plan an effective home program and instruct the patient in this program.



Most of the general population has experienced TMD on a minimum of one occasion, and some have reported persistent symptoms. The American Academy of Orofacial Pain uses orofacial pain as a collective term for several dysfunctions and sensory complaints associated with the TMJ, the masticatory muscles, and associated structures encompassing Costen syndrome, craniomandibular disorders, and mandibular dysfunction. TMD is a collective term used to describe several related disorders affecting the stomatognathic system and its related structures, all of which may have common symptoms. TMJ dysfunction as an overall descriptor of stomatognathic system dysfunction has been discontinued because it implies structural problems when none may exist and does not include the many other factors involved.

Like that of whiplash syndrome, the diagnosis of TMD remains controversial due in part to a lack of studies regarding the incidence, course, management, and prognosis of claimed TMDs. However, reports of TMD appear to be quite common. TMD tends to affect women more often than men, specifically women over 55. Headaches, orofacial pain, earache, and neck pain are common complaints. Clinical and research reports indicate that head and orofacial pain around the TMJ may or may not be related to TMD.

Due to the complex interplay between the sympathetic and trigeminal nervous systems and an increased understanding of the centralization of pain, TMD is best approached as a cluster of related disorders with many causes and common symptoms. There are likely four etiologic characteristics of TMD: (1) myogenic, (2) traumatic, (3) arthrogenic, and (4) neurogenic factors1:

  • Myofascial TMD pain, often described as pain around the TMJ without reference to a particular pathophysiological mechanism, can occur during orofacial activities such as chewing, swallowing, sucking, speaking, and facial expression. Dental occlusion, parafunctional activities, neuroendocrine factors, genetic factors, and stress that pass a certain threshold have all been ...

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