Conservative treatment for a traumatic temporomandibular disorder: a case report

Background and Purpose: Temporomandibular disorder (TMD) is a prevalent condition that affects the jaw. TMD is very limiting and has several etiologies such as trauma, overuse, stress, and parafunctions (clenching, grinding, nail-biting, and cheek chewing). Currently, dentists and physical therapists are the main providers of conservative services. This case report is relevant because the literature behind conservative treatment of TMD is limited despite the prevalence of the disorder.

Case Description: The patient is a 60-year-old Caucasian male that weighs 168 lbs and is 5’ 6”. The patient went to the dentist on 7/7/22 for a crown procedure that resulted in an anterior disc displacement without reduction to the right temporomandibular joint (TMJ). The patient was referred to physical therapy where he was evaluated and treated on 7/21/22. The main interventions include joint mobilization, soft tissue mobilization, trigger point dry needling, therapeutic exercise, and patient education.

Outcomes: The patient’s pain improved from 9/10 at the initial assessment to 5/10 at the progress note. TMJ ROM improved from 23 mm of opening before distraction at initial assessment to 37 mm of opening before distraction at progress note. Manual muscle test has improved from 3/3- to 4- globally. The joint play was hypomobile at C1-C7 and bilateral TMJs at both the initial assessment and progress note. The patient’s Mandibular Function Impairment Questionnaire (MFIQ) improved from a 68 to a 10.

Discussion: The patient is halfway through their plan of care and has improved significantly in strength, ROM, pain, palpation, and MFIQ. This indicates that conservative treatment of TMD from an evidence-based perspective is an effective rehabilitation method for this patient population.