TMJ Dysfunction – Basic Management and Treatment Strategies

Webinar/Seminar Contents

The most significant parts of the human spine are the cranium, cervical spine, pelvis and TMJ. There is moderately strong research evidence indicating a susceptibility of patients with pelvic instability, extensor neck muscular hypertonicity and global/upper neck vertebral hypomobility to develop TMD. The muscles with “lower endurance” indicate that they are not functioning as efficiently as intended. As a result, they fatigue more quickly, leading to head and neck issues such as neck discomfort, shoulder pain, headaches, and migraines.

With TMD, it may not be merely a problem of “malocclusion” or “stress,” but can include postural distortions, weak or inhibited muscles, faulty biomechanics and neurologic proprioceptive alterations associated with chronic misalignment patterns. When the structural integrity of this area is disrupted, it is crucial for all chiropractors to grasp the local or global repercussions of how and why they may arise.

A significant number of the population suffer from some version of TMD and could inadvertently develop instability and chronicity. Many undergraduate chiropractic programs provide only a basic understanding of the approaches and assessments to effectively manage TMJ issues. One outcome of these webinar/seminars is to provide a greater degree of confidence on how to examine and assess TMJ conditions, either in isolation or best, in conjunction with other health disciplines.

The introductory seminar will cover the items on the ‘TMJ Examination Flowchart”. There will be a review of anatomy, biomechanics, examination procedures (observation and postural inspection), differentiating TMJ conditions, mobilizations, adjustments, and recommended homecare and/or co-management with dentists.

As a result of attending this seminar, you will be more confident in assessing and working with several types of TMD presentations.  However, if you wish to pursue further advanced education in TMD management (involving specific neurological and cranial components), you could be directed to appropriate resource personnel.

Proposal for Seminar: Chiropractic TMJ Management

1. Introduction

Temporomandibular Joint Disorders (TMDs) affect a significant portion of the population, with symptoms ranging from jaw pain and clicking to headaches, neck discomfort, and difficulty chewing. As neuromusculoskeletal specialists, chiropractors are uniquely positioned to assess and manage TMJ dysfunction through non-invasive, evidence-informed techniques. The inclusion of a comprehensive TMJ management module in chiropractic continuing education reflects current clinical needs, interprofessional collaboration trends, and the scope of chiropractic care.

1. Educational Principles

The proposed TMJ management seminar/module will be grounded in the following educational principles:

1. Evidence-Based Practice (EBP): Participants will be taught to integrate the best available research, clinical expertise, and patient preferences when managing TMJ conditions.
2. Clinical Reasoning & Critical Thinking: Emphasis will be placed on differential diagnosis, biomechanics, and functional analysis of the stomatognathic system.
3. Hands-On Competence: Training will include palpation, joint mobilization, cranial techniques, and myofascial therapies with supervised clinical application.
4. Interdisciplinary Awareness: Participants will understand collaborative roles with functional dentists, orthodontists, physical therapists, and speech-language pathologists in managing complex TMJ cases.

III. Chiropractic TMJ Management Strategies

Instructions will cover the following assessment and treatment strategies:

1. Assessment Techniques

• History taking with TMJ-specific questioning
• Functional jaw movement testing (ROM, deviation patterns)
• Palpation of TMJ and masticatory muscles (masseter, temporalis, pterygoids)
• Auscultation for clicks, pops, and crepitus
• Cranial nerve screening
• Postural (cervical spine and pelvis) analysis

1. Treatment Approaches

1. Chiropractic Adjustments:
   • Manual (Diversified/Gonstead and Terminal Point) and instrument-assisted (Activator) techniques for the upper cervical spine (C0-C3) and craniomandibular articulation
   • Sacro Occipital Technique (SOT) cranial releases (e.g., temporal, sphenoid, maxilla bone adjustments)
2. Myofascial Release & Soft Tissue Work:
   • Intraoral and extraoral techniques for the temporalis, masseter, pterygoids, and digastric
   • Trigger point therapy and fascial release
3. Neuromuscular Reeducation:
   • TMJ stabilization exercises
   • Postural retraining and jaw proprioception drills
4. Adjunctive Therapies:
   • Low-level laser therapy (LLLT) and/or Cold Laser
   • Cold packs, moist heat, and electrotherapy (as needed)
   • Nutritional guidance for inflammatory control

1. Benefits of Learning TMJ Management

Integrating TMJ management into the chiropractic curriculum will:

• Enhance Scope of Clinical Competency: Participants will be able to identify and manage TMJ dysfunction confidently, increasing treatment options for a broad patient base.
• Address a Commonly Overlooked Condition: Many patients seek non-invasive alternatives to pharmacologic or surgical TMJ interventions.
• Foster Interdisciplinary Collaboration: Equips chiropractors to coordinate care with dental and allied health professionals.
• Improve Patient Outcomes: Treating TMJ dysfunction holistically can reduce pain, restore function, and improve quality of life.

1. Training Methodologies

The module will utilize a multimodal instructional approach:

1. Didactic Instruction:
   • Lectures on anatomy, physiology, biomechanics, and pathology of the TMJ
   • Case-based learning for clinical application
2. Laboratory Practice:
   • Peer-to-peer hands-on sessions with real-time instructor feedback
3. Clinical Integration:
   • Participant supervised clinical rotation focused on TMJ assessment and treatment
4. Interprofessional Workshops:
   • Joint seminars with dental and physical therapy programs for collaborative case management

VI (a). Proposed Seminar Outline

 Total Hours: 12

VII. Conclusion

The integration of TMJ management into chiropractic practice reflects the growing demand for conservative, evidence-informed care of jaw-related disorders. By equipping chiropractors with comprehensive knowledge and hands-on skill this initiative enhances both the quality and scope of chiropractic care, fostering more competent, collaborative, and patient-centered practitioners.