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Professional Papers _______________________________________________________ 
Conservative management of temporomandibular joint dys-function
Franklin Schoenoltz, DC, DABCO Arcadia, California
 ACA Journal of Chiropractic /August 1978
Copyright American Equilibration Society 1980. Copyright Franklin Schoenholtz
“Authorization granted to the American Equilibration Society for reprint in their Compendium 15, by the ACA Journal of Chiropractic.”
 
Temporomandibular joint (TMJ) pain is a condition which may need a multi-pro-fessional approach for its successful resolution. Because of the unique problems itpresents, there is no place for intellectual isolationism in the total approach to thediagnosis and treatment of this disorder.The etiology of the TMJ pain dysfunction syndrome is the topic of much debate.One group feels that occlusion is the major etiologic factor and the other groupfeels that myofascial muscle spasm with psychological factors initiates the syn-drome.
The controversy as to which comes rst, the malocclusion or the muscle spasm
dictates, in fact, that the syndrome seems to be multifactorial and the treatmentshould be directed to eliminate the multiple etiologic factors.
Examination
When examining the temporomandibular joint the clinician should remember howthe joint hinges with in the glenoid fossa and then glides forward to the eminentia(see Figure 1). The dual heads of each of the external Pterygoid muscles act asynchronously, withone head pulling the meniscus forward as the second opens the joint (see Figure2).  A technique of bony palpation of the temporomandibular joint is accomplished by
placing the index nger into the patient’s auditory canal and pressing anteriorly.
When the patient opens and closes his mouth the doctor may palpate the mandib-
ular condyle with his ngertip. (see Figure 3).
Soft tissue palpation of the external Pterygoid muscle is important clinically. Spasmof this muscle will cause temporomandibular joint pain as well as asymmetrical,
lateral movement of the jaw. The technique for this examination is to place one’snger in the patient’s mouth between the buccal mucosa and superior gum anddirect the tip of one’s index nger posteriorly, past the last upper molar to the
neck of the mandible. The clinician should request the patient to open and closehis mouth in a slow, deliberate manner. As the mouth opens, the doctor will feelthe neck of the mandible swing forward and the external Pterygoid muscle tighten
against the tip of his nger (see Figure 4).
 
Figure 1. The meniscus divides the joint into anupper and lower portion with its hinge and glide ac-tion.Figure 2. The two heads of the external Pterygoidmuscle act asynchronously to open the temporo-mandibular joint.
Figure 3. Palpation of the temporomandibular jointcan be accomplished by placing the index nger in
the auditory canal.
Figure 4. Palpation of the external pterygoid muscle
can be accomplished by placing the tip of the index
nger posteriorly between the buccal mucosa and
the superior gum.
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