Intra-oral TMJ Therapy

1) Palpate the patient¶s jaw and observe their normal gait. a. Note any deviations from mid-line with the chin on excursion and return. b. Note and deviation of the mandibular condyles from medial to lateral. c. Listen for clicking or clunking. 2) Evaluate and treat one side at a time. Begin by donning a glove. If the patient is sensitive to latex, use nitrile. 3) Ask the patient to open their mouth fully and enter their mouth with your index finger. Stay well to the side to avoid any gag reflexes. Have the patient relax their jaw with their mouth closed. If you are treating the patient¶s right side, use your right hand and vice versa on the left.

4) Using the index finger in the patient¶s mouth and the thumb of that same hand on the outside of their cheek, evaluate the masseter muscle by squeezing it. Evaluate the entire length and depth of the muscle. If tight or tender portions are present, use light pressure in a press-and-release method until the tension dissipates. a. If the patient is able to tolerate more intensive therapy, have them open their mouth slowly while you pinch a section of the muscle. This is more of a muscle stripping technique.

5) When you are satisfied with the masseter, move on to the temporalis. Have the patient open their mouth halfway. Using your index finger, follow the ridge of their mandible until you reach the topmost point; the coronoid process. Pull the pad of your finger toward you, that is, away from the patient¶s midline. The tendon you encounter is the temporalis muscles¶ tendon. Use the same pressure technique listed above until you are satisfied with the muscle relaxation.

6) To move on to the lateral pterygoid, keep your finger at the same height as it was for the temporalis. Move the point of your finger medially and slightly posteriorly. You will either encounter an opening or a mass of tendon/muscle. If you encounter an empty opening, the patient¶s lateral pterygoid is too small for you to feel. Move on to the next muscle. If you can feel the muscle, evaluate and treat as needed. This particular muscle tends to be very tender and can almost feel as though you are cutting the patient¶s oral mucosa. For this reason, be sure your finger nails are as short and dull as possible.

a. You can have the patient participate on this muscle by keeping your finger in position and having them open their mouth slowly. This action will increase the pressure on the muscle and becomes a form of active release. 7) To move on to the medial pterygoid, keep you finger in the patient¶s mouth and keep it to the side. You are going to move so that the pad of your finger is on the medial side of the ramus of the mandible, deep to the tongue. Begin by informing the patient that you are going to place your finger under their tongue. Then place you finger tip on the medial side of the patient¶s teeth and press inferiorly and posteriorly until you can feel the muscle belly pressed up against the mandible. This muscle tends to feel almost glandular to the touch. Again use light pressure to treat any tension you find.

8) To remove your finger, inform the patient that you are done with treatment and have them relax. Keeping your finger to the side, draw your finger out of their mouth and be careful not to transfer any saliva onto the patient¶s face. Discard your glove and repeat the procedure on the other side of the patient¶s jaw. 9) Inform the patient that soreness following treatment is normal and that they can use an ice pack on their cheek, suck on ice cubes or use a popsicle as an ³ice wand´ to alleviate any discomfort.