From the Guidelines
Physiotherapy is strongly recommended for the management of bilateral anterior disc displacement with reduction in the Temporomandibular Joints (TMJs), characterized by limited movement, as it can significantly improve morbidity, mortality, and quality of life outcomes. A comprehensive physiotherapy program should include gentle jaw exercises performed 3-4 times daily, such as controlled mouth opening, lateral movements, and protrusion exercises, each held for 5-10 seconds and repeated 5-10 times 1. Heat application for 10-15 minutes before exercises can help relax muscles and improve range of motion. Massage of the masseter and temporalis muscles using gentle circular motions for 2-3 minutes can reduce tension. Postural correction is also important, as forward head posture can exacerbate TMJ problems. These interventions work by gradually stretching tight tissues, strengthening supporting muscles, and retraining proper joint mechanics.
Key Components of Physiotherapy
- Gentle jaw exercises
- Heat application
- Massage of the masseter and temporalis muscles
- Postural correction Additionally, practicing proper tongue position (resting against the roof of the mouth) and avoiding habits like clenching, grinding, nail biting, and chewing gum will support recovery 1. Most patients see improvement within 4-6 weeks of consistent therapy, though complete resolution may take 3-6 months depending on severity. It is essential to note that the guideline panel issued strong recommendations in favour of cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care (such as home exercises, stretching, reassurance, and education) 1.
From the Research
Implications of Bilateral Anterior Disc Displacement with Reduction
- Bilateral anterior disc displacement with reduction in the Temporomandibular Joints (TMJs) is characterized by limited movement and joint pain 2, 3.
- The condition can lead to significant reductions in mouth opening and function, as well as increased pain levels 3, 4.
Physiotherapy as a Treatment Option
- Physiotherapy may be an effective management strategy for patients with bilateral disc displacement without reduction of the TMJs 3.
- Manual physical therapy, therapeutic exercise, and patient education can help improve maximal mouth opening, function, and reduce pain levels 3, 4.
- The treatment aims to make symptoms disappear and joint function regained through various techniques, including modality, manual, and movement therapy 2.
Effectiveness of Physiotherapy
- Studies have shown that physiotherapy can be effective in reducing pain and improving mouth opening in patients with anterior disc displacement without reduction 3, 4.
- The simultaneous use of stabilization splint and physical therapy may be more efficient in reducing deviations and improving range of mouth opening than the stabilization splint used alone 4.
- Physiotherapy can also help restore anatomical relationships and improve joint function, although this may not always be the primary goal of treatment 2, 5.
Treatment Approaches
- Different treatment approaches, including anterior repositioning and stabilization splints, can affect the disc-condyle relation in patients with TMJ disc displacement with reduction 6.
- Anterior repositioning of the mandible can improve the spatial relationship between the disc and condyle in patients with disc displacement with reduction 6.
- Platelet-rich plasma injection combined with immobilization and physical therapy may also be an effective treatment option for some patients 5.