Learning with laughter

Treatment of Anterior Disc with Reduction

February 06th, 2011

Objectives:

1.  To promote pain free function even if the disc is out of place

2.  If there are concerns regarding disc position or condition consider MRI

3.  Consider topical diclofenac applied to the preauricular region (in front of ear) if there is pain during meals

4.  Consider a referral for Physiotherapy

5.  Ask your dentist about

– An Oral appliance

– Whether you are grinding or clenching your teeth

– If you have lost posterior support ie: missing teeth, this could be increasing the joint loading or occlusal instability.

Begin with:

o    Basic self care, see blog

o    Controlled opening exercise 10 times a day

Controlled Opening Exercise

Awareness of posture and breath.

    • Breathe in slowly and place the tip of tongue in the mid part  of roof of the mouth
    • While keeping the tongue in contact with the roof of the mouth, allow the jaw to drop open and close back
  • When closing, do not bring the teeth together fully
  • Open and close 10 times and with every repetition keep the tongue up, do mindful breathing and have good relaxed posture
  • Do this 10 times a day
  • This exercise should not cause discomfort

Jaw / Mandibular Stabilisation Exercises

Objectives:

1.  To strengthen jaw muscles

2.  To balance the strength and function of the right and left TMJ Muscles

3.  To establish a normal jaw position at rest and in the open mouth position

4.  Isometric muscular contractions are performed which means that the muscle length is maintained at constant; fixed tension develops in the muscle as patient contracts against an equal counterforce applied by therapist or own finger. This technique primarily reduces hypertonus and resets resting length, thereby restoring more normal articular mobility

Important considerations:

  • The following exercises require the application of light pressure to the jaw using the index finger

(Important the resistance you use should be amount of pressure you would apply when touching eye when eyelid closed or the intensity of the pressure should be 2 on a scale of 1-10)

  • The lower jaw should not move during application of pressure (monitor in mirror) This is an
  • Phase 2 builds on phase 1 and phase 3 builds on 2. Consequently, the earliest phases are continued as the higher phases are added.
  • Phase 3 (2 knuckle opening) is an advanced exercise performed by patients with no jaw pain and good performance of Phase 1 and 2 stabilization. Not all patients will automatically be progressed to phase 3.
  • Good general posture
  • Place jaw in a restful position and slow breathing should be done throughout exercises,

Mandibular Stabilisation Phase 1

1.  Breathe in, tongue tip up on roof of mouth, and apply pressure to the jaw with index finger as shown in pictures A-F

2.  Hold breath and pressure on jaw for 2 seconds from left, right, underneath, diagonals from bottom left, top right, bottom right and top left.

3.  Breath out as remove pressure

4.  Repeat each direction 5 times, 5 times per day

CRpressright

A:  Pressure to the right

CRpressleft

B:  Pressure to the left

CRpressup

C:  Pressure up to ceiling

CRpresschin

D:  Pressure toward neck

CR ePress

E:  Pressure diagonally back toward left ear

CR fPress

F:  Pressure diagonally toward right ear

Mandibular Stabilisation Phase 2

CrJaw

Jaw position: teeth one knuckle widths apart

Directions

1.  Relax, maintain good posture and awareness of breath

2.  Place knuckle of index finger between to and bottom teeth

3.  Remove it, keeping teeth separated on knuckle width apart

4.  Place tongue on roof of mouth ( Clucking position)

5.  Apply gentle pressure to the lower jaw as shown in photographs A-F in Mandibular stabilisation phase 1

6.  Breathe in hold breath and pressure on jaw for 2 seconds

7.  Repeat 5 times, 5 times  per day

CR 2knuckleMandibular Stabilisation Phase 3

Jaw position: Teeth two knuckle widths apart

Repeat as above – End goal is to do exercises above with three knuckles width apart.

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