In this article, we’ll provice step-by-step TMJ exercises and treatments for Dentists and self-mobilization stretches for patients.
The main reason why a jaw locks closed is due to a derangement of the TM joint (disk displacement without reduction or DDNR). It is also possible that the closed locking is due to trismus of the jaw closers. The pain of closed locking is usually triggered with attempts to open wide, and at rest with the jaw closed it is much less painful.
It is logical to delay a mobilization procedure until you confirm the clinical diagnosis of DDNR with an MRI of the TMJ. In most DDNR cases, mobilization exercises and stretches are adequate treatments but patients will not regain 100% of their open motion.
Related Reading: TMJ Assessment: Jaw Range of Motion, Noise, and Tenderness
If the closed locking is not due to DDNR but is limited due to trismus, mobilization will achieve 100% motion although if the cause of the trismus is still present (e.g. parafunction) it will return.
Treatment of closed locking is considered a mobilization procedure not a manipulation since in most situations, you are not able to “recapture” the displaced disk, but instead you increase the mobility of the jaw without recapturing it.
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TMJ Mobilization Procedure
Note: If muscular trismus exists, apply heat pack to the jaw for 10 minutes before mobilizing them.
First, put the patient in an upright position in a dental chair, and while standing next to them with their head about chest high, place one hand behind the head and headrest of the patient and place your fingers over the TMJ that is locked to feel it’s position and mobilize.
Next, reach in front of the patient’s face with the with other hand and grip the posterior mandible by putting your thumb on the lower incisors and fingers beneath the mandible. Using the hand on the jaw, pull the mandible down and slightly forward with slow but moderate pressure. You can lever the jaw up in the front (with your fingers under the jaw) and down in the back (with your thumb) as your hand pulls the mandible forward. If you are mobilizing a persistent trismus or an adhesion case to increase opening, then downward distraction of the temporomandibular joints is not needed.
Note: Downward condyle distraction is only needed if you are trying to mobilize an acute DDNR case.
In all cases the mobilization of a limited opening mandible involves a gentle, slow, midline sustained (usually painless) stretching of the tissues that are restricting jaw motion. As you open the jaw, assuming the problem is one sided, you can mobilize slightly off the midline, towards the medial.
Note: Side-to-side mobilization of the mandible is to be avoided since this can put substantial strain on the contralateral joint.
Perform these mobilization “stretches” slowly holding the jaw at the open position for a count of 10 seconds each time. Repeat this mobilization maneuver 5-6 times. If the patient is in pain during stretch, have them apply ice pack to jaw for 10 minutes between every 3 mobilizations. This entire process should take less than 15- 30 minutes.
Post-Mobilization Procedures
Whether reasonable mobilization is achieved or not, you should prescribe ibuprofen 400mg TID, always apply an ice pack to the TMJ after mobilization, and teach the patient to apply finger stretching of the incisors 3 times a day for 10 minutes each time until pain starts or three fingers of interincisal opening is achieved.
TMJ Self-mobilization
Place the index finger on the lower incisors and the thumb of the same hand on the maxillary premolars. This is done using both hands and using a spreading motion have the patient apply pressure to the teeth with their fingers. Be sure to encourage patients to use ice packs after home stretching if the stretch causes them pain.
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