CabinetMaxillo·Facial
Temporomandibular disorders (TMD) affect about one adult in three at some point in life. Pain in front of the ear, clicking when chewing, mornings with a stiff jaw, episodes of locking: most of it responds to conservative, measured physiotherapy.
TMD covers muscle and joint problems of the jaw. Research (the OPPERA study) validated a bio-psycho-social model: pain results from the interaction of musculoskeletal factors, individual sensitivity and life context. Mouth opening below 40 mm is considered restricted; normal adult opening lies between 40 and 60 mm. Care is conservative in the vast majority of cases.
Patients rarely come for a diagnosis. They come because something in daily life has become difficult.
Cutting food smaller, avoiding baguettes and apples, chewing on one side only. Meals take planning.
A pop at every opening, sometimes loud enough for the person next to you. With or without pain.
Stiffness on waking, a jaw that needs to warm up, occasional episodes where it blocks completely.
« I saw my dentist, my GP, even an ENT. Everything is normal, but I still cannot open my mouth properly. »
What patients typically say at the first visitThe temporomandibular joints work as a pair: every bite, word and yawn uses both at once, guided by the masticatory muscles. Problems can come from the joint itself (disc displacement, inflammation), from overloaded muscles, or from both, and about half of chronic TMD patients also have neck pain, which is why the assessment always includes the cervical spine.
In front of the ear or in the cheek, worse when chewing. Ear fullness or tinnitus modulated by jaw movements can share the same origin.
Popping on opening, a jaw that shifts to one side, tiredness when talking or eating.
Less than 40 mm between the incisors, difficulty with dental care, yawning or large bites.
A measured baseline comes first: opening in millimetres, deviation, lateral movements, muscle palpation, OMES and JFLS-8 scores. Then treatment, re-measured across sessions.
Clicking alone, without pain or locking, is common and often needs no treatment. Clicking with pain, limited opening or episodes of locking deserves an assessment.
Rarely. The vast majority respond to conservative care: manual therapy, exercises and habit modification. Surgery concerns a small minority of cases, decided by a surgeon.
Sudden severe pain, fever, trauma, or a jaw completely blocked warrants medical or dental review before physiotherapy. For most other situations, assessment can be the first step.
Mouth opening in millimetres, deviation, lateral movements, plus the OMES protocol and the JFLS-8 scale from the DC/TMD framework. You receive a one-page report, and your doctor too if you wish.