Physical therapy for temporomandibular disorders: evidence-based improvements and enhancements for diagnosis and management

The most common oral and maxillofacial disorders treated by physical therapists are temporomandibular disorders (TMD), and rehabilitation strategies continue to evolve with advancements in research and technology. While physical therapy is an evidence-supported approach to the management of TMD, difficulties with referral to and access to appropriately trained physical therapists can create disparity in care for patients. Lack of interdisciplinary collaboration and practice is an ongoing issue, particularly among dentists and physical therapists and this can translate to less than optimal care for individuals with TMD. While dentists and physical therapists may utilize similar diagnostic criteria, implementation gaps in use of consistent diagnostic criteria still exist across both professions. Additionally, possibilities exist for the future expansion of such criteria to recognize the contribution of structures and comorbidities outside of the masticatory system such as the cervical spine and central nervous system changes that can promote the persistence of pain in some individuals with TMD. Pain neuroscience education, epigenetics, and other rehabilitation tools such as virtual reality may allow physical therapists to address the central nervous system changes associated with pain persistence and a fear of movement seen in some individuals with TMD. Applying biomechanical knowledge gained from real-time ultrasound muscle imaging and musculoskeletal modeling will enhance diagnostic management and post-surgical rehabilitation approaches. The purpose of this review paper is to describe novel evidence-based rehabilitative tools or concepts that can be used to improve the diagnosis and management of individuals with TMD. Continued growth and development in research and clinical practice related to TMD will ultimately lead to improved care for individuals with TMD, both conservatively and post-surgically.