Oral Motor Treatment of TMD
Patients with temporomandibular disorder (TMD) exhibit impairment of orofacial muscles, mastication, and swallowing. The objective of oral motor treatment is to rehabilitate the stomatognathic (or orofacial) functions and to resolve the signs and symptoms
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Oral Motor Treatment of TMD Cláudia Maria de Felício
Abstract
Patients with temporomandibular disorder (TMD) exhibit impairment of orofacial muscles, mastication, and swallowing. The objective of oral motor treatment is to rehabilitate the stomatognathic (or orofacial) functions and to resolve the signs and symptoms of TMD. The basis of this treatment, the way it is performed, and the possibility of combining it with other modalities and future perspectives are discussed in this chapter.
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Introduction
The present chapter focuses on the application of orofacial motor treatment or therapy (OMT) for temporomandibular disorder (TMD). A brief argument is presented in order to justify OMT, followed by a general view of orofacial functions and the changes related to TMD, and finally by a description of the methods for evaluation and the therapeutic conducts. The main characteristic of TMD is orofacial pain, with an impact on the functions of the stomatognathic system such as a sensation of limitation of mastication [1–3], and, to a lesser extent, of speech. In addition, real impairment of orofacial (or stomatognathic) functions has been detected in persons with TMD [4–9]. Conservative methods focusing on pain are recommended for the treatment of TMDs, although, thus far, no modality has been considered to be definitive and not C. M. de Felício (*) Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil Craniofacial Research Support Center, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil e-mail: [email protected] © Springer Nature Switzerland AG 2019 S. T. Connelly et al. (eds.), Contemporary Management of Temporomandibular Disorders, https://doi.org/10.1007/978-3-319-99912-8_6
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all patients respond in a favorable manner. However, a question that has not been properly targeted in most treatment plans is the need to rehabilitate the orofacial motor functions, which are negatively affected in many of the individuals who seek treatment. As can be easily observed in many investigations, the measurement of the results of functional recovery is limited to an increase of the limits of mandibular movements, associated or not with subjective scales regarding the functional limitations or difficulties. However, this does not necessarily mean that the orofacial functions have been rehabilitated [4, 9]. The relief of pain after antalgic treatment such as low- intensity laser therapy, for example, permits a reduced perception of the difficulty in masticating [10] and an increase of maximal mouth opening [2, 3, 11] and of masticatory efficiency [12], i.e., better food grinding, but does not solve the orofacial myofunctional disorders (OMD) [6, 9]. OMD include changes of orofacial muscles and stomatognathic functions such as mastication, swallowing, and speech that can have a negative impact on oral and general health [13]. An altered motor performance may
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