TMD/Facial Pain and Forward Head Posture
by Leonard B. Goldstein, DDS, PhD and Howard W. Makofsky, PT, DHSc, OCS
 Differential diagnosis is a key component in any successful
dental treatment, and that key is especially applicable in patients who demonstrate head,
neck, and facial pain. One such dysfunction that has been shown to contribute to head,
neck, and facial pain, is temporomandibular joint disorder (TMD), where successful
diagnosis often proves to be vital for successful intervention and treatment.1,2
TMD has been shown to manifest itself as pain and hypertonicity in the muscles of
mastication, and in the muscles of the head, neck-jaw complex, as demonstrated by
increased electromyographic activity.3-7 TMD and associated head neck and
facial pain is most frequently treated by dentists, physical therapists, and
psychologists.8 Traditionally, dentists have utilized oral appliances to treat
TMD.9-13 Physical Therapists have commonly used a variety of TMD treatment
procedures including exercise, heat, cold, ultrasound, electrical stimulation,
biofeedback, soft-tissue techniques, massage, and mobilization/manipulation.14-16
The interventions of both dentist and physical therapist may result in resolution of
symptoms, but desired outcomes may often elude both patient and practitioner. The dentist
has only partial success in cases where TMD and cervical problems exist together, whereas
the physical therapist cannot resolve cervical problems if adjacent TM disorders are
ignored.17
Postural Contribution to TMD
The dental profession is aware of the relationship of head, neck, and jaw posture.18
Many authors have suggested that postural problems may lead to pain and dysfunction, while
others postulate that Forward Head Posture (FHP) is associated with temporomandibular
disorders (TMD).18,19 However, postural considerations are often overlooked by
the dental profession in the diagnosis and treatment of facial pain and TMD.
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— Jul/Aug 2005
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