Having the patient involved in their own care is critical to their understanding of the nature of the problem being managed and how their day-to-day lifestyle and routines may even contribute to the problem. Developing a relationship with the patient that promotes a “therapeutic partnership” and negates the “fix me doctor” mentality will always be beneficial and often contributes to optimum outcomes. The keys to patient involvement include motivation, cooperation, and compliance.

The objectives of a successful self-management program are to promote healing and to prevent further injury to the musculoskeletal system. To be effective, this will require guidance and counseling and continued monitoring for progress and problems during the course of treatment. It should involve voluntary limitation of mandibular function, habit awareness and modification, and incorporation of a home physiotherapy program.

Modification of Functional Behavior

• Avoidance of heavy mastication, gum chewing, wide yawning, and singing.

Habit Awareness and Reversal of Parafunctional Behaviors

• Clenching, bruxing, tongue thrusting, cheek biting, poor sleeping posture, ergonomic issues when sitting, object biting, and playing some musical instruments.

Incorporating a Home Physiotherapy Program

•This can include posture training, range of motion exercises, mobilization, application of heat and/or cold, and massage.

Guidance and instruction in all of the above is often most effective if provided by a trained physical therapist with particular knowledge, skill, and experience in masticatory musculoskeletal problems. A physical therapist with these skills will evaluate the patient, not just with respect to what is going on with their jaw, but will look at them from a wider perspective. They can also provide other physical agents and modalities such as electrotherapy, ultrasound, iontophoresis, etc. that will further enhance the therapeutic response. Close communication with the physical therapist will allow the dentist to reinforce what is being provided by the physical therapist. (Link to Physical Medicine)