Temporomandibular Joint Disorder
Epidemiology
Female-to-male ratio is 4:1.
adults aged 20-40 years.
Hx
Chronic pain - dull ache, typically unilateral
radiate to the ear and jaw - worsened with chewing
Locking of the jaw when attempting to open the mouth
Ear clicking or popping, usually when displacement of the articular disk is present
Headache and/or neck ache: In some cases, patients may complain of headache without localized pain in the temporomandibular joint
A bite that feels uncomfortable
Neck, shoulder, and back pain
Bruxism, teeth clenching
Increasing pain over the course of the day
History of jaw and/or facial trauma
Clinical
Limitation of jaw opening (normal range is at least 40 mm as measured from lower to upper anterior teeth)
Palpable spasm of facial muscles (masseter and internal pterygoid muscles)
facial swelling
Clicking or popping in the TMJ
Tenderness to palpation of the TMJ via the external auditory meatus (the tips of the fingers placed behind the tragi at each external acoustic meatus and pulled forward while the patient opens the jaw)
Lateral deviation of mandible
Imaging
Panorex may show a fracture, evidence of osteoarthritis, or displacement of the articular disk
Plain radiographs may demonstrate resting and hinge movement of the TMJ
CT scan may reveal greater detail of bones than radiographs alone
MRI is the test of choice when looking for disk displacement or pathology
Treatment
Analgesics - Nonsteroidal anti-inflammatory drugs (NSAIDs)
Muscle relaxants – Benzodiazepines
Moist heat and massage of masticatory muscles
Warm and cold compresses should be used at night along with gentle massage of the TMJ area.
Patients need to avoid jaw clenching and teeth grinding if possible.
If conservative therapies fail, intra-articular injection of local anesthetics or steroids may be used for TMJ syndrome. However, repeated intra-articular injections are not recommended.
Dental splints can be used to keep the jaw more properly aligned. They also help limit nocturnal bruxism and teeth grinding.
Some patients also find benefit from ultrasonic therapy. This provides deep heat to the area of tenderness and may alleviate some patients' symptoms.
If failure of these more conservative treatments occurs, operative repair may be considered. Operative repair can range from arthroscopic procedures that can wash out the joint and allow for small repairs to open procedures. Open procedures can utilize jaw implants and synthetic articular disks. Surgery, however, is far from a cure. Friction et al demonstrated in a long-term study in which patients with synthetic implants did not have improved outcome over patients with nonimplant surgical repair or patients with nonsurgical rehabilitation.[10]
Suggest that stress can play a major role in illness.
Teach stress reduction strategies.
Provide behavior modification and counseling.
Prescribe soft diet for patients with chewing pain, and advise them to chew more slowly and take smaller bites.
Instruct patient in jaw-opening exercises.
For excellent patient education resources, see eMedicineHealth's patient education article Temporomandibular Joint (TMJ) Syndrome.