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Temporomandibular Dysfunction TMD

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33 views3 pages

Temporomandibular Dysfunction TMD

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control the chaos
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© © All Rights Reserved
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Temporomandibular dysfunction (TMD)

geekymedics.com/temporomandibular-dysfunction-tmd

October 9, 2015

Temporomandibular dysfunction or TMD refers to a range of disorders causing pain in


the pre-auricular area and muscles of mastication. It is the most common non-dental cause
of orofacial pain and often goes hand in hand with other chronic pain disorders such as
headaches and fibromyalgia. This article will discuss the aetiology and clinical signs of TMD
and then outline its management.

Anatomy

Figure 1 showing the temporomandibular joint. The


meniscus is located between the head of the mandibular
condyle and the glenoid fossa of the temporal bone and
can contribute to clicking and locking of the joint.

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Causes
Multifactorial pathophysiology with no conclusive theory on the exact cause of the
condition but thought to relate to:

Stress
Low mood
Bruxism (Tooth grinding)
Co-morbidities such as chronic pain (Fibromyalgia, Chronic Fatigue Syndrome, Back
pain, Headache)
Trauma to the teeth/face causing malocclusion (an abnormal bite)

Clinical features
Pain in the pre-auricular area (can radiate to jaw/temporal region)

Clicking (due to “sticking” of the meniscus/disc)

Locking (where the disc becomes trapped preventing the jaw from closing)

Trismus (reduced mouth opening)

Examination

Inspection
This should include inspection of the mouth and teeth to rule out any dental pathology
and an examination of the patient’s occlusion (bite).

Palpation
Palpation of the TMJs bilaterally and the muscles of mastication should help define
where the pain is located. Place your fingertips just anterior to the tragus to feel for
clicking, locking and local tenderness. In addition, patients often complain of pain along
the insertions of the masseter and temporalis muscles and so it is worth palpating there
too.

Ask the patient to open and close their mouth whilst palpating the joint to detect
clicking. Any deviation or locking of the jaw can be observed at this point (i.e. where the
mouth doesn’t open fully in a straight line.)

Management
The aim of treatment is to eliminate pain and aid a return to normal jaw function. The vast
majority of cases can be managed conservatively with only a small minority requiring
invasive surgical management.

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Conservative management
Explanation and reassurance – probably the most important aspect of management as
explaining the benign nature of the condition often helps significantly

Identification of problem habits such as nail biting and chewing gum

Jaw exercises (advice sheets are available online and in OMFS units)

Pharmacotherapy

Regular NSAID treatment – reduction in pain and inflammation around the TMJ.
A short course of Amitriptyline (a tricyclic antidepressant) can be used in more severe
cases of pain.

Splint therapy – often helps reduce bruxism and jaw clenching at night. Requires referral
to a Dentist or Oral Surgery unit.

Physiotherapy – improves joint function through jaw stretch and muscle relaxation.

Acupuncture – Often done by the physiotherapist alongside physiotherapy.

Surgical management
Only to be considered for patients refractory to the above measures.

It includes procedures such as:

Arthrocentesis
Arthroscopy
Arthroplasty
TMJ replacement surgery (rare)

Always consider other important differential diagnoses such as giant cell arteritis and
oropharyngeal tumours and ask for help if unsure.

References
1. Dwonkin SF. The OPPERA study: Act One. J pain 2011; 12: T1-T3
2. Durham J, Newton-John TR, Zakrzewska JM. Temporomandibular Disorders.
BMJ2015;350:h4154
3. Ghurye S, McMillan R. Pain-Related Temporomandibular Disorder – Current
Perspectives and Evidence-Based Management. Dental Update 2015; 42 (6): 533-
546
4. TMJ image: Anatomy & Physiology, Connexions Web site.
http://cnx.org/content/col11496/1.6/, Jun 19, 2013.

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