Temporomandibular disorders
Temporomandibular disorders are a group of conditions involving the temporomandibular joint and muscles of mastication that cause unilateral facial pain worsened by jaw motion, clicking or locking, and limited jaw opening. Diagnosis is clinical, and first-line management is patient education, a soft diet, NSAIDs, and a dental splint, escalating to intra-articular corticosteroid injection or surgical referral for refractory disease.
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What this article covers
- Overview
A disorder of the joint and its muscles, not a single disease: temporomandibular disorders (TMD) are a group of conditions involving the temporomandibular joint (TMJ) and the muscles of mastication…
- Epidemiology
Common cause of orofacial pain: TMD is one of the more frequently encountered causes of chronic facial pain and jaw dysfunction.
- Risk factors
Bruxism and joint trauma: repetitive parafunctional grinding or clenching and direct trauma to the TMJ are the leading contributors.
- Pathophysiology
Joint trauma and repetitive loading: bruxism and other parafunctional habits repeatedly load the TMJ and masticatory muscles, driving joint and muscle pain.
- Clinical features
Unilateral facial pain that worsens with jaw motion, waxing and waning: the hallmark feature; pain is typically one-sided and fluctuates in intensity, worsening with chewing or other jaw movement.
- Differential diagnosis
Giant cell (temporal) arteritis: unlike TMD, presents with jaw claudication (mandibular pain and fatigue triggered by chewing and relieved by rest), new temporal headache, tender or pulseless…
- Diagnosis
A clinical diagnosis: the diagnosis of TMD is made primarily on history and physical examination findings, no laboratory test or imaging study is required to confirm it; the combination of…
- Management
First, patient education and self-care measures: advise a soft diet and avoidance of triggers such as wide yawning, gum chewing, and hard or chewy foods; these non-pharmacologic measures are first-line for all patients.
- Complications
Chronic jaw locking: progression of disc or joint dysfunction can lead to persistent limitation of jaw opening that interferes with eating and speech.
- Prognosis
Generally favorable with conservative therapy: most patients improve with patient education, a soft diet, NSAIDs, and splinting without needing injection or surgery.
- Prevention
Treat bruxism early with an occlusal splint: fitting a dental splint (night guard) at the first sign of bruxism-related tooth wear or jaw symptoms reduces the parafunctional loading that drives TMD.
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