Temporomandibular disorders (TMDs) (previously temporomandibular joint syndrome) are a group of disorders associated with pain in the mouth and face that can progress to chronic pain.
TMDs typically present with four characteristic features: temporomandibular joint pain, noise in the joint, masticatory muscle tenderness, and limited mandibular movement.
TMDs can be self-limiting and can considerably affect quality of life.
Diagnostic Criteria for TMD, which comprises the Axis I (physical assessment) and Axis II (psychosocial assessment) domains, provides a standard criteria for the diagnosis of TMDs.
TMDs can primarily be treated by resting the affected joint.
Nonsteroidal anti-inflammatory drugs applied topically may help people with internal derangement (disk displacement) or osteoarthritis subtypes.
TMDs comprise several painful disorders involving the mandibular joint and muscles of mastication. The characteristic features of TMDs include temporomandibular joint pain, noise in the joint, masticatory muscle tenderness, and limited mandibular movement. The presenting symptoms include one or all of the following: temporomandibular joint pain or pain in the muscles of mastication; temporomandibular joint clicking, popping, or crepitus with/without locking; headache in the temporal region; and otalgia and/or tinnitus without a significant ear disorder. The US prospective OPPERA multicenter study, which included patients with TMDs, defined TMD as "a complex condition with a biopsychosocial model of illness" and stated that it is no longer appropriate to regard TMDs as a localized jaw/dental condition. Disorders related to pain (myalgia, headache related to TMD, and arthralgia) and those associated with the temporomandibular joint (disk replacements, degenerative diseases) are the most common types of TMDs. TMDs can have an impact on an individual’s quality of life.
History and exam
Key diagnostic factors
- cyclic pain
- continuous pain
- joint noise
- abnormal mandibular movement
- masticatory muscle tenderness
Other diagnostic factors
- depression or anxiety
- headache, backache, earache, or neck pain
- female sex
- pain comorbidities
- age 20-40 years
- depression, anxiety, or stress
1st investigations to order
- clinical diagnosis
Investigations to consider
- CT or cone-beam CT
temporomandibular joint pain: at initial presentation
persistent pain after 2 weeks of joint rest
refractory pain or disability: osteoarthritis or internal derangement subtype
- Chronic headache
- Acquired temporomandibular disorders in infants, children, and adolescents
Temporomandibular joint syndrome (clicking jaw)More Patient leaflets
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