Temporomandibular disorders

Last reviewed: 27 Aug 2023

Last updated: 20 Jun 2023

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.

Definition

TMDs comprise several painful disorders involving the mandibular joint and muscles of mastication.[1][2] 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.[2] 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.[3] 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.[1] 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

More key diagnostic factors

Other diagnostic factors

depression or anxiety
headache, backache, earache, or neck pain

Other diagnostic factors

Risk factors

female sex
pain comorbidities
age 20-40 years
depression, anxiety, or stress
genetics

More risk factors

Diagnostic investigations

1st investigations to order

clinical diagnosis

More 1st investigations to order

Investigations to consider

MRI
CT or cone-beam CT

More investigations to consider

Treatment algorithm

INITIAL

temporomandibular joint pain: at initial presentation

ACUTE

persistent pain after 2 weeks of joint rest

ONGOING

refractory pain or disability: osteoarthritis or internal derangement subtype

Contributors

Authors

Andrew Sidebottom, BDS, FDSRCS, MBChB, FRCS, FRCS (OMFS)

Consultant Oral and Maxillofacial Surgeon

Spire Nottingham Hospital

Nottingham

Disclosures

AJS has been and continues to be reimbursed for provision of educational lectures and cadaveric training courses by the following companies: Stryker, Biomet, KLS Martin. These companies make surgical implants used during maxillofacial surgery. AJS has written patient information leaflets for EIDO on various aspects of TMJ surgery. AJS has a medicolegal practice which includes provision of expert testimony for the court related to TMD. AJS is author of a number of book chapters on management of TMD. None of the above have been influenced by the paid educational provision to the above three companies.

Nabeela Ahmed, BDS, MFDS RCS England, MBChB, FRCS (OMFS)

Consultant Maxillofacial Deformity and Trauma Surgeon

Queens Medical Centre

Nottingham

Disclosures

NA declares she has no competing interests.

Acknowledgements

Dr Andrew Sidebottom and Dr Nabeela Ahmed would like to gratefully acknowledge Dr Sandra McNeal, a previous contributor to this topic.

Disclosures

SM declares that she has no competing interests.

Peer reviewers

Shanti Kaimal, BDS, MS

Clinical Associate Professor

Director, Advanced Education Program in Orofacial Pain

Division of TMD and Orofacial Pain

University of Minnesota

Minneapolis

Disclosures

Differentials
- Sinusitis
- Pericoronitis
- Chronic headache
More Differentials
Guidelines
- Acquired temporomandibular disorders in infants, children, and adolescents
More Guidelines
Patient leaflets
Temporomandibular joint syndrome (clicking jaw)
More Patient leaflets
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Temporomandibular disorders

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

temporomandibular joint pain: at initial presentation

persistent pain after 2 weeks of joint rest

refractory pain or disability: osteoarthritis or internal derangement subtype

Contributors

Authors

Andrew Sidebottom, BDS, FDSRCS, MBChB, FRCS, FRCS (OMFS)

Disclosures

Nabeela Ahmed, BDS, MFDS RCS England, MBChB, FRCS (OMFS)

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Shanti Kaimal, BDS, MS

Disclosures

Differentials

Guidelines

Patient leaflets

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

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