Typically presents with 4 characteristic features: TMJ pain, noise in the joint, masticatory muscle tenderness, and limited mandibular movement.
Diagnosis is based on history and physical examination.
Imaging tests are usually not required. A CT that includes the mandibular condyles may be useful for diagnosing osteoarthritis, if bone degeneration is present.
Generally a self-limiting disorder. Treatment options include joint rest, or a brief course of benzodiazepines may be useful in selected patients. Nonsteroidal anti-inflammatory drugs may help people with the internal derangement or osteoarthritis subtypes.
TMJ syndrome is a term describing several painful disorders involving the mandibular joint. The 3 most common subtypes are myofascial pain and dysfunction, internal derangement, and osteoarthritis. Myofascial pain and dysfunction is the most common subtype and affects the muscles of mastication. Internal derangement involves the dislocation of the articular disc in the glenoid fossa. Osteoarthritis of the TMJ involves degeneration of the articular cartilage.
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
- depression, anxiety, or stress
- age 20 to 40 years
1st investigations to order
- no initial test
Investigations to consider
- panoramic radiograph
- CT or cone beam CT
TMJ pain: at initial presentation
persistent pain after 2 weeks of joint rest
refractory pain or disability: osteoarthritis or internal derangement subtype
Sandra McNeal, MD, DMD
Private Dental Practice
SM declares that she has no competing interests.
William Maixner, DDS, PhD
Department of Endodontics
University of North Carolina Dental Research Center
WM declares that he has no competing interests.
Kamran Ali, BDS, FDS RCS, FCPS, FFDRCSI, MMEd, FHEA
Clinical Lead in Oral Surgery
Plymouth University Peninsula Schools of Medicine & Dentistry
KA declares that he has no competing interests.
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