Temporomandibular Joint Disorders

 

• Definition and types

  Chronic disorder of temporomandibular joint (TMJ) function.

  3 main types:

  • Myofascial pain: characterised by ↑tension/spasm. May be stress-related.
  • Disc displacement (aka internal derangement): anterior misalignment of joint disc with condyle.
  • Osteoarthritis (OA): TMJ degeneration.

• Presentation

  Myofascial pain:

  • Unilateral dull ache of masticators.
  • May radiate to ear, temple, cheek, and/or cause headache.
  • Worse on eating, talking, and in the evening.
  • Association with bruxism (night grinding).

  Disc derangement:

  • 'With reduction': jaw clicking as condyle moves onto disc on jaw opening and off disc on jaw closing.
  • 'Without reduction': limited jaw movement, including locking on opening.

  OA:

  • Pain on jaw movement and tender TMJ.
  • Limited movement and possibly deviation to affected side.
  • Crepitus

• Investigations

  • Diagnosis is clinical.
  • Consider underlying psychological problems as possible exacerbating factors.
  • Rule out other causes if suspected: XR (also useful for OA), WBC/ESR/CRP (inflammatory arthritis), RF (RA), dental referral.

• Management

  • Symptoms usually self-resolve.
  • Patient advice: soft foods which need less chewing, apply gentle heat, massage masticators.
  • Medical options: simple analgesia if mild, short-course benzodiazepine if severe.
  • Further options: splint, intra-articular steroids, arthroscopy.