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Updated: Dec 17 2021

Temporomandibular Disorders

  • Snapshot
    • A 31-year-old woman presents to her primary care physican for facial pain. Her pain is dull-like and worsens with mastication or fingernail biting. The pain begins at the jaw and radiates to the ear. Physical examination is notable for tenderness to palpation of the temporomandibular joint, along with a "knocking" sound when the jaw is opened.
  • Introduction
    • Overview
      • a group of conditions that lead to abnormalities of the muscular and/or articular parts of the temporomandibular joint
    • Associated conditions
      • other chronic pain disorders
        • migraine
        • fibromyalgias
        • myofascial pain syndrome
  • Epidemiology
    • Demographics
      • more common in women
      • greatest risk between 18-44 years of age
    • Risk factors
      • rheumatoid arthritis
      • trauma
      • parafunctional chewing habits
        • fingernail biting
        • jaw clenching/bruxism
        • wind instrument playing
    • Pathophysiology
      • Mechanism of injury
        • joint trauma
        • poor head and cervical posture
  • Presentation
    • Symptoms
      • facial pain
        • unilateral and typically dull-like
        • worsens with jaw motion
        • pain can radiate to the
          • ear
          • temporal region
          • mandible
          • posterior neck
      • headache
        • ear or preauricular pain
          • radiates to the jaw, temple, or neck
      • neck pain
    • Physical exam
      • facial or jaw tenderness
      • limited mouth opening
      • temporomandibular joint (TMJ) noises with use
  • Imaging
    • Radiography
      • indications
        • when there is suspicion for
          • articular disc derangement
          • arthropathy
          • malignancy
      • comments
        • CT and/or MRI is used if radiography is abnormal or if there is severe pain on exam, cranial nerve involvement, or previous surgery in the TMJ
  • Differential
    • Trigeminal neuralgia
      • differentiating factors
        • pain is described as paroxsymal and severe stabbing pain
  • Treatment
    • Conservative and lifestyle
      • avoiding triggers
        • indication
          • initial management
        • modalities
          • patients are counseled to adjust
            • head posture
            • sleeping position
            • parafunctiona oral behaviors (e.g., pen chewing)
    • Medical and pharmacologic
      • nonsteroidal antiinflammatory drugs
        • indication
          • initially pharmacologic therapy for pain management
      • muscle relaxants
        • indication
          • pain upon palpation of the mastication muscles
  • Complications
    • Headache
    • Jaw deformity and dysfunction
  • Prognosis
    • Most patients are responsive to treatment and a small percentage of patients develop chronic temporomandibular joint pain
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