disorders (TMD) or Jaw joint/ TMJ disorders
are one of the most common causes of facial pain after
odontogenic origin (dental causes).
The temporomandibular disorders (TMD) are of
multifactorial etiology and characterized by multiplicity of clinical signs and
symptoms, making its diagnosis and management very difficult for the clinician.
TMD should be considered in the differential diagnosis of headache, neck pain, back pain, shoulder pain, pain around eyes and forehead, blurring of vision, ear pain, fullness in the ears, tinnitus (ringing in the ears), vertigo, dizziness, psychological problems, lack of concentration,anxiety, nausea, vomiting, and
oro-facial pain in the absence of specific attributable organic cause
Scientific evidence shows that non-invasive methods are preferred in the management
of TMD. These include occlusal, behavioural physical and pharmacological
Practitioners of medicine and dentistry have the responsibility of
diagnosing and managing people with TMD or refer them to an appropriate health
care professional based on the nature and etiology of the problem. Uniqueness of the TM
Signs and Symptoms
of Temporo mandibular joint disorders / Jaw Joint problems
TMJs are 2 joints, formed by 3 bones and their functions are
articulating surfaces of the TMJ are covered by a fibrous connective
tissue; this avascular and non-innervated structure has a greater capacity
to resist degenerative change and regenerate itself than the hyaline
cartilage of other synovial joints.
are synovial joints with both rotatory and translatory movements possible.
articular disc completely divides the joint space into separate upper and
lower joint compartments.
functions of the joints are not only influenced by the muscles and
ligaments, but also by the teeth and their alignment.
- Soreness of
Muscles of mastication
- Attrition of
teeth and sensitivity
- Hypermobility of
- Pain in the
- Clicking in the
- Crepitation in
- Difficulty in
opening of mouth
- Open lock of the
The signs and
symptoms of TMD improve for most of the patients over time with or without
treatment. As much as 50 percent of the patients improve from TMD symptoms in
one year and almost 85 percent improve completely in three years. Interventions
that change the anatomy of the joint, invade the integrity of the joint space,
or manipulate the jaw have the potential to cause harm and have not been shown
to improve symptoms. Therefore, self-care and noninvasive treatments are good
options and should be attempted before invasive or permanent therapies, such as
orthodontics or surgery, are recommended.
There is little
evidence to suggest that any TMJ disorder treatment modality is superior to any
other, although it is generally accepted that self-care and behavioral
interventions should be encouraged for all patients, regardless of which
therapies are considered. Providing a few simple exercises, behavioral
instructions, and reassurance are important steps when treating the average
patient with new or intermittent symptoms.
therapies are commonly used for the treatment of TMJ disorders. The disciplines
of medicine, dentistry (occlusal splint therapy, replacement of missing teeth,
correcting malocclusion), physical therapy, and psychology can provide
effective treatment in different clinical situations.
The indicated classes of pharmacologic agents
include analgesics, anti-inflammatory agents, corticosteroids, anxiolytics,
muscle relaxants and antidepressants. Non-opiate analgesics are effective for
mild to moderate acute pain associated with TMD, and opioid narcotics are
considered for short-term use in only controlling acute severe pain.
Additionally, tricyclic antidepressants appear to be effective in the control
of chronic orofacial pain of non-inflammatory origin, independent of their
effects on mood, with daily doses smaller than those typically used in the treatment
of depression. As most of the patients with TMJ disorders improve with or without treatment, these
conservative therapies should be encouraged before invasive treatments are
occlusal splint therapy, replacement of
missing teeth, correcting malocclusion using braces, Occlusal adjustments
corticosteroid or anesthetic injection,
treatment, Acetaminophen, Anxiolytics, Benzodiazepines, Muscle relaxants
anti-inflammatory drugs, .Tricyclic
Superficial or deep
Lateral jaw movement
electrical nerve stimulation
is indicated only in specific articular disorders, usually in cases that do not
respond to conservative treatment, and when the patient’s quality of life has
been significantly affected.Surgical
management may vary from closed surgical procedures, such as arthrocentesis and
arthroscopy, to more complex open joint operations, such as arthrotomy, disk
repositioning, diskectomy and condylotomy.
Medical and dental
practitioners should consider temporomandibular Joint disorders as a possible cause
in the diagnosis of oro-facial pain including headaches, shoulder and neck
pain, vertigo and associated pain, blurring of vision, disorders of hearing,
nausea, vomiting, and disturbances in concentration, in the absence of any specific, attributable or organic cause.
While orofacial pain
and headache secondary to jaw muscle function and dental structures ideally be
managed by dentists, pain in the head and neck region unrelated to it should be
should be referred to an appropriate medical care specialists for management.
– TMD, Temporomandibular disorders, headache, facial pain, diagnosis
Review article by
Consultant orthodontist -Venkat Dental Center
Professor and Head, Department of Orthodontics
Chettinad Dental College and Research Institute
Ph 044-24746073, 24746078, 9444845443, 9003230250
Doctor Dr. Venkateswaran Sundaram, 2013081923:33:58