Dentistry Book

Intervertebral Disc Disorders

Miscellaneous

  • Temporomandibular Joint Disease

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Temporomandibular Joint DiseaseAka: Temporomandibular Joint Syndrome, Temporomandibular Joint Disorder, Temporomandibular Joint Dysfunction, TMJ

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  1. See Also
    1. Temporomandibular Joint
  2. Definition
    1. Temporomandibular Joint inflammation
  3. Etiologies
    1. Malocclusion
    2. Displacement of condylar head
    3. Bruxism
    4. Trauma
    5. Acute synovitis
    6. Arthritis (Osteoarthritis or Rheumatoid Arthritis)
  4. Symptoms
    1. Pain on opening and closing mouth
      1. Pain is classically anterior to tragus
      2. Worse in the morning
      3. Radiation
        1. Ear Pain
        2. Cheek pain
        3. Temple pain
        4. Neck pain
        5. Shoulder Pain
    2. Restricted Jaw function
      1. Jaw movement feels 'Tight'
      2. Sudden 'catching' suggests mechanical dysfunction
    3. Noise or crepitation at TMJ
      1. Clicking or grating sound (common and not a marker of worsening or improvement)
      2. Exacerbated by chewing
  5. Signs
    1. Temporomandibular Joint exam technique
      1. Apply index finger on either side of face
        1. Position finger preauricular over pretragal area or inside external meatus
      2. Patient opens mouth widely and closes several times
    2. Observe for:
      1. Clicking noises
      2. Limited range of opening (Normally 4-5cm)
      3. Subluxation (locking on opening)
      4. Deviation of jaw during movement
      5. Pain to palpation of joint
  6. Diagnosis
    1. Consider Temporomandibular Joint Diagnostic Injection
  7. Classification
    1. TMJ due to articular disorder
      1. Congenital disorder or tumor of the mandible or cranial bones
      2. Articular disc displacement
      3. Condylar process Fracture
      4. Anklyosis, synovitis, capsulitis or Osteoarthritis of the Temporomandibular Joint
      5. Temporomandibular Joint disclocation
    2. TMJ due to masticatory muscle disorders
      1. Myofascial pain
      2. Myofibrotic contracture
      3. Myositis or muscle spasm
  8. Imaging (consider)
    1. XRay
    2. Arthroscopy
    3. MRI
  9. Differential Diagnosis
    1. See Orofacial Pain
  10. Management: General Measures (Effective in 80% of cases)
    1. No chewing gum or ice
    2. Very soft diet
    3. Analgesics
      1. NSAIDs are effective for local synovitis or Myositis
    4. Local massage
    5. Heating pad or local moist heat as needed
    6. Elevate head of bed to 30 degrees or more
  11. Management: Bruxism and Chronic Pain Management
    1. Muscle relaxants (e.g. Flexeril)
    2. Tricyclic Antidepressants at bedtime (e.g. Amitriptyline)
    3. Cognitive behavioral therapy
    4. Transcutaneous electrical nerve stimulation (TENS unit)
    5. Anxiolytics or Antidepressants
      1. Risk of bruxism with SSRIs (rare)
  12. Management: Dental Occlusion
    1. Orthodontic appliances
      1. Nonoccluding splint (simple splints)
        1. Prevent teeth clenching and bruxism by opening the jaw
        2. Inexpensive, pre-fabricated splints are available at pharmacies
      2. Occlusal dental device (Occluding splints, stabilization splints)
        1. Custom made to assist teeth alignment
        2. Price runs several hundred dollars due to custom fit and adjustment by dentist
        3. Alleviates symptoms in over 70% of TMJ patients
    2. Surgery
      1. Indicated in less than 5% of TMJ patients
  13. Course: Prognosis
    1. Improvement in one year: 50%
    2. Improvement completely in 3 years: 85%
  14. References
    1. Buescher (2007) Am Fam Physician 76(10):1477
    2. Dimitroulis (1998) BMJ 317:190
    3. Shankland (2004) Gen Dent 52:349
    4. Truelove (2006) J Am Dent Assoc 137:1099

Temporomandibular Joint (C0039493)

Definition (MSH)An articulation between the condyle of the mandible and the articular tubercle of the temporal bone.
Definition (CSP)temporomandibular articulation: a bicondylar joint formed by the head of the mandible and the mandibular fossa, and the articular tubercle of the temporal bone.
Definition (NCI)The joint between the head of the lower mandible and the temporal bone.
ConceptsBody Space or Junction (T030)
MSHD013704
EnglishArticulatio temporomandibularis, Jaw Joint, Temporomandibular Joint, Temporomandibular joint structure, Temporomandibular Joints, TMJ
Spanisharticulacion temporomandibular, estructura de la articulacion temporomandibular
Parent ConceptsJaw (C0022359), Joints (C0022417), Stomatognathic System (C0038369), Joint by Site (C1517621), Bilocular joint structure (C0224501), Synovial joint structure (C0224507), Joint of head (C0224525), Lower jaw region (C0460026), Oral cavity (C0226896), Set of cranial synovial joints (C0926697)
SourcesCSP, LCH, LNC, MSH, MTH, NCI, SCTSPA, SNOMEDCT, UWDA
Derived from the NIH UMLS (Unified Medical Language System)



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