Temporomandibular disorder

Background

• TMJ refers to temporomandibular joint dysfunction, a symptom complex caused by pain/dysfunction of the muscles of mastication
• Associated with bruxism, degenerative joint disease, trauma, and anatomical issues of the TMJ joint

Clinical Features

• Jaw pain
• Popping/clicking of jaw
• Ear pain/popping
• Headache
• Intermittent locking of the jaw

Differential Diagnosis

Jaw Spasms

• Acute tetanus
• Akathisia
• Conversion disorder
• Drug toxicity (anticholinergic, phenytoin, valproate, carbamazepine)
• Dystonic reaction
• Electrolyte abnormality
  • Hypocalcemic tetany
  • Magnesium
• Mandible dislocation
• Meningitis
• Peritonsillar abscess
• Rabies
• Seizure
• Strychnine poisoning
• Stroke
• Temporomandibular disorder
• Torticollis

Evaluation

• Clinical diagnosis
• Research Diagnostic Criteria (RDC/TMD) is gold standard for diagnosis/research purposes
  • Pain in muscles of mastication, the TMJ, or the periauricular area, usually worsened by manipulation or function
  • Asymmetric mandibular movement with or without clicking
  • Limitation of mandibular movements
  • Pain present for minimum of 3 months
• Consider imaging if history of trauma/facial trauma

Management

• Analgesia
  • NSAIDs are first line, consider very short term opioids if not well controlled
• Muscle relaxers
• Soft-food diet during acute episodes
• Occlusal splints/bite blocks at night for bruxism

Occlusal splint

Disposition

• Discharge
• Follow up with dentist/primary care provider
• 50% of patients have improvement in 1 year, 85% in 3 years