Temporomandibular disorder

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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

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[1]

  • Analgesia
    • NSAIDs are first line, consider very short term opioids if not well controlled
  • Muscle relaxers - metaxalone and cyclobenzaprine[2]
  • Small studies show treatment with amitriptyline to be effective compared to placebo[3]
    • Dose used was 25mg/day for 14 days
  • Soft-food diet during acute episodes
  • Moist heat, massage of masticatory muscles
  • 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[4]

See Also

External Links

References

  1. Tsai V et al. Temporomandibular Joint Syndrome Treatment & Management. Jan 2018. https://emedicine.medscape.com/article/809598-treatment.
  2. Herman CR, Schiffman EL, Look JO, Rindal DB. The effectiveness of adding pharmacologic treatment with clonazepam or cyclobenzaprine to patient education and self-care for the treatment of jaw pain upon awakening: a randomized clinical trial. J Orofac Pain. 2002;16(1):64-70.
  3. Rizzatti-Barbosa CM, Nogueira MT, de Andrade ED, Ambrosano GM, de Barbosa JR. Clinical evaluation of amitriptyline for the control of chronic pain caused by temporomandibular joint disorders. Cranio. 2003;21(3):221-225. doi:10.1080/08869634.2003.11746254
  4. Guidelines for diagnosis and management of disorders involving the temporomandibular joint and related musculoskeletal structures. Cranio. 2003; 21(1):68-76.