Chronic TMD

Question 1

What are conditions associated with chronic primary oro-facial pain?

Answer 1

• TMJ pain (facial arthromyalgia) - most common
• Atypical facial pain
• Burning mouth syndrome
• Atypical odontalgia

Question 2

What do you examine on a patient with suspected TMD?

Answer 2

• Tenderness on palpation
• Joint noises (clicks, crepitus)
• Range of motion - pain free opening, maximum unassisted opening, deviation on opening
• muscles of mastication tenderness
• check for trismus
• lymph nodes
• suspicious IO soft tissue lesions

Question 3

What does a sustained deviation on opening suggest?

Answer 3

• lesion in joint suspected

Question 4

What does tenderness in the muscles of mastication suggest?

Answer 4

Myalgia/myofascial pain

Question 5

How are TMD and headaches related?

Answer 5

Arthralgia (joint pain) causes headaches and TMJ pain
Clenching makes temporalis tender

Question 6

What are the misdiagnoses for TMD?

Answer 6

Ear pain
Toothache in upper molars
Persistent idiopathic facial pain
Acute and coronary sinusitis

Question 7

What is the management of TMD?

Answer 7

Splints - not evidence based
Surgery - very rare

EBM - biopsychosocial approach - education, physical, psychosocial self-regulation
Identify habits and pain triggers and reverse/reduce triggers
massaging masseters
Heat/cold packs