Module 8.14 - Temporomandibular Joint Disorder

Question 1

What is temporomandibular joint disorder?

Answer 1

• Also called myofascial pain dysfunction (MPI)
• It is a group of symptoms involving pain in the temporomandibular joint (TMJ) and spasm of the masticatory muscles, especially the masseter muscle, thought to be caused by a psychosomatic response to stress and manifested by jaw clenching, or bruxism.

Question 2

What are some predisposing factors for temporomandibular joint disorder?

Answer 2

A. Rheumatoid arthritis

B. TMJ synovitis

C. Trauma

D. Ill-fitting dentures

E. Intra-articular disk disease

F. Oromandibular dysfunction

G. Recent dental work

Question 3

What are some physical exam findings associated with temporomandibular joint disorder?

Answer 3

A. Ranges from mild aching to severe, sharp pain in and around the TMJs.

B. Pain with movement of the joint, especially with chewing and a clicking/popping sound may be heard on movement.

C. Pain often referred to the ear, causing tinnitus, pain and hearing difficulties

D. Possible cervical spine or cranial tenderness

E. Dental malocclusion

F. Dental erosion from bruxism (teeth grinding)

Question 4

What are some laboratory/diagnostic findings used to diagnose temporomandibular joint disorder?

Answer 4

A. Clinical findings are helpful for ruling in MPD
B. Consider X-rays of TMJ, which may reveal bone abnormalities

C. Consider CT, MRI and arthrography- which may show degenerative arthritic or possible neoplastic causes

Question 5

How do you manage a patient with temporomandibular joint disorder?

Answer 5

A. Generally, treatment is supportive.

B. NSAID’s – Ibuprofen 200-600mg q 6 hours prn or Naproxen 500mg initially, followed by 250mg q 6 hours prn pain (NOTE* Patient education regarding chronic use due to potential for reduced renal function; take with meals/food)

C. Local heat prn

D. Soft diet

E. Referral to oral surgeon for severe conditions

F. Consider trigger point injections or arthroscopy.