Orofacial pain

Question 1

What is TMD

Answer 1

• Temporomandibular dysfunction is an umbrella term that covers pain and dysfunction of the muscles of mastication and temporomandibular joint, manifesting as pain associated with chewing, opening the mouth, and the area of the TMJ

Question 2

Aetiology of TMD

Answer 2

• Muscle problems
• Joint mechanic problems
• Arthritic destruction

Question 3

Symptoms of TMD

Answer 3

o Uni/bilateral facial pain
o Ear pain (tinnitus)
o Eye pain (retro or periorbital)
o Headaches (frontal, parietal, or occipital)
o Pain on chewing or yawning
o Inability to open mouth wide

Question 4

Signs of TMD

Answer 4

o MoM tender to palpation
o Joint sounds – clicking or crepitus
o Muscle spasm
o Disc subluxation

Question 5

Special tests for TMD

Answer 5

o OPG
o CT
o MRI
o Arthroscopy

Question 6

Conservative management of TMD

Answer 6

Cognitive behavioural therapy
Physiotherapy
Massage therapy
Diet modification
Counselling for stress
Hot and cold packs
Intra-oral appliance (splint / nightguard)

Question 7

Pharmacological management

Answer 7

o Acute Pain (< 3 months)
 Paracetamol and NSAID
 Ibuprofen 400mg, tds 7 days
 Naproxen 250mg, tds 1 month
 Diclofenac Sodium 25mg, 1-2 tds 1 month
 Opiates for a short duration
o Chronic Pain (> 3 months)
 Benzodiazepines – diazepam 5mg TDS for a maximum of 10 days (more diagnostic)
 Tricyclic antidepressants – Amitriptyline or Dothiepin can be prescribed in conjunction with a physician consultation. Requires monitoring for liver dysfunction as a side effect.

Question 8

Interventional management of TMD

Answer 8

Botox
Arthrocentesis
Correction of malocclusion