TMJ Disorders Flashcards
What are TMDs?
Temporomandibular disorders are a group of related musculoskeletal conditions affecting the masticatory muscles, the TMJ, and associated structures.
What is the instence of TMD in the population?
Anywhere between 5 and 50% of the population will suffer from it in their lifetime.
What are the common clinical findings in TMD?
Pain in the TMJ region and surrounding structures
Limititation of jaw movements
Sounds such as clicking, poping, or crepitus
Headaches limitd to temporal region
Otalgia or tinitus without aural disease
What is crepitus?
Any grinding, grating, crunching, or popping sound in a joint.
What is the difference between acute TMDs and chronic TMDs?
Acute TMD pain is often short duration, self limiting, and may be related to prolonged jaw opening.
Chronic TMD pain is pain which lasts for longer than 3 months.
What are the main types of TMD?
Myalgia/Myofacial pain
Arthralgia
Intra-articular disorders
Headache (temporal region)
When should TMD be suspected?
Pain in/around TMJ or MoM
Reproducible joint noise
Headache limited to temporal region
Otalgia and/or tinitus
When should TMD be referred to a specialist?
Symptoms persisting over 3 months, despite primary care treatment.
History of trauma to the TMJ complex
Significant limited mouth opening.
Severe pain from condition
Persistant inability to manage normal diet
Reccurent dislocation of the mandible
Other chronic pain-related comorbidities.
What would your initial conservative management be for a patient with suspected TMD?
Give advice about the condition
Encourage stress coping methods
Jaw exercises/phsiotherapy
Medication
What advice would you give the patient about TMD if they present with it?
Reassure the person that the condition is usually non-progressive, and that symptoms may fluctuate, but should improve.
Advise them:
- To eat a soft diet and rest the jaw if there is acute pain.
- To try to avoid parafunctional activities that may exacerbate symptoms, such as wide yawning, teeth grinding or jaw clenching, chewing gum or pencils, and nail biting.
- That local measures, such as applying covered ice or a warm flannel or heat pad, or massaging affected muscles may be helpful.
What non-conservative managment techniques can be taken in a patient with TMD?
Hard splint
Soft splint
Anterior bite plane
Distraction splint
Medication
What medications can be used for management of TMD?
Simple analgesia (Paracetamol, NSAIDs)
A short course of diazapam for a maximum of 2 weeks
A trial course of amitriptyline or gabapentin
How can the TMJ be internally deranged?
Disk displacement with reduction (can be associated with intermittent limitation in mouth opening and may be related to TMJ clicking)
Disk displacement without reduction (can be associated with persistent limitation in mouth opening
Subluxation (“open lock” with the patient able to
self-reduce to close their mouth).
Luxation (“open lock” where the patient requires a clinician to conduct a manipulation to close their mouth
What red flags are there for patients with TMD, indicating urgent referal?
- Sensory/motor changes
- Persistant or profound trismus
- Facial asymmetry or palpable massess
- History of recent H+N trauma
- Ipsilateral hearing changes
- Frequent luxation and sub-luxation
- Hyperalgesia
- Tinnitus
What are the main co-morbidities of TMD?
Chronic pain conditions (e.g., fibromyalgia, complex regional pain syndrome)
Anxiety/depression
Connective tissue disease (e.g., rheumatoid
arthritis, Ehlers-Danlos syndromes, systemic
lupus erythematosus, juvenile arthritis)
