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Temporomandibular Joint Disorders (TMD)

  • Elie M. Ferneini
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    Address correspondence and reprint requests to Dr Ferneini, University of Connecticut School of Dental Medicine, Oral & Maxillofacial Surgery, Greater Waterbury OMS/Beau Visage..., 435 Highland Avenue Suite 100, Cheshire, CT 06514
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    Section Editor, Simply Put: JOMS Information for Patients
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      The temporomandibular joints (TMJ) connect your lower jaw to your skull along each side of your head. When they work well, they enable you to talk and chew. The TMJ combines a hinge action with sliding motions. The parts of the bones that interact in the joint are covered with cartilage and are separated by a small disk, which normally keeps the movement smooth (Fig 1). For people with TMJ disorders (TMD), problems with the joint and muscles around it may cause:
      • Muscle pain that travels through the face, jaw, and/or neck.
      • Stiff jaw and neck muscles.
      • Limited movement or locking of the jaw.
      • Painful clicking or popping in the jaw.
      • A change in the way the upper and lower teeth fit together.
      • Pain in your ears or TMJs.
      Chronic TMD pain can lead to long-term problems such as depression, anxiety, and frequent headaches.

      Causes

      TMD affects up to 15 to 20% of adult patients, with a peak incidence at 20 to 40 years of age.
      • Gauer RL
      • Semidey MJ
      Diagnosis and treatment of temporomandibular disorders.
      It tends to be more common in women. The cause of TMD is multifactorial and includes biologic, environmental, social, emotional, and cognitive reasons.
      Painful TMD can occur if:
      • The disk erodes or moves out of its proper position,
      • The joint's cartilage is damaged by arthritis or trauma,
      • Habits such as grinding of one's teeth are present.

      Diagnosis

      If your oral and maxillofacial surgeon suspects a problem, he or she will perform a detailed medical evaluation. This may include:
      • A panoramic X-ray to examine your teeth and jaw bone,
      • Computed tomographic (CT) scanning to provide detailed images of the bones involved in the joint,
      • Magnetic resonance imaging (MRI) to evaluate potential problems with the joint's disk and surrounding soft tissue or muscles.

      Treatment

      TMD symptoms commonly go away without treatment. Routine home treatment can often relieve jaw pain. There are things you can do to reduce pain. These include:
      • Rest your jaw joint by eating soft foods.
      • Use medicines such as ibuprofen for a short time in order to inflammation around the TMJ.
      • Use either an ice or warm pack for 15 minutes several times a day over painful areas.
      • Find ways to reduce stress in your life such as regular exercise.
      • Splints, also called bite plates, can be helpful to alleviate TMD pain. Splints are clear pieces of plastic that fit between the upper and lower teeth. They can help reduce grinding and clenching.
      • Seek care from specially trained physical therapists.
      Surgery is rarely required for the management of TMD and is usually reserved for correction of anatomic or disk problems. Surgical options include arthrocentesis, arthroscopy, and open joint surgery.
      Arthrocentesis is a minimally invasive treatment. It involves placing small needles into the joint spaces, washing the joint with the possibility of depositing a drug or other therapeutic substance. This technique can also remove inflammatory agents.
      Arthroscopy allows your oral and maxillofacial surgeon to see inside your joint using a camera inserted through tiny incisions in your skin. Your surgeon can diagnose problems such as a torn cartilage and damage to the surface of the joint. He or she might be able to treat some problems using surgical instruments through the scope.
      • Askar H
      • Aronovich S
      • Christensen BJ
      • et al.
      Is arthroscopic disk repositioning equally efficacious to open disk repositioning? A systematic review.
      Open joint surgery involves an incision over the joint. It is usually reserved for severe TMD patients that have:
      • Excess tissue or bone growth that stops the joint from moving or functioning properly.
      • Fusion of the joint tissue, cartilage, or bone (ankylosis).
      • Inability to reach the joint with arthroscopy.
      • Severely malpositioned or damaged disc, or severe bony changes.

      References

        • Gauer RL
        • Semidey MJ
        Diagnosis and treatment of temporomandibular disorders.
        Am Fam Phys. 2015; 91: 378-386
        • Askar H
        • Aronovich S
        • Christensen BJ
        • et al.
        Is arthroscopic disk repositioning equally efficacious to open disk repositioning? A systematic review.
        J Oral Maxillofac Surg. 2021; 79

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