Temporomandibular Disorder Flashcards
What is TMJ
Anterior to the tragus of the ear
Articulation between the condyle and glenoid fossa
Biconcave intraarticular disc (separates bone)
Surrounded by ligamentous capsule lined by a synovial membrane (3 extracapsular ligaments stabilise TMJ)
Sensation to joint provided by v3 branch of trigeminal nerve
Movements of TMJ
Openers (depress mandible)
- lateral pterygoid
- geniohyoid
- mylohyoid
- digastric
Closers (elevate mandible)
- temporalis
- masseter
- medial pterygoid
TMD
Group of musculoskeletal and neuromuscular disorders
major cause of non-dental pain in orofacial region
pts will frequently present to GDP
TMD Epidemiology
Most common cause of non-dental orofacial pain
3rd most common of chronic pain
peak incidence 2nd-3rd decade
F>M
Factors associated with the development of TMD
Gender, Age, Ethnicity
Classifications of TMD
Muscular diagnoses –> myofascial pain/myofascial pain with limited opening
Disc displacement –> disc displacement with reduction/ disc displacement without reduction and with limited opening/disc displacement without reduction and with limited opening
Arthralgia, osteoarthritis –> Arthralgia/TMJ Osteoarthritis/TMJ Osteoarthrosis
Difference between acute and chronic pain
Acute –> identifiable cause (eg stress), short duration, identifiable trigger
Chronic –> pain exceeds 3 months/become biopsychosocially destructive/chronic pain behaviour/chronic pain conditions
Presentation
4 major signs:
1. Pain
2. Limited range of motions
3. TMJ Sounds
4. Headache related to temporalis region
Clinical features of TMD
Pain - pre-auricular region, head-neck-shoulders
Muscular tenderness - face
joint noises - clicking/crepitus
locking - open and closed
ear complaints - otalgia/tinnitus
Differential diagnosis
Cracked tooth
Dry socket
GCA
Migraine headache
Neuropathic conditions (GN/Postherpetic neuralgia/Trigeminal neuralgia)
Salivary stones
Sinusitis
Management of TMD
5-10% pts required tx
40% spontaneously resolve
multidisciplinary approach
encourages self management
Pharmacological regimes
Acute onset TMD - NSAIDs e.g., Ibuprofen
- Mod severe pain
- inhibits COX
- Analgesics, anti-pyretic, anti-inflammatory
Paracetamol
- anti-pyretic
Benzodiazepines
- acute exacerbations
Chronic TMD
Antidepressants - muscle relaxations
Muscle relaxants
Gabapentinoids
Surgical treatment
Disc displacement pathology with associated significant pain and functional impairment where conservative management has been ineffective
Treatments –> arthroscopy/athrocentosis/athroplasty/TMJ replacement
