temporomandibular joint (TMJ) syndrome
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Introduction
A syndrome used to describe a collection of symptoms related to temporomandibular joint (TMJ) dysfunction. The presence of only early manifestations of TMJ syndrome (i.e. pain & tenderness without intra-articular manifestations) is referred to as myofascial pain dysfunction (MPD) syndrome.
Etiology
- inflammatory & degenerative joint disease
- infectious arthritis
- tumors of joint structures & surrounding area
- developmental joint anomalies
- risk factors
Epidemiology
- most common in Caucasian females in 2nd to 4th decades
- less than 1/2 individuals with clinical evidence of TMJ syndrome are aware of the problem
Pathology
- persistent malfunction of the TMJ gradually causes degeneration of the intra-articular disc.
- displacement, deformity & eventually perforation of the disc occur
- meniscitis, synovitis & capsulitis occur
- bone to bone contact eventually occur
- pain, tenderness, spasm in regional muscles & noises in the joint & limited mandibular mobility result
Clinical manifestations
- early manifestations
- late manifestations
- joint noises - clicking, grinding & grating sounds
- limited mandibular movement
- inflammation
- disc displacement
Diagnostic procedures
- arthroscopy of TMJ
- injection of local anesthetic into joint to confirm source of pain
Radiology
- radiographs usually not helpful[3]
- TMJ radiographs
- computed tomography may be better for viewing early changes
- magnetic resonance imaging (MRI)
- TMJ arthrography - disc deformity, abnormal motion, perforation
Differential diagnosis
- otitis media
- neuralgia
- sinusitis
- arthritis
- tooth pain
- parotid gland pathology
- tumors
- tetanus
- other muscular &/or neurologic conditions
Management
- initial therapy
- mandibular rest
- soft diet
- local heat
- change habits/behavior
- jaw therapeutic exercises
- pharmaceutical agents
- non-steroidal anti-inflammatory drugs (NSAIDs) of unproven value
- avoid antidepressants
- avoid fluoxetine & paroxetine
- they may be associated with bruxism, exacerbating TMJ syndrome[3]
- avoid fluoxetine & paroxetine
- anxiolytic agents
- avoid narcotics because of prolonged course of TMJ syndrome
- long term management
- referral to TMJ specialist for behavioral modification & stress reduction
- cognitive behavioral therapy reduces pain, depression & interference with activities[3]
- biofeedback may be useful
- hypnosis
- psychologic counseling
- jaw appliances of uncertain benefit
- occlusal bite guards
- occlusal repositioning appliances
- surgery
- referral to oral & maxillofacial surgeon
- arthroscopic surgery in appropriate circumstances
- pharmaceutical agents
- prolotherapy with hypertonic 20% dextrose + lidocaine[6]
- monthly injections into TMJ
- referral to TMJ specialist for behavioral modification & stress reduction
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 772-73
- ↑ Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008 Dec 18;359(25):2693-705 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19092154
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, American College of Physicians, Philadelphia 2009, 2012
- ↑ Mujakperuo HR, Watson M, Morrison R, Macfarlane TV. Pharmacological interventions for pain in patients with temporomandibular disorders. Cochrane Database Syst Rev. 2010 Oct 6;(10):CD004715 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20927737
- ↑ NIH Press Release. Feb 3, 2014 First evidence-based diagnostic criteria published for temporomandibular disorders. http://www.nih.gov/news/health/feb2014/nidcr-03.htm
- ↑ 6.0 6.1 Louw WF et al. Treatment of temporomandibular dysfunction with hypertonic dextrose injection (prolotherapy): A randomized controlled trial with long-term partial crossover. Mayo Clin Proc 2019 May; 94:820. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30878157 Free full text
- ↑ National Institute of Dental and Craniofacial Research TMJ (Temporomandibular Joint & Muscle Disorders) https://www.nidcr.nih.gov/health-info/tmj