Temporomandibular Joint Disorder (TMJD) is an umbrella term for a complex, multifactorial group of conditions. The most common types of TMJD include pain disorders related to the muscles of mastication: myalgia, arthralgia and headache (attributed to TMD); and disorders associated with the temporomandibular joints primarily due to disc displacements and osteoarthritis.
It is estimated to affect between 5% and 12% of the population, with women at least four times as likely to experience the disorder. Medical practitioners will encounter numerous patients suffering from these group of conditions.
Signs and symptoms of TMD include pain modified by jaw movement, function or parafunction, temporal region headache, regional pain, jaw locking, interference with mastication, TMJ noise (clicking or crepitus) and headache modified by jaw movement function or parafunction.
The TMJ is primarily innervated by the auriculotemporal branch of the mandibular division of the trigeminal nerve (V3), which also innervates the anterior wall of the external auditory canal. Neoplastic and inflammatory processes involving the sensory distribution of these nerves may refer to the ear and TMJ causing referred otalgia, ‘fullness’ and tinnitus.
Multiple pathological processes may mimic TMJD. These include trauma (fractures and/or haematomas), infection, developmental defects (e.g. coronoid hyperplasia), synovial proliferation, myositis ossificans, inflammation (parotid gland, temporal bone, temporal arteritis), and referred pain of cardiac origin, odontogenic causes, or facet joint degeneration, and primary or secondary malignancies.
Three questions can be used to screen for temporomandibular disorders which have demonstrated reasonable sensitivity and specificity.
- Do you have pain in your temple, jaw, or jaw joint at least once a week?
- Do you have pain at least once a week when opening your mouth or chewing?
- Does your jaw lock or become stuck at least once a week?
Significant associations have been found between TMJD and beliefs and activity interference, depression, anxiety, somatisation and catastrophising behaviour. Sadly, there is also consistent evidence to suggest an association between early life adversity and TMJD. It has been reported that a higher proportion of patients with TMJD have disclosed a history of physical and/or sexual abuse.
Management of patients with TMJD necessitates expertise and a willingness to explore a patient’s current and previous psychosocial history. A tailored and multimodal approach to treating chronic temporomandibular disorders is important. For the majority of patients, a conservative approach to management should be adopted, and TMJ surgery is not typically indicated as initial therapy.
Conservative management includes patient education and reassurance, jaw rest, soft diet, passive stretching exercises, habit reversal and behaviour modification, stress relief, occlusal splint therapy and/or pharmacotherapy. Referral to an oral medicine specialist should be considered for patients with chronic TMJD, especially if they have been unresponsive to treatment.
Key messages
- TMJ disorders are common
- Three screening questions are useful
- Conservative treatment is used in most cases.
– References available on request