Temporomandibular disorder TMD

Temporomandibular disorder TMD

Temporomandibular disorders (TMDs) are characterized by pain in the muscles of mastication, the temporomandibular joint (TMJ), and/or the muscles associated with mastication in the head and neck.  Patients typically experience pain, limited opening, and/or clicking/popping of the TMJ joint.  This condition is much more common in females.  The severity of TMD ranges from completely unnoticeable to severely debilitating.

Current management varies widely based on who is treating you.  However, the consensus has been formed that conservative reversible treatments are the most likely to be successful long term and have the least negative side-effects.  These treatments include exercises of the masticatory muscles, pharmacological intervention, psychological interventions (ie stress management and relaxation techniques), and splint therapy=night-guard.

Rather than rewriting all the relevant TMD information just click this link to read about the consensus of treatment and other information.  I think this paper is nice because it is not too technical so that anyone can read it and understand it, it is well organized, and it is short and to the point.  A great read if you are interested in knowing about your TMD condition.

Risk factors

  • Women age 18-44 (maybe highest in early child bearing years)
  • Other chronic pain conditions. Around 50% have other chronic pain condition according to KleyKamp JADA 2022 review. There is likely a genetic issue(s) like COMT enzyme variant.
  • Not associated to lower SEC (stark contrast to other chronic pain conditions)

Diagnostic tests and criteria

My recommendations for treating an acute episode of TMD can be found on the preceding link.  The basic idea is similar to other chronic pain, in that we manage the pain but are unable to cure.

For information on this condition click here and search Temporomandibular disorder.

The attached questionnaire is a great initial screening tool that any general practitioner or layperson can use to find the severity of their condition.  The TMD Pain Screener is a short and user friendly tool.

TMJ diagnoses

Image of the TMJ diagnoses

Degenerative joint disease diagnosis

To have a diagnosis of degenerative joint disease you need to find a subcortical cyst, surface erosion, osteophyte formation, or generalized sclerosis. These are best seen on a CT scan as shown by Kaimal Gen Dent 2018.

CT examples of degenerative joint disease

TMD Classification

Image of the Classification of TMD

TMD research

Pre-orthodontic patients MRI study Ikeda JPros 2014

  • 85% girls and 60% boys had some amount of disc displacement
  • Correlated with age (longer alive means more chances for trauma)
  • This was a pool of young patients so the high number is surprising

TMD patient pool Dias 2012

  • Disc displacemnt in 59% TMJ’s (what is non-TMD percentage?)
  • Anterior displacement with reduction was 67% of those displaced

Strong correlation between TMD and mandibular retrognathia Tallents 2012

  • Clinicians may mistakenly perceive this malocclusion to be causing TMD when reality it is the opposite
Absence of an association between dental occlusion and the pathophysiology of TMD EBD 2017 Stone
TMJ damage – juvenile arthritis Carvalho 2012
  • Retrognathia, micrognathia, AOB, crowding, facial asymmetry, opening restrictions

Sleep bruxism does NOT cause TMD Raphael 2012

TMD/TMJ surgery

TMD surgery seems to be making a resurgence after developing a poor reputation in the field many years ago. I think this is do to an advent of more and better microsurgical techniques.

Arthroscopic lysis and lavage and arthroscopy showed excellent results in pain reduction and range of movement in 610 cases.  González 2011

Joint replacements are working as well Linsen 2012

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