Temporomandibular joint disorders (TMJD)
These are a collection of chronic conditions affecting the temporomandibular joint, muscles of mastication and adjacent structures although there can be acutely painful exacerbations. They exert bio-psychosocial effects on patients and should be managed as such. It is important to note that they do not cause long term damage to the joint nor do they cause arthritis. They are a very common cause of presentation of facial pain to both dentists and doctors.
The temporomandibular joint is a complex structure comprising a synovial joint and surrounding capsule, the head of the mandibular condyle, and articular disc and the glenoid fossa of the temporal bone. The articular disc in a healthy joint should move anteriorly synchronously with the head of the condyle as the mouth opens. The anterior portion of the disc is poorly enervated whilst the posterior portion is very well enervated with sensory nerves. In a joint where there is dysfunction in this synchronous movement it is the posterior portion of the disc which receives force and consequently causes the patient to experience pain. The movement of the mandible in function is carried out by the muscles of mastication. A short video clip of how to examine a patient for TMJD can be found via the video link below:
Signs and symptoms of TMJD include:
- Pain on opening and closing which is often worse in the morning.
- Pain in the head, neck and shoulders
- Clicking and crepitus of the TMJ
- Locking of the jaw for instance when yawning.
Management: Patients can present in marked pain particularly during acute exacerbations. It can be difficult to differentiate between this type of pain and the pain of toothache without examining the joint and the muscles of mastication. Reassurance is important and non-invasive techniques are largely successful. These include:
Eating a soft diet for a few days i.e. avoiding crusty bread or raw vegetables
Local heat applied to the area i.e. hot water bottle or heat pack.
Non-steroidal anti inflammatory drugs if these can be taken
Sometimes dentists may make a soft occlusal splint for the patient to wear.