TMD

August 31, 2021 0
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What is TMD?

Temporomandibular joint dysfunction (sometimes abbreviated to TMD or TMJD and also termed temporomandibular joint dysfunction syndrome, temporomandibular disorder or many other names), is an umbrella term covering pain and dysfunction of the muscles of mastication (the muscles that move the jaw) and the temporomandibular joints (the joints which connect the mandible to the skull).

The most important feature is pain, followed by restricted mandibular movement, and noises from the temporomandibular joints (TMJ) during jaw movement. Although TMD is not life-threatening, it can be detrimental to quality of life, because the symptoms can become chronic and difficult to manage. About 20% to 30% of the adult population are affected to some degree. Usually people affected by TMD are between 20 and 40 years of age, and it is more common in females than males. TMD is the second most frequent cause of orofacial pain after dental pain (i.e. toothache). TMD is a symptom complex rather than a single condition, and it is thought to be caused by multiple factors. However, these factors are poorly understood, and there is disagreement as to their relative importance. There are many treatments available, although there is a general lack of evidence for any treatment in TMD, and no widely accepted treatment protocol exists. Common treatments that are used include provision of occlusal splints, psychosocial interventions like cognitive behavioural therapy, and medications like analgesics (pain killers) or others. Most sources now agree that no irreversible treatment should be carried out for TMD.

Diagnosis and Management of TMD

The facial area and related cranial, oral, and dental structures are some of the most complex entities of the body. This contributes to an array of common orofacial disorders that include temporomandibular disorders (TMD), orofacial pain disorders, and orofacial sleep disorders. This site attempts to present a broad, inclusive approach to diagnosis and management of TMD that reflects both conceptual models of human systems in understanding chronic illnesses as well as systematic reviews of treatment for successful management.

An orofacial pain specialist is the best person to diagnose and manage TMD.

Click here for a table of Common diagnoses of temporomandibular disorders (TMD) and their clinical findings.

Some less common diagnoses of temporomandibular disorders (TMD).
I. TMJ
A. Joint pain
  1. Arthritis
B. Joint disorders
  1. Hypomobility disorders other than disc disorders
a. Adhesions/Adherence
b. Ankylosis (Fibrous or Osseous)
  2. TMJ dislocations
C. Joint diseases
  1. Systemic arthritides
  2. Condylysis/Idiopathic condylar resorption
  3. Osteochondritis dissecans
  4. Osteonecrosis
  5. Neoplasm
  6. Synovial Chondromatosis
D. Fractures
E. Congenital/Developmental disorders
  1. Aplasia
  2. Hypoplasia
  3. Hyperplasia
II. Masticatory Muscles
A. Muscle pain
  1. Tendonitis
  2. Myositis
  3. Spasm
B. Contracture
C. Hypertrophy
D. Neoplasm
E. Movement Disorders
  1. Orofacial dyskinesia
  2. Oromandibular dystonia
F. Masticatory muscle pain related to central/systemic pain disorder
  1. Fibromyalgia/widespread pain
III. Associated Structures
A. Coronoid hyperplasia

Table puplished by NIH (Temporomandibular Disorders: Current Concepts and Controversies in Diagnosis and Management)

 

The National Institute of Dental and Craniofacial Research classifies TMD by the following:

  • Myofascial pain. This is the most common form of TMD. It results in discomfort or pain in the fascia (connective tissue covering the muscles) and muscles that control jaw, neck and shoulder function.

  • Internal derangement of the joint. This means a dislocated jaw or displaced disk, (cushion of cartilage between the head of the jaw bone and the skull),  or injury to the condyle (the rounded end of the jaw bone that articulates with the temporal skull bone).

  • Degenerative joint disease. This includes osteoarthritis or rheumatoid arthritis in the jaw joint.

We use our jaw for so many functions, meaning that it merits attention to protect the jaw joint and prevent TMD.

IMAGE SOURCE: NIH: Pain profiling of patients with temporomandibular joint arthralgia and osteoarthritis diagnosed with different imaging techniques


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