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Together we will get through this, and we look forward to seeing you in the near future. Home About Us Dr. Kurt E. Friedman Dr. Kevin L. Payton Dr. Luis E. Cardenas Dr. These include:. The symptoms of TMJ disorders depend on the severity and cause of your condition. The most common symptom of TMJD is pain in the jaw and surrounding muscles. Other symptoms typically associated with these disorders include:.
TMJ disorders can be difficult to diagnose. There are no standard tests to diagnose these disorders. Your doctor may refer you to a dentist or an ear, nose, and throat ENT specialist to diagnose your condition. Your doctor may examine your jaw to see if there is swelling or tenderness if you have symptoms of a TMJ disorder. Your doctor may also use several different imaging tests. These can include:. In most cases, the symptoms of TMJ disorders can be treated with self-care practices at home.
To ease the symptoms of TMJ you can:. Depending on your symptoms, your doctor may prescribe or recommend the following:. In rare cases, your doctor may recommend surgery or other procedures to treat your condition.
Procedures can include:. Procedures used to treat this condition may, in some cases, make your symptoms worse. Talk to your doctor about the potential risks of these procedures. You may not be able to prevent TMJD from developing, but you might be able to reduce symptoms by lowering your stress levels.
It could be helpful to try to stop grinding your teeth if this is an issue for you. Possible solutions for teeth grinding include wearing a mouth guard at night and taking muscle relaxants. You may also help prevent teeth grinding by reducing your overall stress and anxiety through counseling, exercise, and diet. The outlook for a TMJ disorder depends on the cause of the problem. TMD can be successfully treated in many people with at-home remedies, such as changing posture or reducing stress.
If your condition is caused by a chronic long-term disease such as arthritis, lifestyle changes may not be enough. The symptoms of TMD are often associated with jaw movement e. Another source of orofacial pain should be suspected if pain is not affected by jaw movement. Adventitious sounds of the jaw e. Chronic TMD is defined by pain of more than three months' duration.
Physical examination findings that support the diagnosis of TMD may include—but are not limited to—abnormal mandibular movement, decreased range of motion, tenderness of masticatory muscles, pain with dynamic loading, signs of bruxism, and neck or shoulder muscle tenderness.
Clinicians should assess for malocclusion e. Cranial nerve abnormalities should not be attributed to TMD. A single click during opening of the mouth may be associated with an anterior disk displacement.
A second click during closure of the mouth results in recapture of the displaced disk; this condition is referred to as disk displacement with reduction. When disk displacement progresses and the patient is unable to fully open the mouth i.
Crepitus is related to articular surface disruption, which often occurs in patients with osteoarthritis. Reproducible tenderness to palpation of the TMJ is suggestive of intra-articular derangement.
Tenderness of the masseter, temporalis, and surrounding neck muscles may distinguish myalgia, myofascial trigger points, or referred pain syndrome. Deviation of the mandible toward the affected side during mouth opening may indicate anterior articular disk displacement. Imaging can assist in the diagnosis of TMD when history and physical examination findings are equivocal. The initial study should be plain radiography transcranial and transmaxillary views or panoramic radiography.
Acute fractures, dislocations, and severe degenerative articular disease are often visible in these studies. Computed tomography is superior to plain radiography for evaluation of subtle bony morphology. Magnetic resonance imaging is the optimal modality for comprehensive joint evaluation in patients with signs and symptoms of TMD. Ultrasonography is a noninvasive, dynamic, low-cost technique to diagnose internal derangement of the TMJ when magnetic resonance imaging is not readily available.
Imaging modality for temporomandibular joint disorder—a review. Injections of local anesthetic at trigger points involving the muscles of mastication can be a diagnostic adjunct to distinguish the source of jaw pain. This procedure should be performed only by physicians and dentists with experience in anesthetizing the auriculotemporal nerve region. When performed correctly, complication rates are low.
Persistent pain after appropriate nerve blockade should alert the clinician to reevaluate TMD symptoms and consider an alternative diagnosis. Initial treatment goals should focus on resolving pain and dysfunction.
Figure 2 presents an abbreviated treatment algorithm for the nonsurgical management of TMD. Supportive patient education is the recommended initial treatment for TMD. TMJ immobilization has shown no benefit and may worsen symptoms as a result of muscle contractures, muscle fatigue, and reduced synovial fluid production. Physical Therapy. There is evidence—albeit weak—that supports the use of physical therapy for improving symptoms associated with TMD.
Acupuncture is used increasingly in the treatment of myofascial TMD. Sessions typically last 15 to 30 minutes, and the mean number of sessions is six to eight. A Cochrane review supports the use of cognitive behavior therapy and biofeedback in both short- and long-term pain management for patients with symptomatic TMD when compared with usual management.
Pharmacologic treatments for TMD are largely based on expert opinion. Several classes of medication are used to treat the underlying pain associated with TMD. A Cochrane review evaluating nonsteroidal anti-inflammatory drugs NSAIDs; including salicylates and cyclooxygenase inhibitors , benzodiazepines, anti-epileptic agents, and muscle relaxants initially included 2, studies, 11 of which were included in the qualitative synthesis.
Results of an evidence-based literature review of various pharmacologic options are shown in Table 2. Benzodiazepines are also used, but are generally limited to two to four weeks in the initial phase of treatment.
Opioids are not recommended and, if prescribed, should be used for a short period in the setting of severe pain for patients in whom nonopiate therapies have been ineffective. Even with these parameters, opioids should be used cautiously because of the potential for dependence.
Clonazepam Klonopin. Diazepam Valium. Triazolam Halcion. Improved sleep function, but no statistically significant reduction in symptoms. Intra-articular injection e. Injection of 0. Limited evidence of improved joint function and reduction in pain; should be reserved for severe cases because of reports of articular cartilage destruction. Limited evidence; should be reserved for patients with severe joint inflammation associated with autoimmune syndromes. Systematic review of seven RCTs Celecoxib Celebrex.
No statistically significant reduction in pain; combination of ibuprofen and diazepam was more effective than placebo. Naproxen Naprosyn. Piroxicam Feldene. Information from references 38 through Medications that have limited or no effectiveness for the treatment of TMD include tramadol Ultram , topical medications e.
There has been a limited number of studies investigating the effectiveness of onabotulinumtoxinA Botox in the management of TMD.
The use of occlusal splints is thought to alleviate or prevent degenerative forces placed on the TMJ, articular disk, and dentition.
Systematic reviews have shown conflicting results on the preferred occlusal device for relieving TMD symptoms. Occlusal adjustments i. Referral to an oral and maxillofacial surgeon is recommended if the patient has a history of trauma or fracture to the TMJ complex, severe pain and dysfunction from internal derangement that does not respond to conservative measures, or pain with no identifiable source that persists for more than three to six months.
Although invasive, surgical treatments have shown benefit in alleviating TMD symptoms and increasing joint mobility. Data Sources : An OvidSP search was completed using the key terms temporomandibular joint disorders, temporomandibular disorders, headache, diagnosis, acupuncture, treatment, occlusal splints, occlusal adjustment, pharmacotherapy, randomized controlled trials, meta-analysis, botulinum toxin, differential diagnosis, biofeedback, cognitive behavior therapy, physical therapy, and classification.
Search dates: December 22, ; April 8, ; and November 6, The authors thank Katrease Gauer for her assistance with the manuscript. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Medical Department of the U.
Army or the U. Army Service at large. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Robert L. Reprints are not available from the authors.
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