Temporo­mandi­bular joint dys­function

Temporo­mandi­bular joint dys­function (TMD) is an umbrella term covering dys­regu­la­tions of muscle and joint func­tion of the jaw joints, which may be struc­tu­ral, func­tio­nal, bio­chemi­cal and psycho­lo­gi­cal in nature. Pain in the temporo­mandi­bular joint is often not the leading symptom, the temporo­mandi­bular dys­function can also express itself by dizzi­ness, head­ache, photo­sensi­ti­vity or panic attacks (palpi­ta­tions).

Incidence

A temporo­mandi­bular dys­function is found in about 8% of the total popu­la­tion, about 3% are sympto­matic and in need of treat­ment. Symptoms are rare in infants, until puberty the inci­dence rises. Women of child­bearing age are affected more often than men, in the older age TMD is rela­tively rare.

Possible symptoms

  • Restricted jaw opening
  • Cracking or rubbing of the TMJ when opening or closing the jaw
  • Referred pain in the teeth, mouth, face, head, neck, shoulder or back, cervical spine and shoulder problems, limi­ted head rota­tion, headache
  • Suddenly bad fit of the teeth
  • Earache
  • Tinnitus (ringing of the ears)
  • Dizziness
  • Arrhythmia
  • Chest pain (pain in the chest caused by tension of the back)
  • Difficulty swallowing
  • Eye / impaired vision
  • Migraine

Diagnosis

For the diagnosis of TMD the following proce­dure is recom­men­ded:

  1. Detailed medical consultation
  2. Physical exami­nation of jaw opening, jaw muscles and temporo­mandi­bular joints
  3. Instrumental functional analysis
  4. X-ray image of the jaw (panoramic radio­graph) to exclude dental and oral surgi­cal etio­logies
  5. A questionnaire to evalu­ate psycho­social impair­ment

Therapy

Mouthguard
Mouthguard, photo: Metalhead64

A cracking alone does not neces­sarily require treat­ment. In case of symp­toms self-treat­ments such as soft food, stretching, heating or cooling appli­ca­tions, rela­xa­tion exer­cises and stress manage­ment may be tried. Other­wise medical measures like mouth­guards (see figure), pain relieving drugs, electri­cal nerve stimu­la­tion, and in severe cases, dental resto­ra­tions, ortho­dontic or surgi­cal measures can be necessary.