In , the International Research Diagnostic Criteria for Temporomandibular Dysfunction Consortium Network published an updated classification structure for TMD eTable A.

Clinicians should be vigilant in diagnosing TMD in patients who present with pain in the TMJ area. Conditions that sometimes mimic TMD include dental caries or abscess, oral lesions e.

The diagnosis of TMD is based largely on history and physical examination findings. 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.

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. Despite the multiple choices of NSAIDs available, only naproxen Naprosyn has proven benefit in reduction of pain. 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.

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.

Additional literature searches included the Cochrane library, UpToDate, Essential Evidence Plus, International Association for Dental Research, and the TMJ Association, Ltd.

Search dates: December 22, ; April 8, ; and November 6, 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.

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Miloro M, Peterson LJ. Peterson's Principles of Oral and Maxillofacial Surgery. Shelton, Conn. McNeely ML, Armijo Olivo S, Magee DJ. According to the National Institutes of Health brochure on TMJ , it strongly recommends using the most conservative, reversible treatments possible.

Conservative treatments do not invade the tissues of the face, jaw, or joint, or involve surgery. Reversible treatments do not cause permanent changes in the structure or position of the jaw or teeth.

If TMJ issues become persistent and severe, moving toward aggressive treatments does not necessarily ensure improvement of the symptoms.

More research is needed that will lead to understanding of the condition and development of safe and effective TMJ treatments. As science learns more about the TMJ and its associated structures , many in the health care community are reassessing TMJ treatments and ways in which they were developed.

Clearly, the various TMJ disorders are far more complex than previously believed. For this group of people, no treatment is necessary and this is not considered to be a TMJ problem. The treating community remains in chaos and controversy about TMJ treatments. The advice we must still offer patients is — you may get better on treatments; you may be unaffected by treatments; you may even get better in spite of treatment, or you may get worse.

Arthroscopic surgery is quite effective in helping TMJ disorders. A small, thin tube, known as a cannula, is placed into the joint space. Next, an arthroscope is inserted and keyhole surgery is performed. This is a more direct approach. Surgery is performed on the mandible and the joint.

It consists of a repair or even a replacement of the joint. In most cases, the surgeon will make an incision around the ear but sometimes the incision extends up towards the hairline.

Once the treatment is done, the scar behind or around the ear is stitched up. This usually heals quite well. Any blood collected during the surgery is also drained. The area in front of the ear can get quite sore a few days after surgery — this can be treated with painkillers.

Swelling can also occur but this usually dies down after a few days to a week. In some cases swelling can reduce within hours and most patients find that the area settles quite nicely within a week. Some of the side-effects are:. TMD is definitely curable. TMD sufferers should ideally have a chat with their dentist or doctor — just walk into your local clinic and book an appointment.

Make sure you cover all the bases. Remember to remain positive, and rest assured that your dentist and doctor are there to help. New Patient Existing Patient. Top 5 Treatment Options for TMJ. Symptoms Identifying whether you suffer from TMD is the start to getting treatment.

Other symptoms include: Pain around the ear Facial pain Locking of the jaw So, keep a lookout. Medications 1. Tricyclic antidepressants Medications such as amitriptyline can be prescribed, in lower doses, for pain relief.

Self-care practices , such as eating soft foods, applying ice or moist heat and avoiding extreme jaw movements such as wide yawning, loud singing, and gum chewing are helpful in easing symptoms. According to the National Institutes of Health brochure on TMJ , it strongly recommends using the most conservative, reversible treatments possible.

Conservative treatments do not invade the tissues of the face, jaw, or joint, or involve surgery. Reversible treatments do not cause permanent changes in the structure or position of the jaw or teeth.

If TMJ issues become persistent and severe, moving toward aggressive treatments does not necessarily ensure improvement of the symptoms. More research is needed that will lead to understanding of the condition and development of safe and effective TMJ treatments.

As science learns more about the TMJ and its associated structures , many in the health care community are reassessing TMJ treatments and ways in which they were developed. And most importantly, relax your jaw muscles. When you are relaxed, your teeth should be slightly apart and your tongue should rest on the floor of your mouth with your lips barely touching or slightly apart.

There should be a slight space between your upper and lower teeth except during chewing, speaking or swallowing. After a thorough examination and, if needed, appropriate x-rays, your dentist may suggest a plan to treat your TMD. This treatment plan may include relaxation techniques, a referral to a physiotherapist, a chiropractor or a behavioural therapist to help you ease muscle pain.

Other treatment options may include medicine for pain, inflammation or tense muscles. If getting a good night�s sleep is a problem, a number of approaches to improve sleep may be used.

Your dentist may suggest wearing a night guard, also called an occlusal splint. It is made of clear plastic and fits over the biting surfaces of the teeth of one jaw so that you bite against the splint rather than your teeth.

This often helps your jaw joints and muscles to relax. ww An occlusal splint is made of plastic and fits over the biting surfaces of the teeth of one jaw. If your pain continues, your dentist may also refer you to a dental specialist with extra training in TMDs.

This could be a specialist in oral medicine or orofacial pain, an oral surgeon, an orthodontist, a periodontist or a prosthodontist. If your dentist refers you to a dental specialist, he or she will explain what that specialist does. Surgery is rarely used to treat TMDs.

However, if none of the other treatments have worked, or if it is very hard to open your jaw, you may need surgery.