Oral Medicine And Radiology

TEMPOROMANDIBULAR DISORERS(TMD)

Dr.MehnazLeave a comment

TMD: They are the most common cause of facial pain after toothache.

🔹 Classification:

  1. TMD secondary to Myofacial pain dysfunction syndrome(MPDS)
  2. TMD secondary to true articular disease

🔹Etiology:

1) MPDS –

  • Malocclusion
  • Jaw clenching
  • Bruxism
  • Personality disorders
  • Stress & Anxiety
  • Increased pain sensitivity

2) Articular disease –

  • Disk displacement disorder
  • Degenerative joint disorders
  • Rheumatoid Arthritis, Ankylosis
  • Dislocation
  • Infection
  • Neoplasia
🔘 role of levels of TNF-α(alpha) in synovial fluid contributes to pain & palpation of TMJ

🔹Clinical Features:

➡️ The clinical manifestations in MPDS :

  • Pain without destructive changes of TMJ on radiograph
  • Tenderness
  • Spasm of Masticatory Muscles (Temporalis, Masseter, Lateral & Medial pterygoids)
  • Muscle hyperactivity & dysfunction due to malocclusion

➡️ Age: Young women (20-40 years); M:F – 1:4

➡️ 4 cardinal signs & symptoms of the syndrome:

  1. Pain (Periauricular, with chewing & radiate to head)
  2. Muscle tenderness
  3. Clicking/popping noise in TMJ
  4. Limitation of jaw motion

➡️ Pain: Dull type

  • unilateral/bilateral in MPDS
  • unilateral in articular origin except Rheumatoid Arthritis

➡️ Symptoms:

  • Otalgia
  • Neck pain
  • Shoulder pain
  • Dizziness

🔹Radiograph shows👇🏻

  • Erosion
  • Bony sclerosis
  • Osteophytes
  • Condylar-glenoid fossa remodelling

CT Scan – Material injected into joint cavity.

MRI – Articular pathology

Surgical – Traumatic TMD

Arthroscopy – Internal TMJ derangements

🔹Lab Diagnosis:

  1. Blood count to rule out any infection
  2. Rheumatoid Arthritis – Rheumatoid factor, ESR, Anti-nuclear antibody
  3. Gout – Uric acid levels

🔹Differential Diagnosis:

  1. Clustre/Migraine headache
  2. Temporal/Giant cell arteritis
  3. Post herpetic neuralgia
  4. Trigeminal Neuralgia
  5. Middle ear infections

🔹Treatment options for TMD:

• Self-care practices & conservative approach, surgical (last option)

• Basic treatments include –

  1. Apply moist heat or cold packs
  2. Eat soft foods, Do not chew gum
  3. Take medications – To avoid muscle pain and swelling; NSAID’s (Aspirin, Ibuprofen), Muscle relaxants (who clench teeth), Anti-anxiety drugs, Anti-depressants
  4. Use of night guards & splints
  5. Undergo corrective dental treatments
  6. Avoid extreme jaw movements

• Conservative –

Transcutaneous electrical nerve stimulation (TENS) is a method of pain relief involving the use of a mild electrical current.
  • TENS
  • Ultrasound
  • Trigger point injections
  • Radiowave therapy

Dr. Mehnaz Memon🖊

References:

  1. https://www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens/
  2. https://www.epainassist.com/sports-injuries/head-and-face-injuries/tmd
  3. Image Source: Google
  4. Shafer’sTextbook Of Oral Pathology; Ghoms Oral Medicine

Leave a comment