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

🔹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 –

• 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