Temporomandibular joint pain dysfunction syndrome

Dr. Naveed Iqbal

TMJ pain dysfunction syndrome refers to common triad of jaw clicking, limitation of movement and pain.

It is also called facial arthromyalgia and myofascial pain dysfunction syndrome.

multiple factors are involved in pathogenesis

It commonly affects young adults 20-40 years

Definition

Etiology of the disorder is not well established.2 main predisposing factors are Trauma muscle hyperactivity and in coordination. Role of malocclusion is controversial in etiology. Macro trauma to TMJ can occur due to road accidents,

sports injury, violent yawning, laughing, dental treatment.

Muscle hyperactivity due to stress causes bruxism. Bruxism is a parafunctional grinding of teeth during day or during sleep at night. Bruxism results in micro trauma to TMJ.

Etiology and predisposing factors

Unilateral preauricular dull aching pain made worse by mastication.

Pain in muscles of mastication with trigger points.

Limitation of mouth opening “Locking of jaw”.

Clicking sound from involved joint during opening or closing.

Condition is self limiting and dose not progress to permanent damage or degenerative arthiritis.

Clinical features

Exclude organic causes of pain especially pain referred from teeth.

Palpate TMJ to detect tenderness and swelling if present suggest organic diseases like arthiritis.

Radiographs are advised to exclude intraarticular pathologies.

Trigeminal neuralgia should be excluded especially in elderly patients.

Investigations

Reassurance and patient education Habit management and exercises. Occlusal appliances Analgesics, muscle relaxants,

antidepressants. Application of heat and cold packs. Soft diet

Management

This condition is common It does not lead to any serious diseases. It appears to be related to stress and

abnormal habits Symptoms may improve spontaneouly Various drugs, occlusal appliances, physical

thrapies can be helpful.

Education of patients

Instructions for patients with TMJ pain Rest yourself and your

jawRelax and practice stress

reduction.Take soft diet, avoid hard

crusty foods.Eat small bites from your

back teeth.Avoid joint or muscle

damageAvoid excessive yawing,

clenching and grinding.Avoid contact sports, nail

biting, pen, pencil biting.

Reduce muscle pain byAnalgesics andHot and cold packs for 20

minutes every 3 hours.Re-educate the jaw

opening.Exercise daily 5 minutes

infront of mirror ensuring jaw open downwards vertically with deviating.

Exercise daily for 5 minutes with isokinetic movements.

These are acrylic splints used which covers occlusal surfaces of either upper or lower arches.

True mechanism of their action is not known however they may

1. Reduce joint loading 2. Reduce bruxism and clenching. 3. Increase vertical dimension. 4. Removes occlusal interferences.

Occlusal splints

Occlusal splints

Initially advice patient rest, avoidance of trauma, wide opening, and abnormal habits.

Hot pack application and excercises. Analgesics and muscle relaxants like

clonazepam. Temazepam and baclofen. If this initial treatment remains insufficient

use Occlusal splints, correct occlusal interferences, start psychotherapy, relaxation.

Give Anxiolytics.

Treatment regimens