Definition
TMJ dysfunction is pain caused by functional and/or structural abnormalities of the temporomandibular joint.
Aetiology
TMJ dysfunction can be subdivided into muscular, discogenic and arthrogenic disorders.
Prevalence, based on the demand for pain treatment, is between 3% and 7% of the population. Aetiological risk factors are age, hypermobility, occlusion disorders, female gender, Whiplash Associated Disorders, prolonged gum chewing and teeth grinding.
Signs and symptoms
Most patient experience pain around the ear, whether or not in combination with pain radiating to the upper jaw. Eating and talking can provoke the pain. Headache and neck pain may co-exist.
Diagnostics
Physical Examination
Pain on palpation of the temporomandibular joint is a clear sign of TMJ dysfunction.
Additional Somatic Diagnostics
When there is resistance to therapy, a dental surgeon should be requested to perform additional examinations.
Additional Psycho-cognitive Diagnostics
- RAND-36 (quality of life)
- VAS-Pain (maximal, minimal, actual, average/week)
- PCS (catastrophising)
- HADS (fear and depression)
Multidisciplinary Treatment
Whether or not somatic treatment is indicated is based on the pain diagnosis. Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.
Non-somatic Treatment
- Psychological Treatment
- Depression Treatment
- Cognitive-Behavioural Treatment
- Rehabilitation Treatment
Somatic Treatment
Pharmacological treatment:
- Non-steroid Anti-inflammatories (short period)
Other Treatments
- Primary treatment by a dentist or dental surgeon
- Manual/Musculoskeletal Medicine (only segmental mobilisation)
- Physiotherapy (specialised in jaw disorders)
Interventional Pain Treatment