temporomandibular joint pain

1. Dr. Naveed Iqbal

2.  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

3.  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.

4.  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.

5.  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.

6.  Reassurance and patient education
 Habit management and exercises.
 Occlusal appliances
 Analgesics, muscle relaxants,
antidepressants.
 Application of heat and cold packs.
 Soft diet

7.  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.

8.  Rest yourself and your
jaw
Relax and practice stress
reduction.
Take soft diet, avoid hard
crusty foods.
Eat small bites from your
back teeth.
Avoid joint or muscle
damage
Avoid excessive yawing,
clenching and grinding.
Avoid contact sports, nail
biting, pen, pencil biting.
 Reduce muscle pain by
Analgesics and
Hot 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.

9.  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.

11.  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.