Temporomandibular disorder: Difference between revisions
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*Jaw pain | *Jaw pain | ||
*Popping/clicking of jaw | *Popping/clicking of jaw | ||
*Ear pain/popping | *[[Earache|Ear pain]]/popping | ||
*Headache | *[[Headache]] | ||
* | *Intermittent locking of the jaw | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 14: | Line 14: | ||
==Evaluation== | ==Evaluation== | ||
* | *Clinical diagnosis | ||
*Research Diagnostic Criteria (RDC/TMD) is gold standard for diagnosis/research purposes | *Research Diagnostic Criteria (RDC/TMD) is gold standard for diagnosis/research purposes | ||
**Pain in muscles of mastication, the TMJ, or the periauricular area, usually worsened by manipulation or function | **Pain in muscles of mastication, the TMJ, or the periauricular area, usually worsened by manipulation or function | ||
| Line 21: | Line 20: | ||
**Limitation of mandibular movements | **Limitation of mandibular movements | ||
**Pain present for minimum of 3 months | **Pain present for minimum of 3 months | ||
*Consider imaging if history of trauma/facial trauma | |||
==Management<ref>Tsai V et al. Temporomandibular Joint Syndrome Treatment & Management. Jan 2018. https://emedicine.medscape.com/article/809598-treatment.</ref>== | |||
*[[Analgesia]] | |||
==Management== | **[[NSAIDs]] are first line, consider very short term [[opioids]] if not well controlled | ||
* | *Muscle relaxers - [[metaxalone]] and [[cyclobenzaprine]]<ref>Herman CR, Schiffman EL, Look JO, Rindal DB. The effectiveness of adding pharmacologic treatment with clonazepam or cyclobenzaprine to patient education and self-care for the treatment of jaw pain upon awakening: a randomized clinical trial. J Orofac Pain. 2002;16(1):64-70.</ref> | ||
**NSAIDs are first line, consider | *Small studies show treatment with [[amitriptyline]] to be effective compared to placebo<ref>Rizzatti-Barbosa CM, Nogueira MT, de Andrade ED, Ambrosano GM, de Barbosa JR. Clinical evaluation of amitriptyline for the control of chronic pain caused by temporomandibular joint disorders. Cranio. 2003;21(3):221-225. doi:10.1080/08869634.2003.11746254</ref> | ||
**Dose used was 25mg/day for 14 days | |||
*Soft-food diet during acute episodes | |||
*Moist heat, massage of masticatory muscles | |||
*Occlusal splints/bite blocks at night for bruxism | *Occlusal splints/bite blocks at night for bruxism | ||
| Line 33: | Line 36: | ||
==Disposition== | ==Disposition== | ||
*Discharge | *Discharge | ||
*Follow up with dentist/ | *Follow up with dentist/primary care provider | ||
*50% of patients have improvement in 1 year, 85% in 3 years<ref>Guidelines for diagnosis and management of disorders involving the temporomandibular joint and related musculoskeletal structures. Cranio. 2003; 21(1):68-76.</ref> | |||
==See Also== | ==See Also== | ||
| Line 41: | Line 45: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ENT]] | |||
Latest revision as of 20:05, 15 January 2021
Background
- TMJ refers to temporomandibular joint dysfunction, a symptom complex caused by pain/dysfunction of the muscles of mastication
- Associated with bruxism, degenerative joint disease, trauma, and anatomical issues of the TMJ joint
Clinical Features
Differential Diagnosis
Jaw Spasms
- Acute tetanus
- Akathisia
- Conversion disorder
- Drug toxicity (anticholinergic, phenytoin, valproate, carbamazepine)
- Dystonic reaction
- Electrolyte abnormality
- Hypocalcemic tetany
- Magnesium
- Mandible dislocation
- Meningitis
- Peritonsillar abscess
- Rabies
- Seizure
- Strychnine poisoning
- Stroke
- Temporomandibular disorder
- Torticollis
Evaluation
- Clinical diagnosis
- Research Diagnostic Criteria (RDC/TMD) is gold standard for diagnosis/research purposes
- Pain in muscles of mastication, the TMJ, or the periauricular area, usually worsened by manipulation or function
- Asymmetric mandibular movement with or without clicking
- Limitation of mandibular movements
- Pain present for minimum of 3 months
- Consider imaging if history of trauma/facial trauma
Management[1]
- Analgesia
- Muscle relaxers - metaxalone and cyclobenzaprine[2]
- Small studies show treatment with amitriptyline to be effective compared to placebo[3]
- Dose used was 25mg/day for 14 days
- Soft-food diet during acute episodes
- Moist heat, massage of masticatory muscles
- Occlusal splints/bite blocks at night for bruxism
Disposition
- Discharge
- Follow up with dentist/primary care provider
- 50% of patients have improvement in 1 year, 85% in 3 years[4]
See Also
External Links
References
- ↑ Tsai V et al. Temporomandibular Joint Syndrome Treatment & Management. Jan 2018. https://emedicine.medscape.com/article/809598-treatment.
- ↑ Herman CR, Schiffman EL, Look JO, Rindal DB. The effectiveness of adding pharmacologic treatment with clonazepam or cyclobenzaprine to patient education and self-care for the treatment of jaw pain upon awakening: a randomized clinical trial. J Orofac Pain. 2002;16(1):64-70.
- ↑ Rizzatti-Barbosa CM, Nogueira MT, de Andrade ED, Ambrosano GM, de Barbosa JR. Clinical evaluation of amitriptyline for the control of chronic pain caused by temporomandibular joint disorders. Cranio. 2003;21(3):221-225. doi:10.1080/08869634.2003.11746254
- ↑ Guidelines for diagnosis and management of disorders involving the temporomandibular joint and related musculoskeletal structures. Cranio. 2003; 21(1):68-76.