Temporomandibular disorders (TMDs)
Questionnaire/history:
Focal pain and tenderness in the muscles of mastication?
Diffuse pain in head/neck?
Pain anterior to the tragus of the ear and extending down the border of the mandible and up into the temporal region (commonest)?
Limited mouth opening?
‘Locking' of the jaw?
Clicking/crepitus in TMJ?
Painful teeth?
Past medical history?
Current medication?
Known drug allergies?
Examination:
Instability/crepitus while palpating over the TMJ and opening the jaw?
Tenderness over the muscles of mastication with teeth clenched?
Facial/neck asymmetry/swelling?
Cranial nerve signs?
Lymphadenopathy (?alternative cause)?
Differential diagnosis:
Giant cell arteritis (with jaw claudication, headache/scalp tenderness and systemic symptoms), serious causes of orofacial pain (eg head and neck malignancies and infection)?
Management:
Advised:
Benign nature, TMDs rarely progressive, symptoms can fluctuate but usually improve
To eat a soft diet for 7-14 days and rest jaw if acute pain
To avoid activities that may exacerbate symptoms, eg wide yawning, teeth grinding or jaw clenching, chewing gum or pencils and nail-biting
Ice pack, warm flannel, heat pad or massaging affected muscles
Identify and address stress, anxiety or depression
Dental review if poor dental health, suspected malocclusion or dental pathology or for consideration of an occlusal splint (usually worn at night; particularly useful for people who grind or clench their teeth)
Jaw exercises after the initial pain has started to improve may be of benefit
Usually, self-management with paracetamol or NSAID is sufficient
If symptoms are acute and severe consider diazepam eg 2mg TDS for max 2 weeks
If symptoms chronic consider neuropathic agent eg amitriptyline, gabapentin
To read online info Temporomandibular (Jaw) Joint problems and Orofacial Pain Patient Leaflets
Resource(s):
British Journal of General Practice 2019; 69 (687)
Information for patients/carer(s):
British Association of Oral Surgeons: Temporomandibular (Jaw) Joint Problems