TMJ

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

• Jaw pain
• Popping/clicking of jaw
• Ear pain/popping
• Headache
• intermittent locking of the jaw

Differential Diagnosis

Jaw Spasms

• Dystonic reaction
• Acute tetanus
• Conversion disorder
• Mandibular dislocation
• Electrolyte abnormality
  • Hypocalcemic tetany
  • Magnesium
• Meningitis
• Seizure disorder
• Strychnine poisoning
• Akathisia
• Stroke
• Drug toxicity (anticholinergic, phenytoin, valproate, carbamazepine)
• Torticollis
• PTA
• Rabies
• TMJ

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

• Analgesia
  • NSAIDs are first line, consider opioids if not well controlled
• Occlusal splints/bite blocks at night for bruxism

Occlusal splint

Disposition

• Discharge
• Follow up with dentist/primary care provider

References

Authors

Colin Hoff, Claire