Temporomandibular Joint Disorder
What is Temporomandibular Disorder
Temporomandibular pain and dysfunction are common problems that occur in about 33% of the general population. It has been estimated that 75% of the population have symptoms and that 33% have signs of temporomandibular disorders. About 5% of the population will require treatment for temporomandibular disorders . Interestingly, most patients seeking treatment are young women, 20 to 40 years of age.
Typically, patients have complaints of orofacial pain, joint noise, and limitations of mandibular movement. Other symptoms, such as headache, neck ache, earache, dizziness, and tinnitus, also have been associated with this condition. Despite extensive research during the past two decades, the etiology of most cases remains elusive. Proposed etiologies include malocclusion (bad bite), bruxism (clenching or grinding the teeth), and trauma.
Because of the nonspecific nature of patients' symptoms, temporomandibular disorders have been difficult to classify. As a result, confusing terminologies have appeared in the literature. These include temporomandibular joint (TMJ), Costen's syndrome, temporomandibular joint syndrome (TMJS), myofascial pain and dysfunction (MPD), and craniomandibular disorders (CMDs). Currently, these complaints are broadly classified as temporomandibular disorders (TMDs). Collectively, TMDs appear to represent an assemblage of disorders that can be divided into subcategories. It has been recognized finally that TMD complaints represent not a single disease entity, but a family of clinical conditions similar to those involving other joints. TMDs have, for the most part, been managed by dentists. Dentists became the primary care providers because the etiology was believed to be associated with abnormalities of occlusion, and therefore treatment was directed at modifying the dentition. In recent years, it has been recognized that the etiology is multifaceted and that malocclusion does not play a central role. It is important that physicians become informed about TMDs to facilitate diagnosis and treatment. Although no statistics exist, it is apparent that many patients undergo inappropriate and expensive diagnostic procedures because physicians do not consider TMDs in their differential diagnosis.
Diagnosis of Temporomandibular Disorder
The evaluation of the patient with temporomandibular pain and dysfunction is like that of any other diagnostic workup. The evaluation should include a thorough history, physical examination of the masticatory system, and some type of plain TMP radiography. Special diagnostic studies such as laboratory tests or advanced imaging techniques should be performed only as indicated and not as routine studies.