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TMJ/Temporomandibular Joint Dysfunction (TMD)

Many of my patients with headaches and face pain have questioned me about the role and treatment for TMD (temporomandibular joint dysfunction).  Here is a brief outline of classification of head and face pain due to TMJ disorders and its treatment.

When a patient presents with facial pain, the first challenge is to make a diagnosis. It is crucial to determine if the patient’s pain is due to TMD, or if they show signs of a non-TMD problem such as migraine, neuralgia, intracranial lesion, neoplasm, radiculopathy, tooth pulpalgia, third molar pericornitis, etc.  Once we have determined that the patient has TMD (which might be contributing to headaches), the next question is whether the patient has a primary TMJ or a muscle problem, or both? Treatment depends on making the correct diagnosis.

Below are the DIAGNOSTIC CRITERIA established by the American Academy of Orofacial Pain for joint disorders and muscle disorders.

Diagnostic Criteria for Joint Disorders

1. Congenital or developmental disorders (rarely cause TMD)

2. Disk displacement

3. Dislocation (also known as open lock or subluxation)

4. Inflammatory disorders

5. Osteoarthritis

6. Ankylosis

Diagnostic Criteria for Masticatory Muscle Disorders

1. Myofascial pain

2. Myositis

3. Myospasm

4. Local myalgia

5. Myofibrotic contracture

TREATMENT

We have success in managing the majority of persons suffering from TMD by using noninvasive, conservative treatment regimen involving self-care, physical therapy (PT), behavioral therapy (BT), injections, etc.  But there are still a significant number of patients (5%–20%) that are refractive to treatment and require more invasive therapies.  We refer these patients to dentists for occlusal devices and surgery as last resort if conservative therapy fails.