Temporomandibular Joint Syndrome Follow-up

  • Author: Vivian Tsai; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jan 13, 2012
 

Further Outpatient Care

  • Outpatient therapies should begin conservative and become more invasive when other options have been exhausted. Along with NSAIDs and muscle relaxants, initial treatment should also include behavior and diet modification.
  • Patients should eat a soft diet, and avoid habits such as excessive gum chewing. Warm and cold compresses should be used at night along with gentle massage of the TMJ area. Patients need to avoid jaw clenching and teeth grinding if possible.
  • If conservative therapies fail, or for severe acute exacerbations, intra-articular injection of local anesthetics or steroids may be used for TMJ syndrome. However, repeated intra-articular injections are not recommended.
  • Dental splints can be used to keep the jaw more properly aligned. They also help limit nocturnal bruxism and teeth grinding.
  • Some patients also find benefit from ultrasonic therapy. This provides deep heat to the area of tenderness and may alleviate some patients' symptoms. High-voltage electrogalvanic stimulation is sometimes used to reduce muscle spasms.
  • If failure of these more conservative treatments occurs, operative repair may be considered. Operative repair can range from arthroscopic procedures that can wash out the joint and allow for small repairs to open procedures. Open procedures can utilize jaw implants and synthetic articular disks. Surgery, however, is far from a cure. Friction et al demonstrated in a long-term study in which patients with synthetic implants did not have improved outcome over patients with nonimplant surgical repair or patients with nonsurgical rehabilitation.[9] This was determined by looking at subjective and objective measures of symptom severity and functional deficits.
Next

Inpatient & Outpatient Medications

  • NSAIDs are the first line of treatment for TMJ pain.
  • Prescribe benzodiazepines for significant muscle pain or spasm.
  • Cyclobenzaprine may be prescribed in patients unable to tolerate benzodiazepines. Clinical efficacy of this drug for TMJ syndrome has not been studied.
Previous
Next

Complications

  • Alterations in dentition
  • Chronic facial pain
  • Malocclusion
Previous
Next

Prognosis

  • Prognosis of TMJ disorders is improved with early diagnosis.
  • TMJ disorders often progress to a chronic state.
  • Some cases may be self-limiting.
  • Patients with ear symptomatology tend to have a prolonged course of illness.
Previous
Next

Patient Education

  • Control pain as needed.
  • Instruct patients to apply moist heat to affected area for no longer than 15 minutes per application.
  • Educate patients about bruxism and the need to avoid clenching and grinding teeth.
  • Suggest that stress can play a major role in illness.
    • Teach stress reduction strategies.
    • Provide behavior modification and counseling.
  • Prescribe soft diet for patients with chewing pain, and advise them to chew more slowly and take smaller bites.
  • Instruct patient in jaw-opening exercises.
  • For excellent patient education resources, visit eMedicine's Back, Ribs, Neck, and Head Center. Also, see eMedicine's patient education article Temporomandibular Joint (TMJ) Syndrome.
Previous
 
Contributor Information and Disclosures
Author

Vivian Tsai  MD, MPH, Assistant Professor of Emergency Medicine, Mount Sinai School of Medicine, Queens Hospital Center

Vivian Tsai is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO  Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Steven M Heffer, MD  Consulting Staff, Department of Emergency Medicine, Greenwich Hospital

Steven M Heffer, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerome FX Naradzay, MD, FACEP  Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina

Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gino A Farina, MD, FACEP, FAAEM  Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Joshua Parnes, MD, to the development and writing of this article.

References

  1. Uyanik JM, Murphy E. Evaluation and management of TMDs, Part 1. History, epidemiology, classification, anatomy, and patient evaluation. Dent Today. Oct 2003;22(10):140-5. [Medline].

  2. Tallents, RH, Katzberg, RW, Murphy W, Proskin, et al. Magnetic resonance imaging findings in asymptomatic volunteers and symptomatic patients with temporomandibular disorders. J Prosthet Dent. 1996;75:529. [Medline].

  3. Sanders AE, Maixner W, Nackley AG, Diatchenko L, By K, Miller VE, et al. Excess risk of temporomandibular disorder associated with cigarette smoking in young adults. J Pain. Jan 2012;13(1):21-31. [Medline]. [Full Text].

  4. Hegde V. A review of the disorders of the temporomandibular joint. J Indian Prosthodont Soc. 2005;5:56-61.

  5. Rammelsberg P, LeResche L, Dworkin S. Longitudinal outcome of temporomandibular disorders: a 5-year epidemiologic study of muscle disorders defined by research diagnostic criteria for temporomandibular disorders. J Orofac Pain. 2003;17(1):9-20. [Medline].

  6. Ahn SJ, Kim TW, Lee DY. Evaluation of internal derangement of the temporomandibular joint by panoramic radiographs compared with magnetic resonance imaging. Am J Orthod Dentofacial Orthop. Apr 2006;129(4):479-85. [Medline].

  7. American Academy of Family Physicians. Temporomandibular join (TMJ) pain. Am Fm Physician. Nov 2007;76(10):1483-4. [Medline].

  8. [Guideline] American Society of Temporomandibular Joint Surgeons. Guidelines for diagnosis and management of disorders involving the temporomandibular joint and related musculoskeletal structures. Cranio. Jan 2003;21(1):68-76. [Medline].

  9. Fricton JR, Look JO, Schiffman E, Swift J. Long-term study of temporomandibular joint surgery with alloplastic implants compared with nonimplant surgery and nonsurgical rehabilitation for painful temporomandibular joint disc displacement. J Oral Maxillofac Surg. Dec 2002;60(12):1400-11; discussion 1411-2. [Medline].

  10. Dierks EJ. Temporomandibular disorders and facial pain syndromes. Otolaryngology. 1991;1:849-64.

  11. Dionne RA. Pharmacologic treatments for temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jan 1997;83(1):134-42. [Medline].

  12. Ficarra BJ, Nassif NJ. Temporomandibular joint syndrome: diagnostician's dilemma--a review. J Med. 1991;22(2):97-121. [Medline].

  13. Greenberg SA, Jacobs JS, Bessette RW. Temporomandibular joint dysfunction: evaluation and treatment. Clin Plast Surg. Oct 1989;16(4):707-24. [Medline].

  14. Laskin DM. Etiology of the pain-dysfunction syndrome. J Am Dent Assoc. Jul 1969;79(1):147-53. [Medline].

  15. Laskin DM. Temporomandibular joint disorders. Arch Otolaryngol Head Neck Surg. 1993;2:1443-50.

  16. Mew JR. The aetiology of temporomandibular disorders: a philosophical overview. Eur J Orthod. Jun 1997;19(3):249-58. [Medline].

  17. Moore KL, Dalley AF. Clinically Oriented Anatomy. 4th ed. 1999.

  18. Okeson JP, de Kanter RJ. Temporomandibular disorders in the medical practice. J Fam Pract. Oct 1996;43(4):347-56. [Medline].

  19. Pharaboz C, Carpentier P. [MR imaging of the temporomandibular joints]. J Radiol. May 2009;90(5 Pt 2):642-8. [Medline].

  20. Weinerger BW. Introduction to the History of Dentistry. St. Louis: CV Mosby Co; 1948:390.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.