eMedicine Specialties > Emergency Medicine > Rheumatology

Temporomandibular Joint Syndrome: Follow-up

Author: Joshua Parnes, MD, Staff Physician, Department of Emergency Medicine, Kings County Hospital Center
Coauthor(s): Richard H Sinert, DO, Associate 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; Steven M Heffer, MD, Consulting Staff, Department of Emergency Medicine, Greenwich Hospital
Contributor Information and Disclosures

Updated: Aug 7, 2009

Follow-up

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.
  • Bite plates 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. Some practitioners perform prylotherapy, where combinations of dextrose, lidocaine, and Sarapin are injected into the TMJs. Injections of steroids may accompany local anesthetic injection as well.
  • 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.6 This was determined by looking at subjective and objective measures of symptom severity and functional deficits.

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.

Complications

  • Alterations in dentition
  • Chronic facial pain
  • Malocclusion

Prognosis

  • Prognosis 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.

Patient Education

  • Control pain as needed.
  • Instruct patient to apply moist heat to affected area for no longer than 15 minutes per application.
  • Educate patient 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.

Miscellaneous

Medicolegal Pitfalls

  • Failure to make appropriate diagnosis (ie, migraine or dental disease is an incorrect diagnosis), leading to delayed treatment of TMJ syndrome
  • Failure to properly estimate patient's level of pain; ineffective pain management may lead to increased morbidity
 


More on Temporomandibular Joint Syndrome

Overview: Temporomandibular Joint Syndrome
Differential Diagnoses & Workup: Temporomandibular Joint Syndrome
Treatment & Medication: Temporomandibular Joint Syndrome
Follow-up: Temporomandibular Joint Syndrome
References
[ CLOSE WINDOW ]

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

  3. 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].

  4. 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].

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

  6. 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].

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

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

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

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

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

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

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

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

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

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

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

temporomandibular joint dysfunction syndrome, TMJ syndrome, myofascial pain dysfunction syndrome, MPD syndrome, temporal mandibular joint, locked jaw, neck pain, movement of the jaw

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Joshua Parnes, MD, Staff Physician, Department of Emergency Medicine, Kings County Hospital Center
Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO, Associate 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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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

CME Editor

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, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
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.