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Temporomandibular Joint Syndrome Treatment & Management

  • Author: Vivian Tsai, MD, MPH, FACEP; Chief Editor: Herbert S Diamond, MD  more...
 
Updated: Jul 08, 2016
 

Emergency Department Care

Signs and symptoms of temporomandibular joint (TMJ) disorders improve over time with or without treatment for most patients. As many as 50% of the patients have symptomatic improvement in 1 year and 85% in 3 years. The following conservative measures should be attempted before invasive therapies, such as orthodontics or surgery, are recommended[9] :

  • Analgesics - Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Muscle relaxants - Benzodiazepines
  • Moist heat and massage of masticatory muscles
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Consultations

Provide outpatient follow-up care with ear, nose, and throat (ENT) specialist or oral surgeon. However, if intractable pain is present, more urgent consultation is necessary.

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Contributor Information and Disclosures
Author

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

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

Disclosure: Nothing to disclose.

Coauthor(s)

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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; 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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

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.

Joshua Parnes, MD Resident Physician, Department of Emergency Medicine, Kings County Hospital Center

Disclosure: Nothing to disclose.

References
  1. Yule PL, Durham J, Wassell RW. Pain Part 6: Temporomandibular Disorders. Dent Update. 2016 Jan-Feb. 43 (1):39-42, 45-8. [Medline].

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

  3. 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].

  4. 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. 2012 Jan. 13(1):21-31. [Medline]. [Full Text].

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

  6. 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].

  7. 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. 2006 Apr. 129(4):479-85. [Medline].

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

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

  10. Venezian GC, da Silva MA, Mazzetto RG, Mazzetto MO. Low level laser effects on pain to palpation and electromyographic activity in TMD patients: a double-blind, randomized, placebo-controlled study. Cranio. 2010 Apr. 28(2):84-91. [Medline].

  11. Silva PA, Lopes MT, Freire FS. A prospective study of 138 arthroscopies of the temporomandibular joint. Braz J Otorhinolaryngol. 2015 Jul-Aug. 81 (4):352-7. [Medline].

  12. 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. 2002 Dec. 60(12):1400-11; discussion 1411-2. [Medline].

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

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