Jaw Pain and Dysfunction
- Temporomandibular disorders (TMDs) are conditions that affect the muscles of mastication, temporomandibular joints (TMJs), and associated structures.
- TMDs can cause pain in the masticatory muscles and TMJs, restricted or asymmetric opening of the mouth, and TMJ noises.
- No single aetiologic factor causes TMDs; rather, a combination of influences, including trauma, occlusion, systemic disease and can be compounded by psychosocial factors.
- Some genetic conditions (e.g., Pierre Robin) can result in jaw deformities and presents in newborn with feeding difficulties.
- TMJ synovitis is inflammation of the synovial membrane of the TMJ. Synovitis often presents following trauma, some type of infection or idiopathic inflammation.
- Arthritis involving the temporomandibular joint (TMJ) complicates 40 - 96% of cases of juvenile idiopathic arthritis (JIA), potentially leading to devastating changes to the jaw profile form (micrognathia) and function.
- A complete history and a thorough examination, which may include imaging, are needed to make a definitive diagnosis and achieve successful treatment of these conditions. pGALS assesses the facial profile and jaw opening.
- MRI can provide detailed joint anatomy and identify inflammation, sometimes before symptom onset. Ultrasound scan is a convenient emerging modality to evaluate the joint and guide therapeutic injections. Radiography and computed tomography provide osseous detail to recognise early morphologic changes of the mandibular condyle and provide operative planning.
- Management of TMDs consists of a combination of patient education, home selfcare, biobehavioural medicine, physiotherapy, pharmacotherapy, orthotic jaw appliance therapy, and surgery.