Temporomandibular Dysfunction (TMD)

Causes

• Muscular (most common): Bruxism (grinding or clenching), stress or anxiety, tension

• Joint-related: Disc displacement, osteoarthritis, trauma, rheumatoid arthritis

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History

• Pain exacerbated by jaw movements such as chewing or yawning

• Clicking, popping, or locking of the jaw, sometimes leading to trismus

• Associated symptoms including tension headache, ear pain, tinnitus, vertigo, or hearing loss

• Psychosocial factors like anxiety, poor sleep, or high stress

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Examination

• Palpation of the TMJ and masticatory muscles, assessing for tenderness or clicking

• Observation of jaw opening for restriction, deviation, or locking

• Otoscopy to rule out primary ear pathology

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Investigations

• Primarily clinical diagnosis

• MRI for detailed assessment of disc displacement

• CT or X-ray if degenerative changes or trauma are suspected

• Ultrasound for intra-articular disc visualisation, noting operator dependency

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Management

• Non-Pharm

  • Education on the role of bruxism, stress, posture, and avoidance of hard foods

  • Jaw relaxation exercises, warm compresses, and good sleep hygiene

  • Occlusal splint via dental referral if bruxism persists

• Pharm

  • NSAIDs as first-line pain relief

  • Muscle relaxants (e.g. short-term benzodiazepines) or TCAs for chronic pain and tension headaches

  • Botulinum toxin for refractory myofascial pain

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Red Flags

• Persistent swelling or fever suggestive of septic arthritis or malignancy

• Weight loss or unresponsive trismus pointing to malignancy or systemic inflammatory conditions

• Unilateral jaw deviation with neurological deficits requiring urgent evaluation

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Other Interventions

• Physiotherapy for specific jaw and postural exercises

• Referral to dentist or maxillofacial surgeon for joint dysfunction resistant to conservative measures

• Psychological support or CBT for stress-related bruxism