English

Abstract

Introduction Temporomandibular joint dysfunctions present with a variety of symptoms that comprise pain in the joint and its surroundings, jaw clicking, limited jaw opening or locking and headaches. The management of chr-onic temporomandibular joint dysfunction may be defined as simple or complex. The preference of the treatment, based on the aetiology, may be char acterized as psychosomatic or operational. Conservative treatment is helpful in most cases. This up-todate review focuses on the pathogenesis and management of this multifactor ial clinical entity. Conclusion Chronic TMD is a complex clinical condition of yet unknown pathogenesis. Further research is required to investigate the aetiological patterns. On examination, the most common features are tenderness upon palpation of the joint or muscles of mastication, diminished mouth opening, side-to-side movement and clicking or grating sounds in the joint upon movements of the mandible 4,5 . Lack of tenderness in the external auditory canal could be an additional diagnostic feature of the pain syndrome 4 . An acute episode of pain generally has a sudden onset due to local tissue inflammation and it usually resolves within 4–12 weeks 6 . The conversion from acute to chronic pain may result from the body’s inability to restore normal physiological function 7,8 . Historically, there have been several TMD classifications emphasizing either mechanical or psychological concepts. Classifying TMD has been a difficult task and several suggestions exist in the literature. One of the oldest classification systems distinguishes two categories of TMJ pain: (a) masticatory pain (musclerelated) and (b) TMJ arthralgia (jointrelated). The former is subdivided into splinting, spastic and inflammatory pain while the latter into discal, retrodiscal, capsular and arthropathic pain 9,10 . Later, TMJ non-arthritic arthralgia was re-classified as a deep somatic pain of disc attachment 11 .