Management of temporomandibular disorders in the primary care setting

Abstract

Temporomandibular disorders (TMDs) are a major cause of orofacial pain resulting in significant morbidity and reduction in an individual’s perceived quality of life. They are a group of disorders affecting the temporomandibular joint (TMJ), masticatory muscles and surrounding structures. Up to 70% of the general population have detectable signs of TMDs, of whom only 15% are significantly affected and only 5% seek treatment, with women being twice as likely to be affected. Most acute articular inflammation is transient, resulting in patients not seeking treatment, and those with chronic pain tend to have acute exacerbations managed with simple conservative measures. The TMJ is a ginglymoarthrodial joint between the mandibular condyle and temporal bone of the skull, with the external auditory canal as its posterior border. It is the most frequently used joint in the body and comprises two joint spaces separated by an articular disc, allowing it to function as both a sliding and hinge joint. The joint has proximity to numerous other structures and is intrinsically related to the masticatory muscles, with the lateral pterygoid having anterior attachments to both the condylar head and the disc. Branches of the third division of the trigeminal nerve provide sensory innervation to the TMJ via the auriculotemporal and masseteric branches of the mandibular nerve.