Temporomandibular Joint Pain Dysfunction Syndrome Research Articles

Head and neck pain: T-M joint syndrome.

AbstractThe otolaryngologist is frequently consulted by patients with a confusing array of complaints of pain in the head and neck region. It is the purpose of this paper to re‐introduce the problem of the temporomandibular joint pain dysfunction syndrome and stress its frequent occurrence.Costen in 1934 and 1944 brought to the attention of otolaryngologists the problem of temporomandibular joint dysfunction. In his 1944 report he stated that the diagnosis of tic doloreaux had been frequently made in patients with temporomandibular joint pain dysfunction syndrome. The number of cases included in this report are those collected over the past six months. Between June and December of 1973, 25 patients with the diagnosis of temporomandibular joint pain dysfunction syndrome were asked to fill out a questionnaire covering the history and symptomatology of their problem. Just over 50 percent were under the age of 50, with the largest number between the ages of 30 and 49. No patients had symptoms less than three months and most of the patients had symptoms from three months to one year. Unilateral symptoms were present in all but four cases, and the right side was most frequently involved. Many physicians were consulted and averaged 2.3 for each patient. All but two patients described pain in multiple areas, the most frequent combinations being the joint, ear and lower jaw; however, most patients were unaware of joint pain primarily. One patient complained only of throat pain and one complained only of pain in the lower jaw. Eight patients described “popping” in the joint, and eight had a history of teeth clenching or bruxing. Thirteen complained of fullness or pressure along with tinnitus and vertigo on an intermittent basis. Four case histories are presented to exemplify certain problems.The history is one of many nerve roots involved with pain in and around the ear, pain down the side of the neck, a gnawing aching tight feeling under the jaw to a burning sensation down the skin of the neck. In most all patients treatment has often been given by many doctors. They frequently present to the examiner as an individual with a large psychosomatic overlay.Physical examination reveals subjective pain and tenderness in the joint, clicking or crepitation upon auscultation of the joint, spasm of the external pterygoid, tenderness of the masseter muscle, deviation of the mandible on opening, impaired motion of one or both condyles and a generalized sensitiveness of the skin in the involved region.Representative X‐rays are presented. Intra‐articular injection of 1 cc. of 2 percent lidocaine will relieve some or all of the symptoms the patient is experiencing. Complications of the injection have been minimal. A small number of patients obtained complete relief of their head and neck pain after three to five injections. A possible mechanism to explain the genesis of the syndrome is presented. Treatment is varied and not agreed upon. Three patients have been treated by the insertion of a temporomandibular joint prosthesis.

Gonococcal arthritis of the temporomandibular joint: Report of a case

Arthritis of the temporomandibular joint due to gonococcal infection occurs in about 14 per cent of patients afflicted with joint pathosis. The great increase in the veneral disease rate in the United States, particularly in gonorrhea, could presumably increase the incidence of temporomandibular joint involvement. This disease entity, then, must be considered in the differential diagnosis of any temporomandibular joint or myofacial pain dysfunction syndrome.

Temporomandibular Joint Gout

To the Editor.— Hyperuricemia due to reduced urate secretion in patients not overproducing uric acid is frequently encountered among Filipinos, Chinese, and Japanese. Temporomandibular joint pain appearing in this susceptible population, particularly after thiazide therapy as well as surgery and the other usual precipitating events, should suggest an episode of acute gouty arthritis. This is a very common and remediable cause of temporomandibular joint pain dysfunction syndrome (224:622, 1973) occurring among populations with these ethnic backgrounds.

The temporomandibular syndrome.

To the Editor.— In his editorial (224:622, 1973) Greene called attention to the problems of the many patients who suffer with the temporomandibular joint pain-dysfunction syndrome (TMJ-PDS). He proposed a clinical of diagnosis and treatment in which the central modalities are proper explanation, medications, rest, and heat. Dr. Greene referred to an extensive literature and cited his own recent survey of professional attitudes about the TMJ-PDS, 1 both of which indicate that his proposed system has been widely employed for many years by physicians and dentists. We agree that, initially, a conservative approach is always the method of choice. However, in the editorial, Dr. Greene did not include the results of his own studies which showed that these modalities are beneficial in only about 60% of TMJ patients and infrequently effect a complete remission of symptoms. 2-4 He appears to have ignored the 40% of his patients who were

Personality and response to treatment of the temporomandibular joint pain dysfunction syndrome

The Eyesenck Personality Inventory was employed to assess the personalities of seventy-seven patients who underwent a series of conservative treatments for the temporomandibular joint pain dysfunction syndrome. The patients who failed to respond to all the treatments were married women who recorded abnormally high neuroticism scores and were of a specific socioeconomic group. The study indicates that the Inventory may have application in the treatment of patients suffering from this syndrome.

The Temporomandibular Syndrome

Patients with facial pain frequently consult physicians or dentists, or both, about their problems. Sometimes the diagnosis can be made easily, as in cases of obvious otitis, sinusitis, or dental abscess. Other conditions, however, can be considerably more difficult to identify or to manage. One such condition is the temporomandibular joint (TMJ) pain-dysfunction syndrome, which has been described extensively in the medical and dental literature over the past 40 years. Yet, a recent survey published in the<i>Journal of the American Dental Association</i>¹showed that many physicians and dentists still are either uninformed about the syndrome, or they are following outdated concepts of diagnosis and treatment for TMJ problems. In fact, a substantial number of practitioners in both professions did not even acknowledge the existence of a TMJ pain-dysfunction syndrome. In the survey, which included a random group of physicians and a sampling of members of the American Association

A Unifying Concept of the TMJ Pain-Dysfunction Syndrome

Pain, muscle tenderness, clicking, or alteration of mandibular movement are cardinal symptoms of the temporomandibular joint (TMJ) pain-dysfunction syndrome (PDS). Controversy still exists over the origin of the syndrome and what is the best treatment for it. One group holds that occlusion is the major etiologic factor; another that psychological and muscle factors are of the greatest etiologic importance. A number of investigators now hold that occlusal and psychologic factors operate together to produce the PDS. A theory is offered here that muscle hyperactivity associated with PDS is not a generalized hyperactivity but one in which activity of certain motor units is increased disproportionately. Treatment should combine psychologic and physiologic modalities. Pain and tension should be controlled, and spasm eliminated. However, if symptoms continue, occlusal treatment should be instituted. A full-coverage splint may serve either as the sole occlusal treatment or as a preliminary to equilibration or restorative procedures. Pain, muscle tenderness, clicking, or alteration of mandibular movement are cardinal symptoms of the temporomandibular joint (TMJ) pain-dysfunction syndrome (PDS). Controversy still exists over the origin of the syndrome and what is the best treatment for it. One group holds that occlusion is the major etiologic factor; another that psychological and muscle factors are of the greatest etiologic importance. A number of investigators now hold that occlusal and psychologic factors operate together to produce the PDS. A theory is offered here that muscle hyperactivity associated with PDS is not a generalized hyperactivity but one in which activity of certain motor units is increased disproportionately. Treatment should combine psychologic and physiologic modalities. Pain and tension should be controlled, and spasm eliminated. However, if symptoms continue, occlusal treatment should be instituted. A full-coverage splint may serve either as the sole occlusal treatment or as a preliminary to equilibration or restorative procedures.

Temporomandibular joint pain-dysfunction problems can be solved

The temporomandibular joint pain-dysfunction syndrome can be diagnosed and treated on a predictable basis. It can be differentiated from other causes of facial and head pain, and there are methods to determine when treatment has been completed and the joint syndrome has been eliminated. The most superior position of the condyle-disc assembly is the true terminal-hinge position, because it is the only point at which the condyle is braced against both bone and ligament. The method of manipulation for locating the superior terminal-hinge position is extremely important and must be learned and carried out expertly if predictable results are to be achieved in the treatment of TMJ disorders.

A Survey of Current Professional Concepts and Opinions about the Myofascial Pain-Dysfunction (MPD) Syndrome

Opinions were solicited on the existence of a temporomandibular joint pain-dysfunction syndrome and its etiologic factors, sequelae, and therapy in this survey of six groups of physicians and dentists. In general, the responses to this survey revealed widespread differences of opinion among both physicians and dentists on nearly every aspect of this syndrome. Also, it was found that many professionals still adhere to obsolete concepts of etiology and, therefore, use inappropriate therapies in treating MPD problems.

Psychological factors associated with non-organic temporomandibular joint pain dysfunction syndrome.

Psychological factors associated with non-organic temporomandibular joint pain dysfunction syndrome

Hearing aids as an etiologic factor in temporomandibular joint pain: Report of a case

The temporomandibular joint pain-dysfunction syndrome may arise from a variety of conditions. When patients wearing hearing aids complain of ear, muscle, or temporomandibular joint pain, the hearing appliances should be considered among the possible etiologic factors.

The Examination of the Patient with Facial Pain and/or Mandibular Dysfunction

In the examination of patients presenting the signs and symptoms of facial pain and mandibular dysfunction, a complete but not necessarily time consuming history is essential. The clinical examination should be comprehensive, including: the noting of facial deformities; the range and character of mandibular movements; the range of condylar motion and the nature of joint sounds, if present; the size, state of the masticatory musculature, and the location of painful areas; dental findings, including the occlusion of the teeth. X-ray examination of the temporomandibular joints is a useful adjunct. With a history of trauma, it is essential and precedes the physical examination. If a temporomandibular joint pain-dysfunction syndrome is suspected as a result of the examination, the use of physical treatment of the musculature by providing an index of treatment response is an important diagnostic aid. In the differential diagnosis of temporomandibular joint pain and dysfunction, the problem of pain is the more difficult. The organic causes of dysfunction are rheumatic disease, trauma, neoplasms, neurologic disorders, infections, and congenital deformities. The most common cause is nonorganic in the form of a pain-dysfunction syndrome. In reaching a diagnosis, one must be on guard against interpretation of data obtained by the examination according to some rigid mechanistic concept. Perhaps the most important consideration in the examination is that expressed in an article by an internist.3 In it, he asks colleagues to remember that all patients, even nervous ones, have a right to a complete examination, and quotes the admonition of Sir William Osier to his students: “Listen to the patient; he is giving you the diagnosis.”

The orthodontist's role in the diagnosis and treatment of temporomandibular joint disorders

The orthodontist can play an important role in the diagnosis and treatment of temporomandibular joint disorders. The broad biologic approach demanded by the problems of growth and development which arise in his specialty provides an advantage. The very nature of orthodontic practice—conservative treatment carried out over long periods of time—does not exist to the same extent in other branches of dentistry. Such treatment requires patience, which is of great value in managing such disorders as the temporomandibular joint pain-dysfunction syndrome. For effective management of temporomandibular joint disorders, the orthodontist must master the art of diagnosis. In addition, he must receive training in methods of therapy other than occlusal therapy. The gaining of such diversified skills will provide a large therapeutic armamentarium. With experience will come the judgment that enables the practitioner to evaluate prognosis and select methods of treatment that are best suited for the particular clinical problem of the individual patient.

A temporomandibular joint pain-dysfunction syndrome

ACIAL pain which does not respond readily to simple treatment is often alarming to the patient and perplexing to the practitioner. When pain is believed to arise in the temporomandibular joint, treatment is often radical. Administering cortisone, infiltrating the joint with a sclerosing agent, excising the meniscus, and altering the occlusion of the teeth through radical dental treatment, are some of the methods used. Spasm of the masticatory muscles has been found to be a common cause of facial pain. In such cases, pain is accompanied by dysfunction of the mandibular muscles, the symptoms constituting a temporomandibular joint pain-dysfunction syndrome. This syndrome responds to conservative treatment. Since heroic measures are rarely successful, the presentation of some simple effective office procedures seems timely. THE TEMPOROMANDIBULAR JOINT The temporomandibular joint is unique in form and unusual in function. The physiology of this joint, a subject of much controversy, is as yet not clearly understood. Agreement centers mainly about its structure. This is understandable since the anatomy of the temporomandibular joint has been known for centuries. Vesaliusl first observed the articular disc during the sixteenth century, and John Hunter2 in 1771 described this articulation between the mandible and the cranium so completely that there has remained little to add. The temporomandibular joint is a highly specialized joint. It is divided into two compartments by an articular disc or meniscus interposed between the head of the condyle of the mandible and the mandibular fossa of the temporal bone creating a double joint with two pairs of articulating surfaces. Another distinguishing characteristic is that the temporomandibular joints, attached as they are to the end of the U-shaped mandible, constitute the only system of yoked joints in the human body. Neither joint functions without the other. The mandibular joints are loose, hanging joints. Through their ability to turn in practically all directions as they glide, they permit the mandible an extremely wide range of movement. This versatility of movement has pre