Management of temporomandibular joint disorders: A surgeon’s perspective G Dimitroulis Maxillofacial Surgery Unit, Department of Surgery, St.Vincent’s Hospital, The University of Melbourne, Melbourne, Vic., Australia. ABSTRACT Disorders of the Temporomandibular joint (TMJ) may clinically present with jaw pain and restricted mouth opening that may limit a patient’s access to comprehensive dental care. The aim of this article is to provide a general overview of the current treatment strategies available in the management of disorders of the TMJ. Both conservative and surgical treat- ment options will be discussed as there is no one treatment for temporomandibular disorders (TMD) which encompasses a wide range of diagnoses. A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients so that treatment can be specifically tailored to individual patient needs. Keywords: Diagnosis, temporomandibular Joint, TMJ surgery, treatment. Abbreviations and acronyms: TENS = transcutaneous electrical nerve stimulation; TMD = temporomandibular disorders; TMJ = tem- poromandibular joint. Accepted for publication October 2017. INTRODUCTION Disorders of the Temporomandibular joint (TMJ) have an adverse effect on jaw function so that patients may present with limited mouth opening or difficulty chewing because of pain and locking in the TMJ 1 (Fig. 1). In the general dental practice setting, patients may complain of cramp like pain in their masticatory muscles or painful clicking in their temporomandibu- lar joints (TMJ) which may have been exacerbated by lengthy dental procedures. 2,3 While most patients recover with simple measures such as jaw rest and soft diet, others require professional care that may involve any combination of occlusal splint therapy, physiotherapy and medications. 3 The aim of this arti- cle is to provide a general overview of the clinical fea- tures and current treatment strategies involved in dealing with disorders of the TMJ. The first part will briefly discuss non-surgical treatment strategies and the second part will be focusing on surgical treatment. DEMOGRAPHICS About 60–70 per cent of the general population har- bour at least one sign of a temporomandibular disor- der (TMD) and yet only about one in four people with signs are actually aware of, or report, any symp- toms. 1 Furthermore, only about 5 per cent of those with one or more signs of a temporomandibular dis- order will actually seek treatment. 2 Of those who seek treatment for temporomandibular disorders, the majority are female who outnumber males by at least 4 to 1. 1 Although temporomandibular disorders may occur at any age, the most common time of presenta- tion is in early adulthood. About 90–95% of treat- ment strategies begin with non-surgical treatment. Less than 10% of TMD patients may be suitable for surgical intervention 3,4 as we will see later in this article. TYPES OF TEMPOROMANDIBULAR DISORDERS (TABLE 1) The three most common temporomandibular disor- ders are myofascial pain & dysfunction, internal derangement and osteoarthrosis. 3 Myofascial pain and dysfunction is by far the most prevalent. 5,6 It is pri- marily a muscle disorder resulting from oral parafunc- tional habits such as clenching or bruxism that is sometimes related to psychogenic disorders such as headache, fibromyalgia, chronic back pain and irrita- ble bowel syndrome with stress, anxiety and depres- sion being the key features. 7,8 Internal derangement is used to describe a temporomandibular disorder where there is an abnormal position of the articular disc 9 resulting in mechanical interference (i.e., clicking) and © 2018 Australian Dental Association S79 Australian Dental Journal 2018; 63:(1 Suppl): S79–S90 doi: 10.1111/adj.12593 Australian Dental Journal The official journal of the Australian Dental Association
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