Temporomandibular disorders J. Palmer and J. Durham* School of Dental Sciences, Newcastle University, Newcastle-upon-Tyne, UK *Corresponding author: [email protected] Keywords: chronic pain; temporomandibular joint disorders; temporomandibular joint dysfunction syndrome Learning objectives By reading this article, you should be able to: Describe the aetiology and epidemiology of temporomandibular disorders (TMD). Undertake a simple assessment and examination to allow diagnosis of TMD. Discuss the basic management techniques for TMD and when referral to specialists is indicated. Introduction Temporomandibular disorders (TMD) have been known by a variety of different names over the years including facial arthralgia, pain dysfunction syndrome, ‘TMJD’, ‘TMJ’ and Costen’s syndrome. 1 The currently accepted term is tempo- romandibular disorders. It is important to note TMD is not a diagnosis; it is the collective term for a group of differing musculoskeletal conditions involving pain, dysfunction, or both in the masticatory muscles, temporomandibular joints (TMJ) and associated structures. 2 Temporomandibular disorders are the most common type of non-odontogenic orofacial pain and have the potential to produce persistent (chronic) pain. 3 Individuals with TMD commonly also have other painful and non-painful comor- bidities including headaches, fibromyalgia, irritable bowel syndrome, tinnitus, chronic fatigue syndrome, depression and sleep disturbance. 4 As seen with other chronic pain con- ditions, TMD are influenced by biopsychosocial factors. 5 Early diagnosis and management of TMD can greatly improve prognosis and quality of life for patients. 3 Efficient care pathways and the establishment of multidisciplinary treatment centres are required to ensure that treatment- seeking patients are recognised and treated accordingly, reducing overall healthcare costs. 6 Epidemiology It has been estimated that 4% of TMD-free adults aged 18e44 yrs develop clinically confirmed primary onset painful TMD each year. The incidence of TMD increases with age, peak incidence being reported as 4.5% within the 35e44 yr old age Julia Palmer MJDF RCS(Eng) PG Cert Dent(Ed) is an academic clinical fellow in oral surgery at Newcastle upon Tyne Dental Hospital and Newcastle University. She is a member of the International Associ- ation of Dental Research and INfORM. Justin Durham MFDS RCD(Ed) PhD FDS (OD) RCS is head of the School of Dental Sciences and professor of orofacial pain and hon- orary consultant oral surgeon at Newcastle upon Tyne Dental Hos- pital. Professor Durham is president-elect of INfORM and an elected member of the European Academy of Craniomandibular Disorders. His current research programmes include acute inflammatory dental pain and persistent orofacial pain. Key points Temporomandibular disorders (TMD) is the col- lective term for a group of musculoskeletal con- ditions involving pain, dysfunction, or both in the masticatory muscles, temporomandibular joints (TMJ), and their associated structures. The pathophysiology of common painful TMD is biopsychosocial and multifactorial. Early diagnosis and management of TMD is likely to greatly improve prognosis and quality of life, and reduce healthcare and wider economic costs. Certain sinister or significant diagnoses may present with similar symptoms to TMD; clini- cians should be aware of these ‘red flags’. Conservative techniques are effective in the management of TMD. When indicated, some pa- tients may benefit from specialist referral and multidisciplinary management. Matrix codes: 1A01, 2E03, 3A02 BJA Education, 21(2): 44e50 (2021) doi: 10.1016/j.bjae.2020.11.001 Advance Access Publication Date: 24 December 2020 Accepted: 5 November 2020 © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved. For Permissions, please email: [email protected] 44
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