Tmj Was Improving Now Hurts Again
Diagnosis and Treatment of Temporomandibular Disorders
Am Fam Physician. 2015 Mar 15;91(6):378-386.
Patient information: See related handout on temporomandibular disorders, written past the authors of this article.
Related letter of the alphabet: Temporomandibular Disorder: An Underdiagnosed Cause of Headache, Sinus Pain, and Ear Pain
This clinical content conforms to AAFP criteria for standing medical didactics (CME). See CME Quiz Questions.
Writer disclosure: No relevant financial affiliations.
Article Sections
- Abstruse
- Etiology
- Classification
- Differential Diagnosis
- Evaluation
- Treatment
- Referral
- References
Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular weather condition involving the temporomandibular joint complex, and surrounding musculature and osseous components. TMD affects up to xv% of adults, with a acme incidence at 20 to 40 years of age. TMD is classified as intra-articular or extra-articular. Common symptoms include jaw hurting or dysfunction, earache, headache, and facial pain. The etiology of TMD is multifactorial and includes biologic, environmental, social, emotional, and cognitive triggers. Diagnosis is most often based on history and concrete examination. Diagnostic imaging may be benign when malocclusion or intra-articular abnormalities are suspected. Near patients improve with a combination of noninvasive therapies, including patient instruction, self-care, cognitive behavior therapy, pharmacotherapy, physical therapy, and occlusal devices. Nonsteroidal anti-inflammatory drugs and muscle relaxants are recommended initially, and benzodiazepines or antidepressants may exist added for chronic cases. Referral to an oral and maxillofacial surgeon is indicated for refractory cases.
The temporomandibular joint (TMJ) is formed by the mandibular condyle inserting into the mandibular fossa of the temporal bone. Muscles of mastication are primarily responsible for move of this articulation (Figure 1). Temporomandibular disorders (TMD) are characterized by craniofacial hurting involving the articulation, masticatory muscles, or muscle innervations of the head and cervix.ane TMD is a major cause of nondental pain in the orofacial region. Population-based studies show that TMD affects ten% to 15% of adults, only just 5% seek treatment.2,3 The incidence of TMD peaks from 20 to xl years of historic period; it is twice every bit mutual in women than in men and carries a significant fiscal brunt from loss of work.4 Symptoms can range from mild discomfort to debilitating pain, including limitations of jaw part.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | References |
|---|---|---|
| Nonsteroidal anti-inflammatory drugs should be recommended for initial pharmacotherapy of TMD. The improver of a musculus relaxant is recommended if at that place is clinical prove of muscle spasm. | C | 37, 44, 47, 51 |
| Cerebral beliefs therapy and biofeedback amend short- and long-term pain management for patients with TMD. | B | 10, 36 |
| Occlusal adjustments of the teeth (i.due east., grinding the enamel) should not be recommended for the direction or prevention of TMD. | B | 61 |
| Referral to an oral and maxillofacial surgeon should be recommended for patients in whom conservative therapy is ineffective and in those with functional jaw limitations or unexplained persistent pain. | C | ten, 14, 62 |
Figure 1.
Anatomy of the temporomandibular joint and the structures responsible for movement of the articulation. The about mutual musculoskeletal conditions associated with temporomandibular disorders (TMD) are noted below: 1. Teeth and mandible. Dental occlusion – normal position is a one- to ii-mm overbite. Bruxism – expect for dental impairment and enamel erosion. Mandibular function – opening less than xxx to 35 mm is considered abnormal. ii. Muscles of mastication. TMD findings may include spasm and/or tenderness to palpation of the masseter, temporalis and/or pterygoid muscles. The evaluation is all-time performed with clenched teeth. 3. Temporomandibular articulation (TMJ). The TMJ is a gliding joint formed past the mandibular condyle and temporal bone fossa. The ligamentous capsule, articular disk, and retrodiskal tissue allow for smooth joint move. Examine the joint by palpating anterior to the tragus bilaterally. Clicking and popping may occur when the articular disk has moved anterior to the condylar head (click) merely then is recaptured in proper position (pop).
The spectrum for TMD is reflected in its classification (eTable A). The nearly mutual syndromes are myofascial pain disorder, disk derangement disorders, osteoarthritis, and autoimmune disorders. The discussion of astute dislocations, trauma, and neoplasia is beyond the telescopic of this article.
eTable A.
Classification of Temporomandibular Disorders
| Articular disorders (intra-articular) | |
| Congenital or developmental disorders | |
| Condylar hyperplasia | |
| First and 2d branchial arch disorders | |
| Idiopathic condylar resorption | |
| Degenerative joint disorders | |
| Inflammatory: capsulitis, synovitis, polyarthritides (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Reiter syndrome, gout) | |
| Noninflammatory: osteoarthritis | |
| Disk derangement disorders | |
| Displacement with reduction | |
| Displacement without reduction (closed lock) | |
| Perforation | |
| Infection | |
| Neoplasia | |
| Temporomandibular hypermobility | |
| Dislocation | |
| Articulation laxity | |
| Subluxation | |
| Temporomandibular hypomobility | |
| Ankylosis: true ankylosis (bony or fibrous) or pseudoankylosis | |
| Postradiation fibrosis | |
| Trismus | |
| Trauma | |
| Contusion | |
| Fracture | |
| Intracapsular hemorrhage | |
| Masticatory musculus disorders (extra-articular) | |
| Local myalgia | |
| Myofascial pain disorder | |
| Myofibrotic contracture | |
| Myositis | |
| Myospasm | |
| Neoplasia | |
Etiology
- Abstract
- Etiology
- Classification
- Differential Diagnosis
- Evaluation
- Treatment
- Referral
- References
The etiology of TMD is multifactorial and includes biologic, environmental, social, emotional, and cognitive triggers. Factors consistently associated with TMD include other pain conditions (eastward.yard., chronic headaches), fibromyalgia, autoimmune disorders, slumber apnea, and psychiatric disease.1,3 A prospective cohort study with more than 6,000 participants showed a twofold increase in TMD in persons with depression (rate ratio = 2.ane; 95% confidence interval, 1.5 to 3; P < .001) and a 1.viii-fold increment in myofascial pain in persons with anxiety (rate ratio = ane.8; 95% confidence interval, 1.2 to ii.6; P < .001).five Smoking is associated with an increased risk of TMD in females younger than 30 years.6
Nomenclature
- Abstract
- Etiology
- Classification
- Differential Diagnosis
- Evaluation
- Handling
- Referral
- References
TMD is categorized equally intra-articular (within the joint) or extra-articular (involving the surrounding musculature).7 Musculoskeletal atmospheric condition are the well-nigh common crusade of TMD, bookkeeping for at least 50% of cases.8,9 Articular disk displacement involving the condyle–disk relationship is the most common intra-articular cause of TMD.ten
In 2013, the International Research Diagnostic Criteria for Temporomandibular Dysfunction Consortium Network published an updated classification structure for TMD (eTable A).
Differential Diagnosis
- Abstruse
- Etiology
- Nomenclature
- Differential Diagnosis
- Evaluation
- Treatment
- Referral
- References
Clinicians should be vigilant in diagnosing TMD in patients who present with pain in the TMJ area. Weather condition that sometimes mimic TMD include dental caries or abscess, oral lesions (e.g., herpes zoster, herpes simplex, oral ulcerations, lichen planus), conditions resulting from muscle overuse (e.thousand., clenching, bruxism, excessive chewing, spasm), trauma or dislocation, maxillary sinusitis, salivary gland disorders, trigeminal neuralgia, postherpetic neuralgia, glossopharyngeal neuralgia, giant cell arteritis, primary headache syndrome, and pain associated with cancer.11,12 The differential diagnosis and associated clinical findings are presented in Tabular array 1.11,12 TMD symptoms can besides manifest in autoimmune diseases, such as systemic lupus erythematosus, Sjögren syndrome, and rheumatoid arthritis.11
Table 1.
Conditions That May Mimic Temporomandibular Disorders
| Condition | Location | Hurting characteristics | Aggravating factors | Typical findings | Diagnostic studies | Management | |
|---|---|---|---|---|---|---|---|
| Dental conditions | |||||||
| Caries | Afflicted tooth | Intermittent to continuous dull hurting | Hot or common cold stimuli | Visible disuse | Radiography | Extraction, filling | |
| Croaky molar | Affected tooth | Intermittent tiresome or sharp pain | Biting, eating | Often hard to visualize crevice | Radiography | Possible extraction | |
| Dry out socket | Affected tooth | Continuous, deep, sharp pain | Hot or cold stimuli | Loss of clot, exposed bone | None | Antibiotics, irrigation | |
| Giant cell arteritis | Temporal region | Sudden onset of continuous dull hurting | Visual disturbance, loss of vision | Scalp tenderness, absence of temporal avenue pulse | Erythrocyte sedimentation rate, temporal artery biopsy | Corticosteroids | |
| Migraine headache | Temporal region, behind the center, cutaneous allodynia | Astute throbbing, occasionally with aureola | Activity, nausea, phonophobia, photophobia | Often normal, disfavor during ophthalmoscopic test, normal cranial nerve findings | None | Antiemetics, ergot alkaloids, nonsteroidal anti-inflammatory drugs, triptans | |
| Neuropathic conditions | |||||||
| Glossopharyngeal neuralgia | Most oftentimes ear, occasionally neck or natural language | Paroxysmal attacks of electric or precipitous pain | Coughing, swallowing, touching the ear | Hurting with light touch on | Magnetic resonance imaging | Anticonvulsants, surgery | |
| Postherpetic neuralgia | Site of dermatomal nerve and its distribution | Continuous, burning, abrupt hurting | Eating, light touch | Hyperalgesia | None | Anticonvulsants, tricyclic antidepressants | |
| Trigeminal neuralgia | Unilateral trigeminal nerve | Paroxysmal attacks of precipitous hurting | Common cold or hot stimuli, eating, light impact, washing | Pain with low-cal touch | Magnetic resonance imaging | Anticonvulsants, surgery | |
| Salivary rock | Submandibular or parotid region | Intermittent dull pain | Eating | Tenderness at gland, palpable rock, no salivary catamenia | Computed tomography, sialography | Often conservative; antibiotics, stone removal | |
| Sinusitis | Maxillary sinus, intraoral upper quadrant | Continuous tiresome anguish | Headache, nasal discharge, contempo upper respiratory infection | Tenderness over maxillary sinus or upper posterior teeth | Radiography, computed tomography | Antibiotics | |
Evaluation
- Abstract
- Etiology
- Nomenclature
- Differential Diagnosis
- Evaluation
- Treatment
- Referral
- References
DIAGNOSIS
The diagnosis of TMD is based largely on history and physical examination findings. The symptoms of TMD are often associated with jaw movement (due east.k., opening and closing the mouth, chewing) and pain in the preauricular, masseter, or temple region. Another source of orofacial pain should be suspected if pain is not affected by jaw movement. Adventitious sounds of the jaw (east.m., clicking, popping, grating, crepitus) may occur with TMD, but also occur in upwardly to 50% of asymptomatic patients.1 A large retrospective report (n = four,528) conducted past a single examiner over 25 years noted that the most common presenting signs and symptoms were facial pain (96%), ear discomfort (82%), headache (79%), and jaw discomfort or dysfunction (75%).thirteen Other symptoms may include dizziness or cervix, eye, arm, or back pain. Chronic TMD is defined by pain of more than three months' duration.
Concrete examination findings that support the diagnosis of TMD may include—simply are not express to—abnormal mandibular movement, decreased range of motion, tenderness of masticatory muscles, pain with dynamic loading, signs of bruxism, and neck or shoulder muscle tenderness. Clinicians should assess for malocclusion (eastward.k., acquired edentulism, hemifacial asymmetries, restorative occlusal rehabilitation), which can contribute to the manifestation of TMD. Cranial nerve abnormalities should not be attributed to TMD.fourteen A clicking, crepitus, or locking of the TMJ may accompany joint dysfunction. A single click during opening of the mouth may be associated with an anterior disk displacement. A second click during closure of the mouth results in recapture of the displaced disk; this condition is referred to as disk displacement with reduction. When disk deportation progresses and the patient is unable to fully open the oral cavity (i.e., the disk is blocking translation of the condyle), this status is referred to as closed lock. Crepitus is related to articular surface disruption, which often occurs in patients with osteoarthritis.11
Reproducible tenderness to palpation of the TMJ is suggestive of intra-articular derangement. Tenderness of the masseter, temporalis, and surrounding neck muscles may distinguish myalgia, myofascial trigger points, or referred pain syndrome. Deviation of the mandible toward the affected side during mouth opening may indicate anterior articular deejay displacement.15
IMAGING
Imaging can assist in the diagnosis of TMD when history and physical examination findings are equivocal.sixteen Although infrequently used, multiple imaging modalities are available to obtain boosted information nearly suspected TMD etiologies17,18 (eTable B). The initial report should be plain radiography (transcranial and transmaxillary views) or panoramic radiography. Acute fractures, dislocations, and severe degenerative articular disease are often visible in these studies. Computed tomography is superior to evidently radiography for evaluation of subtle bony morphology. Magnetic resonance imaging is the optimal modality for comprehensive articulation evaluation in patients with signs and symptoms of TMD. Although there is a 78% to 95% correlation between magnetic resonance imaging findings and articulation morphology in symptomatic patients,xv,19–21 faux-positive findings occur in twenty% to 34% of asymptomatic patients.22 Magnetic resonance imaging is typically reserved for patients with persistent symptoms, those in whom bourgeois therapy has been ineffective, or in those with suspected internal articulation derangement. Ultrasonography is a noninvasive, dynamic, low-cost technique to diagnose internal derangement of the TMJ when magnetic resonance imaging is not readily available.23
eTable B.
Adjunctive Imaging for Temporomandibular Disorders
| Condition | Transcranial or transmaxillary radiography* | Panoramic radiography | Computed tomography | Magnetic resonance imaging |
|---|---|---|---|---|
| Arthritides | + | + | ++ | +++ |
| Bony pathology | 0 | 0 | +++ | + |
| Deejay position | 0 | 0 | + | +++ |
| Fractures or | + | ++ | +++ | ++ |
| dislocations | ||||
| Inflammatory | 0 | 0 | + | +++ |
| conditions | ||||
| Neoplasia | + | + | +++ | +++ |
DIAGNOSTIC INJECTIONS
Injections of local anesthetic at trigger points involving the muscles of mastication tin exist a diagnostic adjunct to distinguish the source of jaw pain. This process should exist performed simply past physicians and dentists with experience in anesthetizing the auriculotemporal nerve region. When performed correctly, complication rates are depression. Persistent hurting after appropriate nerve occludent should alert the clinician to reevaluate TMD symptoms and consider an alternative diagnosis.24
Treatment
- Abstract
- Etiology
- Classification
- Differential Diagnosis
- Evaluation
- Handling
- Referral
- References
Only 5% to x% of patients require treatment for TMD, and 40% of patients have spontaneous resolution of symptoms.25 In a long-term follow-upwardly study, 50% to 90% of patients had pain relief after conservative therapy.26 A multidisciplinary approach is successful for the management of TMD. Initial treatment goals should focus on resolving pain and dysfunction. More than 1,500 persons in an online TMD registry reported that they had received anti-inflammatory agents (73%), nonprescription pain relievers (56%), antidepressants (50%), opioids (48%), anxiolytics (41%), and musculus relaxants (40%).27 Surgical interventions were reserved for patients whose symptoms did not meliorate later on a trial of bourgeois therapy. Figure two presents an abbreviated treatment algorithm for the nonsurgical management of TMD.
Management of Temporomandibular Disorders
Figure 2.
Algorithm for nonsurgical management of temporomandibular disorders.
NONPHARMACOLOGIC Management
Supportive patient education is the recommended initial handling for TMD.28,29 Adjunctive measures include jaw rest, soft diet, moist warm compresses, and passive stretching exercises. TMJ immobilization has shown no do good and may worsen symptoms equally a result of muscle contractures, muscle fatigue, and reduced synovial fluid production.30
Physical Therapy. There is evidence—admitting weak—that supports the utilize of physical therapy for improving symptoms associated with TMD.31 Techniques may be active or passive (e.g., scissor opening with fingers, employ of medical devices) with the goal of improving muscle forcefulness, coordination, relaxation, and range of motion.31 Specialized concrete therapy options such as ultrasound, iontophoresis, electrotherapy, or depression-level laser therapy have been used in the direction of TMD, despite the lack of bear witness to support their utilize.32 Handling of underlying comorbid conditions results in greater likelihood of success in the direction of TMD.
Acupuncture. Acupuncture is used increasingly in the treatment of myofascial TMD. Sessions typically final 15 to 30 minutes, and the mean number of sessions is six to eight.33 2 systematic reviews suggested that acupuncture is a reasonable adjunctive treatment for short-term analgesia in patients with painful TMD symptoms.34,35
Biofeedback. A Cochrane review supports the utilize of cerebral behavior therapy and biofeedback in both short- and long-term pain direction for patients with symptomatic TMD when compared with usual management.36 Patients should be counseled on beliefs modifications such as stress reduction, sleep hygiene, elimination of parafunctional habits (e.thou., teeth grinding, pencil or ice chewing, teeth clenching), and abstention of extreme mandibular motility (e.g., excessive opening during yawning, tooth brushing, and flossing).
PHARMACOLOGIC MANAGEMENT
Pharmacologic treatments for TMD are largely based on expert opinion. Several classes of medication are used to care for the underlying pain associated with TMD.
A Cochrane review evaluating nonsteroidal anti-inflammatory drugs (NSAIDs; including salicylates and cyclooxygenase inhibitors), benzodiazepines, anti-epileptic agents, and muscle relaxants initially included 2,285 studies, 11 of which were included in the qualitative synthesis.37 The authors plant insufficient evidence to back up or abnegate the effectiveness of whatsoever drug for the treatment of TMD.
Results of an testify-based literature review of various pharmacologic options are shown in Tabular array 2.38–50 NSAIDs are outset-line agents typically used for x to 14 days for initial handling of astute hurting.44,47,51 Patients with suspected early disk displacement, synovitis, and arthritis benefit from early treatment with NSAIDs. Despite the multiple choices of NSAIDs bachelor, just naproxen (Naprosyn) has proven benefit in reduction of pain.47 Muscle relaxants can be prescribed with NSAIDs if at that place is evidence of a muscular component to TMD.46 Tricyclic antidepressants—most unremarkably amitriptyline, desipramine (Norpramin), doxepin, and nortriptyline (Pamelor)—are used for the direction of chronic TMD pain. Benzodiazepines are as well used, but are generally express to ii to four weeks in the initial phase of handling.xl,44 Longer-acting agents with anticonvulsant properties (i.e., diazepam [Valium], clonazepam [Klonopin], gabapentin [Neurontin]) may provide more benefit than shorter-acting agents. Opioids are not recommended and, if prescribed, should be used for a curt catamenia in the setting of severe pain for patients in whom nonopiate therapies accept been ineffective. Even with these parameters, opioids should be used cautiously because of the potential for dependence.51
Table 2.
Effectiveness of Pharmacologic Treatments for Temporomandibular Disorders
| Medication | Dosage | Prove | Written report | |
|---|---|---|---|---|
| Anticonvulsant: gabapentin (Neurontin) | 300 mg per 24-hour interval, increased past 300 mg incrementally | Statistically significant reduction in pain | Double-blind, placebo-controlled RCT (n = 44)38 | |
| Benzodiazepines | ||||
| Clonazepam (Klonopin) | 0.25 mg every night, increased by 0.25 mg each week to a maximum of i mg per day | Conflicting data showing benefit for reduction in hurting | Double-blind, placebo-controlled RCT (n = 20)39 | |
| Diazepam (Valium) | 2.v mg iv times per mean solar day for ane week, then v mg four times per twenty-four hours for three weeks | Statistically significant reduction in pain | Double-blind RCT (n = 39)forty | |
| Triazolam (Halcion) | 0.125 mg every nighttime | Improved sleep function, but no statistically significant reduction in symptoms | Double-bullheaded RCT, 2-period crossover study (n = xx)41 | |
| Corticosteroids | ||||
| Intra-articular injection (east.g., triamcinolone, methylprednisolone) | Injection of 0.5 mL local anesthetic and 5 to 20 mg steroid using 23- to 27-gauge 0.5- to 1-inch needle | Limited evidence of improved joint role and reduction in pain; should be reserved for severe cases because of reports of articular cartilage destruction | Systematic review of vii double-bullheaded RCTs and two unmarried-blind RCTs42,43 | |
| Systemic | Short course (v to seven days), with or without tapering | Express show; should exist reserved for patients with severe joint inflammation associated with autoimmune syndromes | None44 | |
| Hyaluronate (avian) | Single-dose vial, with 2d injection in two weeks | Inconclusive prove | Systematic review of seven RCTs45 | |
| Muscle relaxant: cyclobenzaprine (Flexeril) | 10 mg every dark | More effective than clonazepam and placebo for reduction in pain | Double-blind, placebo-controlled RCT (n = 39)46 | |
| Nonsteroidal anti-inflammatory drugs | ||||
| Celecoxib (Celebrex) | 100 mg two times per day | No statistically pregnant reduction in hurting | Double-bullheaded, placebo-controlled RCT (north = 68)47 | |
| Diclofenac | fifty mg three times per day | No statistically significant reduction in pain | Double-blind, placebo-controlled RCT (n = 32)48 | |
| Ibuprofen | 600 mg 4 times per mean solar day | No statistically significant reduction in pain; combination of ibuprofen and diazepam was more effective than placebo | Double-bullheaded, placebo-controlled RCT (n = 39)xl | |
| Naproxen (Naprosyn) | 500 mg ii times per twenty-four hour period | Statistically significant reduction in pain | Double-blind RCT (n = 68)47 | |
| Piroxicam (Feldene) | 20 mg per day | No statistically meaning reduction in pain | Double-bullheaded, placebo-controlled RCT (due north = 41)49 | |
| Tricyclic antidepressant: amitriptyline | 25 mg per day | Statistically meaning reduction in pain | Double-blind RCT (northward = 12)46,fifty | |
Medications that take express or no effectiveness for the treatment of TMD include tramadol (Ultram), topical medications (eastward.g., capsaicin [Zostrix], lidocaine, diclofenac52), and newer antidepressants (e.g., selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors).37
At that place has been a express number of studies investigating the effectiveness of onabotulinumtoxinA (Botox) in the direction of TMD.53 Early small randomized controlled trials have shown promising results for the improvement of painful myofascial symptoms.54–56 All the same, a recent Cochrane review (iv studies, Northward = 233) found inconclusive evidence to support use of onabotulinumtoxinA for myofascial pain.57 Only one of the four studies demonstrated benefit with this modality.
OCCLUSAL SPLINTS AND ADJUSTMENTS
The utilize of occlusal splints is thought to alleviate or prevent degenerative forces placed on the TMJ, articular disk, and dentition.58 These devices may benefit a select population of patients with astringent bruxism and nocturnal clenching. Systematic reviews have shown conflicting results on the preferred occlusal device for relieving TMD symptoms.59,60 Dental consultation should be obtained to determine the optimal occlusal device. Occlusal adjustments (i.e., grinding enamel surfaces to meliorate dentition) have no do good in the management or prevention of TMD.61
Referral
- Abstract
- Etiology
- Nomenclature
- Differential Diagnosis
- Evaluation
- Handling
- Referral
- References
Referral to an oral and maxillofacial surgeon is recommended if the patient has a history of trauma or fracture to the TMJ complex, severe pain and dysfunction from internal derangement that does not respond to conservative measures, or pain with no identifiable source that persists for more than iii to 6 months.10,14,62 Surgery is rarely required for treatment of TMD and is usually reserved for correction of anatomic or articular abnormalities.1 Surgical options include arthrocentesis, arthroscopy, diskectomy, condylotomy, and total joint replacement.
Although invasive, surgical treatments have shown do good in alleviating TMD symptoms and increasing joint mobility.63,64 Referral to a dentist is indicated for patients with poor dental wellness, dental caries, malocclusions, or dental clothing patterns that may be contributing to TMD symptoms.
Data Sources: An OvidSP search was completed using the key terms temporomandibular joint disorders, temporomandibular disorders, headache, diagnosis, acupuncture, treatment, occlusal splints, occlusal adjustment, pharmacotherapy, randomized controlled trials, meta-analysis, botulinum toxin, differential diagnosis, biofeedback, cognitive behavior therapy, concrete therapy, and classification. Boosted literature searches included the Cochrane library, UpToDate, Essential Evidence Plus, International Association for Dental Research, and the TMJ Association, Ltd. (http://www.tmj.org). Search dates: December 22, 2013; April 8, 2014; and Nov 6, 2014.
The authors give thanks Katrease Gauer for her assistance with the manuscript.
The opinions and assertions contained herein are the private views of the authors and are non to be construed as official or as reflecting the views of the Medical Department of the U.Southward. Regular army or the U.Southward. Regular army Service at large.
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REFERENCES
prove all references
1. Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. North Engl J Med. 2008;359(25):2693–2705. ...
2. Gonçalves DA, Camparis CM, Speciali JG, et al. Temporomandibular disorders are differentially associated with headache diagnoses: a controlled written report. Clin J Pain. 2011;27(7):611–615.
3. Lim PF, Smith Southward, Bhalang Grand, et al. Development of temporomandibular disorders is associated with greater actual pain experience. Clin J Pain. 2010;26(two):116–120.
4. Maixner Westward, Diatchenko L, Dubner R, et al. Orofacial pain prospective evaluation and risk cess study—the OPPERA study. J Pain. 2011;12(11 suppl):T4–T11.e1–2.
5. Kindler S, Samietz S, Houshmand M, et al. Depressive and anxiety symptoms as risk factors for temporomandibular joint pain: a prospective cohort report in the general population. J Pain. 2012;13(12):1188–1197.
6. Sanders AE, Maixner Westward, Nackley AG, et al. Excess take chances of temporomandibular disorder associated with cigarette smoking in young adults. J Hurting. 2012;13(ane):21–31.
seven. Okeson JP. Joint intracapsular disorders: diagnostic and nonsurgical management considerations. Dent Clin N Am. 2007;51(one):85–103.
8. Reiter S, Goldsmith C, Emodi-Perlman A, et al. Masticatory muscle disorders diagnostic criteria: the American Academy of Orofacial Hurting versus the enquiry diagnostic criteria/temporomandibular disorders. J Oral Rehabil. 2012;39(12):941–947.
ix. Stohler CS. Muscle-related temporomandibular disorders. J Orofac Pain. 1999;13(4):273–284.
10. De Leeuw R, Klasser GD; American Academy of Orofacial Hurting. Orofacial Pain: Guidelines for Cess, Diagnosis, and Direction. 5th ed. Chicago, Sick.: Quintessence Publ.; 2013.
11. Okeson JP, de Leeuw R. Differential diagnosis of temporomandibular disorders and other orofacial hurting disorders. Dent Clin N Am. 2011;55(ane):105–120.
12. Zakrzewska JM. Differential diagnosis of facial pain and guidelines for direction. Br J Anaesth. 2013;111(1):95–104.
13. Cooper BC, Kleinberg I. Examination of a large patient population for the presence of symptoms and signs of temporomandibular disorders. Cranio. 2007;25(2):114–126.
fourteen. Scrivani SJ, Mehta NR. Temporomandibular disorders in adults. UpToDate http://www.uptodate.com/contents/temporomandibular-disorders-in-adults?source=search_result&search=temporomandibular&selectedTitle=1%7E74 (subscription required). Accessed July 20, 2014.
fifteen. Emshoff R, Innerhofer K, Rudisch A, et al. Clinical versus magnetic resonance imaging findings with internal derangement of the temporomandibular joint: an evaluation of inductive disc displacement without reduction. J Oral Maxillofac Surg. 2002;60(ane):36–41.
16. Hunter A, Kalathingal S. Diagnostic imaging for temporomandibular disorders and orofacial pain. Paring Clin North Am. 2013;57(three):405–418.
17. Rawlani S, Rawlani South, Motwani Grand, et al. Imaging modality for temporomandibular joint disorder—a review. J Datta Meghe Inst Med Sci University. 2010;v(2):126–133.
18. Lewis EL, Dolwick MF, Abramowicz South, et al. Contemporary imaging of the temporomandibular articulation. Dent Clin North Am. 2008;52(4):875–890.
19. Bertram S, Rudisch A, Innerhofer K, et al. Diagnosing TMJ internal derangement and osteoarthritis with magnetic resonance imaging. J Am Dent Assoc. 2001;132(half dozen):753–761.
20. Maizlin ZV, Nutiu N, Paring Atomic number 82, et al. Deportation of the temporomandibular joint disk: correlation between clinical findings and MRI characteristics. J Can Paring Assoc. 2010;76:a3.
21. Lamot U, Strojan P, Šurlan Popovič Yard. Magnetic resonance imaging of temporomandibular joint dysfunction-correlation with clinical symptoms, age, and gender. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(2):258–263.
22. Kircos LT, Ortendahl DA, Mark AS, et al. Magnetic resonance imaging of the TMJ disc in asymptomatic volunteers. J Oral Maxillofac Surg. 1987;45(ten):852–854.
23. Bas B, Yilmaz N, Gökce E, et al. Diagnostic value of ultrasonography in temporomandibular disorders. J Oral Maxillofac Surg. 2011;69(v):1304–1310.
24. Nascimento MM, Vasconcelos BC, Porto GG, et al. Concrete therapy and anesthetic blockage for treating temporomandibular disorders: a clinical trial. Med Oral Patol Oral Cir Bucal. 2013;xviii(1):e81–e85.
25. Garefis P, Grigoriadou Eastward, Zarifi A, et al. Effectiveness of conservative treatment for craniomandibular disorders: a 2-year longitudinal study. J Orofac Pain. 1994;8(three):309–314.
26. Indresano A, Alpha C. Nonsurgical management of temporomandibular articulation disorders. In: Fonseca RJ, Marciani RD, Turvey TA, eds. Oral and Maxillofacial Surgery. second ed. St. Louis, Mo.: Saunders/ Elsevier; 2009:881–897.
27. Hoffmann RG, Kotchen JM, Kotchen TA, et al. Temporomandibular disorders and associated clinical comorbidities. Clin J Pain. 2011;27(3):268–274.
28. Direction of temporomandibular disorders. National Institutes of Health Technology Assessment Briefing Argument. J Am Paring Assoc. 1996;127(11):1595–1606.
29. Dimitroulis K. Temporomandibular disorders: a clinical update. BMJ. 1998;317(7152):190–194.
30. Miloro M, Peterson LJ. Peterson'due south Principles of Oral and Maxillofacial Surgery. 3rd ed. Shelton, Conn.: People'south Medical Pub Business firm; 2012.
31. McNeely ML, Armijo Olivo Southward, Magee DJ. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Phys Ther. 2006;86(5):710–725.
32. Melis M, Di Giosia One thousand, Zawawi KH. Depression level laser therapy for the treatment of temporomandibular disorders: a systematic review of the literature. Cranio. 2012;30(four):304–312.
33. Rosted P. Practical recommendations for the use of acupuncture in the treatment of temporomandibular disorders based on the outcome of published controlled studies. Oral Dis. 2001;seven(2):109–115.
34. Cho SH, Whang WW. Acupuncture for temporomandibular disorders: a systematic review. J Orofac Pain. 2010;24(2):152–162.
35. La Touche R, Goddard Grand, De-la-Hoz JL, et al. Acupuncture in the handling of hurting in temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials. Clin J Pain. 2010;26(6):541–550.
36. Aggarwal VR, Lovell Thousand, Peters South, et al. Psychosocial interventions for the management of chronic orofacial pain. Cochrane Database Syst Rev. 2011;(eleven):CD008456.
37. Mujakperuo HR, Watson G, Morrison R, et al. Pharmacological interventions for pain in patients with temporomandibular disorders. Cochrane Database Syst Rev. 2010;(10):CD004715.
38. Kimos P, Biggs C, Mah J, et al. Analgesic activity of gabapentin on chronic hurting in the masticatory muscles: a randomized controlled trial. Pain. 2007;127(i–2):151–160.
39. Martin WJ, Perez RS, Tuinzing DB, et al. Efficacy of antidepressants on orofacial pain: a systematic review. Int J Oral Maxillofac Surg. 2012;41(12):1532–1539.
40. Vocalizer E, Dionne R. A controlled evaluation of ibuprofen and diazepam for chronic orofacial musculus pain. J Orofac Pain. 1997;eleven(2):139–146.
41. DeNucci DJ, Sobiski C, Dionne RA. Triazolam improves sleep but fails to alter hurting in TMD patients. J Orofac Pain. 1998;12(two):116–123.
42. Machado Due east, Bonotto D, Cunali PA. Intra-articular injections with corticosteroids and sodium hyaluronate for treating temporomandibular articulation disorders: a systematic review. Dental Press J Orthod. 2013;18(5):128–133.
43. Samiee A, Sabzerou D, Edalatpajouh F, et al. Temporomandibular joint injection with corticosteroid and local anesthetic for limited mouth opening. J Oral Sci. 2011;53(3):321–325.
44. Hersh EV, Balasubramaniam R, Pinto A. Pharmacologic management of temporomandibular disorders. Oral Maxillofac Surg Clin Northward Am. 2008;twenty(two):197–210.
45. Shi Z, Guo C, Awad M. Hyaluronate for temporomandibular joint disorders. Cochrane Database Syst Rev. 2003;(1):CD002970.
46. Herman CR, Schiffman EL, Expect JO, et al. The effectiveness of adding pharmacologic treatment with clonazepam or cyclobenzaprine to patient didactics and self-intendance for the treatment of jaw pain upon awakening: a randomized clinical trial. J Orofac Pain. 2002;xvi(ane):64–70.
47. Ta LE, Dionne RA. Treatment of painful temporomandibular joints with a cyclooxygenase-ii inhibitor: a randomized placebo-controlled comparison of celecoxib to naproxen. Pain. 2004;111(1–two):13–21.
48. Ekberg EC, Kopp South, Akerman S. Diclofenac sodium as an culling handling of temporomandibular articulation pain. Acta Odontol Scand. 1996;54(3):154–159.
49. Roldan OV, Maglione H, Carreira R, et al. Piroxicam, diazepam and placebo in the treatment of temporomandibular joint dysfunction. Double blind study [in Spanish]. Rev Asoc Odontol Argent. 1990;78(2):83–85.
50. Rizzatti-Barbosa CM, Nogueira MT, de Andrade ED, et al. Clinical evaluation of amitriptyline for the control of chronic pain caused by temporomandibular joint disorders. Cranio. 2003;21(iii):221–225.
51. Listing T, Axelsson Southward, Leijon G; Pharmacologic interventions in the treatment of temporomandibular disorders, atypical facial pain, and burning mouth syndrome. A qualitative systematic review. J Orofac Pain. 2003;17(4):301–310.
52. Senye M, Mir CF, Morton S, et al. Topical nonsteroidal anti-inflammatory medications for treatment of temporomandibular joint degenerative pain: a systematic review. J Orofac Pain. 2012;26(one):26–32.
53. Fallah HM, Currimbhoy S. Use of botulinum toxin A for treatment of myofascial pain and dysfunction. J Oral Maxillofac Surg. 2012;70(5):1243–1245.
54. von Lindern JJ, Niederhagen B, Bergé S, et al. Blazon A botulinum toxin in the handling of chronic facial pain associated with masticatory hyperactivity. J Oral Maxillofac Surg. 2003;61(seven):774–778.
55. Freund B, Schwartz M, Symington JM. The use of botulinum toxin for the treatment of temporomandibular disorders: preliminary findings. J Oral Maxillofac Surg. 1999;57(viii):916–920.
56. Castro WH, Gomez RS, Da Silva Oliveira J, et al. Botulinum toxin type A in the management of masseter musculus hypertrophy. J Oral Maxillofac Surg. 2005;63(1):twenty–24.
57. Soares A, Andriolo RB, Atallah AN, et al. Botulinum toxin for myofascial pain syndrome in adults. Cochrane Database Syst Rev. 2014;(7):CD007533.
58. Klasser GD, Greene CS. Oral appliances in the management of tem–poromandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(ii):212–223.
59. Fricton J, Look JO, Wright E, et al. Systematic review and meta-assay of randomized controlled trials evaluating intraoral orthopedic appliances for temporomandibular disorders. J Orofac Pain. 2010;24(3):237–254.
60. Al-Ani MZ, Davies SJ, Gray RJ, et al. Stabilisation splint therapy for temporomandibular pain dysfunction syndrome. Cochrane Database Syst Rev. 2004;(1):CD002778.
61. Koh H, Robinson PG. Occlusal adjustment for treating and preventing temporomandibular joint disorders. Cochrane Database Syst Rev. 2003;(1):CD003812.
62. American Society of Temporomandibular Articulation Surgeons. Guidelines for diagnosis and direction of disorders involving the temporomandibular articulation and related musculoskeletal structures. Cranio. 2003;21(i):68–76.
63. Guo C, Shi Z, Revington P. Arthrocentesis and lavage for treating temporomandibular articulation disorders. Cochrane Database Syst Rev. 2009;(4):CD004973.
64. Rigon M, Pereira LM, Bortoluzzi MC, et al. Arthroscopy for temporomandibular disorders. Cochrane Database Syst Rev. 2011;(five):CD006385.
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