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temporomandibular disorders (TMD)

Time to Chew on Temporomandibular Disease

Teaser: 

Dr. Robert Caratun, BSc, MSc,1
Dr. Aly Abdulla, MD, CCFP, FCFP, DipSportMed CASEM, CTH, CCPE, McPL,2

1is a graduating medical student from The University of Ottawa going into Family Medicine residency at The University of Calgary in June 2019. He has a background in coaching and creating custom mental skills programs for athletes.
2 is a family doctor with specialties in sports medicine, palliative care, and cosmetic medicine. He can be found on Twitter, LinkedIn and https://ihopeyoufindthishumerusblog.wordpress.com/

CLINICAL TOOLS

Abstract: Temporomandibular disorders (TMD) are one of the most common non tooth-related chronic orofacial pain conditions that involve the muscles of mastication and/or the temporomandibular joint (TMJ) and associated structures. This article reviews the etiology, diagnosis, and treatment of this chronic pain condition.
Key Words: chronic pain, temporomandibular disorders (TMD), temporomandibular joint (TMJ).
1. The etiology of TMD is multifactorial in nature
2. TMD is a clinical diagnosis. Clinicians should perform a complete history and physical with special focus on a dental and psychiatric history.
3. Imaging can be considered if history and physical are insufficient for diagnosis. Diagnostic injections can also be used to further guide clinicians.
4. For TMD treatment, supportive patient education should be prioritized (jaw rest, soft diet, passive stretching) in addition to conservative treatment measures (e.g. NSAIDs).
The most common presenting symptoms of TMD are facial pain, ear discomfort, headache and jaw discomfort/dysfunction.
Symptoms of TMD are typically associated with jaw movement and pain in the temple, masseter, or preauricular region. If there is no pain with jaw movement, consider an alternate diagnosis.
A large volume of patients report abnormal jaw sounds with no jaw pain or dysfunction. Do not treat adventitious jaw sounds; only pain or discomfort in TMD
Patent supportive measures and conservative treatment result in significant pain reduction for the majority of patients and should be the main focus of TMD treatment.
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