History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include age 20-40 years, female sex, and pain comorbidities.
cyclic pain
Patients with myofascial pain and dysfunction complain of cyclic pain, particularly in the morning, and possibly tooth pain from night-time bruxing (teeth grinding).
Pain is the most important feature and if it is not related to using the jaw, it is unlikely to be due to TMDs.
Patients with osteoarthritis usually have pain.
continuous pain
Patients with internal derangement often complain of continuous pain that is worse with mandibular movement.[11]
Pain is the most important feature, and if it is not related to using the jaw, it is unlikely to be due to TMDs.
Patients with osteoarthritis usually have pain. Some patients (about 30%) may progress to chronic TMD, with persistent pain for ≥3 months.[4]
joint noise
Patients with myofascial pain and dysfunction may have a palpable or audible joint click in that area as the jaw is opened and closed.
Patients with internal derangement have clicking and possible locking and restriction of opening of the jaw.
Patients with osteoarthritis and with osteoarthrosis may have joint crepitus.
abnormal mandibular movement
Maximal mandibular opening is 35-55 mm.[12] Movement may be reduced to <35 mm.
There may be an uncorrected deviation on maximum mouth opening and patients may complain of their teeth locking or their bite feeling wrong. The teeth should be evaluated for wear facets, which are indicative of bruxism.[11]
masticatory muscle tenderness
The muscles are tender to palpation and on maximal mouth opening. There may be areas of spasm which feel like lumps in the muscles that are tender. The muscles of mastication, particularly masseter and temporalis, may be bulky.
Other diagnostic factors
common
uncommon
headache, backache, earache, or neck pain
A history of headaches, neck pain, earache, or back pain should be sought as cervical pain may be referred to orofacial structures and this can be misinterpreted as TMDs. Patients may have systemic myofascial pain syndromes, hypermobility syndrome, or fibromyalgia.
Risk factors
strong
female sex
TMDs are more common in women than in men.[4][11][15][18] TMDs have been associated with pubertal onset in girls.[17]
Increased prevalence of TMDs in women with menstrual disorders has been reported.[33][34][35]
One study found higher levels of estradiol in both women and men with TMDs.[36]
Another study found an inverse relationship between circulating oestrogen and joint pain.[14] A correlation between temporomandibular joint pain severity and phases of the menstrual cycle has been reported.[37] However, overall, there is insufficient evidence to link TMDs to female hormone levels.
pain comorbidities
TMDs have been linked to pain comorbidities.[38][39] One study found that 83% of patients with TMD pain had one pain comorbidity and 59% had at least two.[38] In one systematic review, a high prevalence of comorbid pain conditions in patients with TMDs was found, with chronic back pain, myofascial syndrome, and chronic stomach pain observed in >50% of patients.[39]
age 20-40 years
weak
depression, anxiety, or stress
Depression may be a risk factor.[18][25] It is commonly associated with chronic pain syndromes.[40] One study found the risk of developing TMDs was greater for severely depressed people than for non-depressed people.[18] Anxiety and stress are also associated with TMDs.[12][40] Some selective serotonin-reuptake inhibitors are associated with bruxism and/or jaw pain, which can exacerbate TMDs.[41][42][43]
It is common to have an increased presentation of TMDs in young adults during exams and relationship break-ups.
genetics
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