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Diseases

Temporomandibular disorders

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • Temporomandibular disorders (TMDs) (previously temporomandibular joint syndrome) are a group of disorders associated with pain in the mouth and face that can progress to chronic pain.

  • TMDs typically present with four characteristic features: temporomandibular joint pain, noise in the joint, masticatory muscle tenderness, and limited mandibular movement.

  • TMDs can be self-limiting and can considerably affect quality of life.

  • Diagnostic Criteria for TMD, which comprises the Axis I (physical assessment) and Axis II (psychosocial assessment) domains, provides a standard criteria for the diagnosis of TMDs. 

  • TMDs can primarily be treated by resting the affected joint.

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

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      • Diagnostics Tests

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        • Treatment Options

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          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Citations

            Key Articles

            • List T, Jensen RH. Temporomandibular disorders: old ideas and new concepts. Cephalalgia. 2017 Jun;37(7):692-704.[Abstract][Full Text]

            • Durham J, Newton-John TR, Zakrzewska JM. Temporomandibular disorders. BMJ. 2015 Mar 12;350:h1154.[Abstract]

            • Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 2014 Winter;28(1):6-27.[Abstract][Full Text]

            • Dimitroulis G. Temporomandibular disorders: a clinical update. BMJ. 1998;317:190-4.[Abstract][Full Text]

            • Kapur N, Kamel IR, Herlich A. Oral and craniofacial pain: diagnosis, pathophysiology and treatment. Int Anesthesiol Clin. 2003;41:115-50.[Abstract]

            • Acquired temporomandibular disorders in infants, children, and adolescents. American Academy of Pediatric Dentistry. 2019 [internet publication].[Full Text]

            Referenced Articles

            • 1. List T, Jensen RH. Temporomandibular disorders: old ideas and new concepts. Cephalalgia. 2017 Jun;37(7):692-704.[Abstract][Full Text]

            • 2. Durham J, Newton-John TR, Zakrzewska JM. Temporomandibular disorders. BMJ. 2015 Mar 12;350:h1154.[Abstract]

            • 3. ​The TMJ Association. Orofacial pain: prospective evaluation and risk assessment (OPPERA) [internet publication].[Full Text]

            • 4. Busse JW, Casassus R, Carrasco-Labra A, et al. Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline. BMJ. 2023 Dec 15;383:e076227.[Abstract][Full Text]

            • 5. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 2014 Winter;28(1):6-27.[Abstract][Full Text]

            • 6. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211.[Abstract][Full Text]

            • 7. ​Nitzan DW, Marmary Y. The "anchored disc phenomenon": a proposed etiology for sudden-onset, severe, and persistent closed lock of the temporomandibular joint. J Oral Maxillofac Surg. 1997 Aug;55(8):797-802.[Abstract]

            • 8. Al-Belasy FA, Salem AS. Is the anchored disc phenomenon a truly distinct entity? a systematic review. J Oral Maxillofac Surg. 2018 Sep;76(9):1883.e1-1883.e10.[Abstract]

            • 9. Durham J, Wassell RW. Recent advancements in temporomandibular disorders (TMDs). Rev Pain. 2011 Mar;5(1):18-25.[Abstract][Full Text]

            • 10. Young AL. Internal derangements of the temporomandibular joint: a review of the anatomy, diagnosis, and management. J Indian Prosthodont Soc. 2015 Jan-Mar;15(1):2-7.[Abstract][Full Text]

            • 11. Dimitroulis G. Temporomandibular disorders: a clinical update. BMJ. 1998;317:190-4.[Abstract][Full Text]

            • 12. Kapur N, Kamel IR, Herlich A. Oral and craniofacial pain: diagnosis, pathophysiology and treatment. Int Anesthesiol Clin. 2003;41:115-50.[Abstract]

            • 13. Slade GD, Fillingim RB, Sanders AE, et al. Summary of findings from the OPPERA prospective cohort study of incidence of first-onset temporomandibular disorder: implications and future directions. J Pain. 2013 Dec;14(7 suppl):T116-24.[Abstract][Full Text]

            • 14. Warren MP, Fried JL. Temporomandibular disorders and hormones in women. Cells Tissues Organs. 2001;169:187-92.[Abstract]

            • 15. Bagis B, Ayaz EA, Turgut S, et al. Gender difference in prevalence of signs and symptoms of temporomandibular joint disorders: a retrospective study on 243 consecutive patients. Int J Med Sci. 2012;9(7):539-44.[Abstract][Full Text]

            • 16. Lund JP, Widmer CG, Feine JS. Validity of diagnostic and monitoring tests used for temporomandibular disorders. J Dent Res. 1995;74:1133-43.[Abstract]

            • 17. Acquired temporomandibular disorders in infants, children, and adolescents. American Academy of Pediatric Dentistry. 2019 [internet publication].[Full Text]

            • 18. LeResche L. Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors. Crit Rev Oral Biol Med. 1997;8:291-305.[Abstract][Full Text]

            • 19. Köhler AA, Helkimo AN, Magnusson T, et al. Prevalence of symptoms and signs indicative of temporomandibular disorders in children and adolescents. A cross-sectional epidemiological investigation covering two decades. Eur Arch Paediatr Dent. 2009 Nov;10(1 suppl):16-25.[Abstract]

            • 20. Yadav S, Yang Y, Dutra EH, et al. Temporomandibular joint disorders in older adults. J Am Geriatr Soc. 2018 Jul;66(6):1213-7.[Abstract][Full Text]

            • 21. Ohrbach R, Fillingim RB, Mulkey F, et al. Clinical findings and pain symptoms as potential risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case-control study. J Pain. 2011 Nov;12(11 suppl):T27-45.[Abstract][Full Text]

            • 22. Kroese JM, Volgenant CMC, Crielaard W, et al. Temporomandibular disorders in patients with early rheumatoid arthritis and at-risk individuals in the Dutch population: a cross-sectional study. RMD Open. 2021 Jan;7(1):e001485.[Abstract][Full Text]

            • 23. Mortazavi N, Babaei M, Babaee N, et al. Evaluation of the prevalence of temporomandibular joint involvement in rheumatoid arthritis using research diagnostic criteria for temporomandibular disorders. J Dent (Tehran). 2018 Nov;15(6):332-8.[Abstract][Full Text]

            • 24. Greenspan JD, Slade GD, Bair E, et al. Pain sensitivity risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case control study. J Pain. 2011 Nov;12(11 suppl):T61-74.[Abstract][Full Text]

            • 25. Auerbach SM, Laskin DM, Frantsve LM, et al. Depression, pain, exposure to stressful life events, and long-term outcomes in temporomandibular disorder patients. J Oral Maxillofac Surg. 2001 Jun;59(6):628-33.[Abstract]

            • 26. Mitrirattanakul S DDS, PhD, Jariyasakulroj S DDS. Dental treatment as perceived etiology of temporomandibular disorders. Cranio. 2020 Mar;38(2):109-14.[Abstract]

            • 27. Shroff B. Malocclusion as a cause for temporomandibular disorders and orthodontics as a treatment. Oral Maxillofac Surg Clin North Am. 2018 Aug;30(3):299-302.[Abstract]

            • 28. Aboalnaga AA, Amer NM, Elnahas MO, et al. Malocclusion and temporomandibular disorders: verification of the controversy. J Oral Facial Pain Headache. 2019 Fall;33(4):440-50.[Abstract]

            • 29. Smith SB, Maixner DW, Greenspan JD, et al. Potential genetic risk factors for chronic TMD: genetic associations from the OPPERA case control study. J Pain. 2011 Nov;12(11 suppl):T92-101.[Abstract][Full Text]

            • 30. Visscher CM, Lobbezoo F. TMD pain is partly heritable. A systematic review of family studies and genetic association studies. J Oral Rehabil. 2015 May;42(5):386-99.[Abstract]

            • 31. Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008 Dec 18;359(25):2693-705.[Abstract]

            • 32. Forssell H, Kauko T, Kotiranta U, et al. Predictors for future clinically significant pain in patients with temporomandibular disorder: a prospective cohort study. Eur J Pain. 2017 Jan;21(1):188-97.[Abstract]

            • 33. Jedynak B, Jaworska-Zaremba M, Grzechocińska B, et al. TMD in females with menstrual disorders. Int J Environ Res Public Health. 2021 Jul 7;18(14):7263.[Abstract][Full Text]

            • 34. Soydan SS, Deniz K, Uckan S, et al. Is the incidence of temporomandibular disorder increased in polycystic ovary syndrome? Br J Oral Maxillofac Surg. 2014 Nov;52(9):822-6.[Abstract]

            • 35. Yazici H, Taskin MI, Guney G, et al. The novel relationship between polycystic ovary syndrome and temporomandibular joint disorders. J Stomatol Oral Maxillofac Surg. 2021 Dec;122(6):544-8.[Abstract]

            • 36. Landi N, Lombardi I, Manfredini D, et al. Sexual hormone serum levels and temporomandibular joint disorders. A preliminary study. Gynecol Endocrinol. 2005;20:99-103.[Abstract]

            • 37. LeResche L, Mancl L, Sherman JJ, et al. Changes in temporomandibular pain and other symptoms across the menstrual cycle. Pain. 2003 Dec;106(3):253-61.[Abstract]

            • 38. Plesh O, Adams SH, Gansky SA. Temporomandibular joint and muscle disorder-type pain and comorbid pains in a national US sample. J Orofac Pain. 2011 Summer;25(3):190-8.[Abstract][Full Text]

            • 39. Kleykamp BA, Ferguson MC, McNicol E, et al. The prevalence of comorbid chronic pain conditions among patients with temporomandibular disorders: a systematic review. J Am Dent Assoc. 2022 Mar;153(3):241-50.e10.[Abstract]

            • 40. Glaros AG. Emotional factors in temporomandibular joint disorders. J Indiana Dent Assoc. 2000-2001;79:20-23.[Abstract]

            • 41. Wise M. Citalopram-induced bruxism. Br J Psychiatry. 2001 Feb;178:182.[Full Text]

            • 42. Raja M, Raja S. Two cases of sleep bruxism associated with escitalopram treatment. J Clin Psychopharmacol. 2014 Jun;34(3):403-5.

            • 43. Garrett AR, Hawley JS. SSRI-associated bruxism: a systematic review of published case reports. Neurol Clin Pract. 2018 Apr;8(2):135-41.[Abstract][Full Text]

            • 44. De Boever JA, Nilner M, Orthlieb JD, et al. Recommendations by the EACD for examination, diagnosis, and management of patients with temporomandibular disorders and orofacial pain by the general dental practitioner. J Orofac Pain. 2008;22:268-78.[Abstract]

            • 45. The Royal College of Surgeons of England. Commissioning guide 2014: Temporomandibular joint disorders. 2014 [internet publication].[Full Text]

            • 46. Temporomandibular disorders. American Association of Oral and Maxillofacial Surgeons. 2017 [internet publication].[Full Text]

            • 47. Larheim TA, Abrahamsson AK, Kristensen M, et al. Temporomandibular joint diagnostics using CBCT. Dentomaxillofac Radiol. 2015;44(1):20140235.[Abstract][Full Text]

            • 48. Krishnamoorthy B, Mamatha N, Kumar VA. TMJ imaging by CBCT: Current scenario. Ann Maxillofac Surg. 2013 Jan;3(1):80-3.[Abstract][Full Text]

            • 49. Shah A, Naqvi A. Temporomandibular disorder: a guide for general dental practitioners. Prim Dent J. 2022 Sep;11(3):118-25.[Abstract]

            • 50. Molin C. From bite to mind: TMD - a personal and literature review. Int J Prosthodont. 1999;12:279-88.[Abstract]

            • 51. Yao L, Sadeghirad B, Li M, et al. Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials. BMJ. 2023 Dec 15;383:e076226.[Abstract][Full Text]

            • 52. Shedden Mora MC, Weber D, Neff A, et al. Biofeedback-based cognitive-behavioral treatment compared with occlusal splint for temporomandibular disorder: a randomized controlled trial. Clin J Pain. 2013;29:1057-65.[Abstract]

            • 53. Penlington C, Bowes C, Taylor G, et al. Psychological therapies for temporomandibular disorders (TMDs). Cochrane Database Syst Rev. 2022 Aug 11;(8):CD013515.[Abstract][Full Text]

            • 54. Arribas-Pascual M, Hernández-Hernández S, Jiménez-Arranz C, et al. Effects of physiotherapy on pain and mouth opening in temporomandibular disorders: an umbrella and mapping systematic review with meta-meta-analysis. J Clin Med. 2023 Jan 18;12(3):788.[Abstract][Full Text]

            • 55. Fricton J, Look JO, Wright E, et al. Systematic review and meta-analysis of randomized controlled trials evaluating intraoral orthopedic appliances for temporomandibular disorders. J Orofac Pain. 2010;24:237-54.[Abstract]

            • 56. Ebrahim S, Montoya L, Busse JW, et al. The effectiveness of splint therapy in patients with temporomandibular disorders: a systematic review and meta-analysis. J Am Dent Assoc. 2012;143:847-57.[Abstract]

            • 57. Tournavitis A, Sandris E, Theocharidou A, et al. Effectiveness of conservative therapeutic modalities for temporomandibular disorders-related pain: a systematic review. Acta Odontol Scand. 2023 May;81(4):286-97.[Abstract]

            • 58. Tran C, Ghahreman K, Huppa C, et al. Management of temporomandibular disorders: a rapid review of systematic reviews and guidelines. Int J Oral Maxillofac Surg. 2022 Sep;51(9):1211-25.[Abstract]

            • 59. Riley P, Glenny AM, Worthington HV, et al. Oral splints for temporomandibular disorder or bruxism: a systematic review. Br Dent J. 2020 Feb;228(3):191-7.[Abstract][Full Text]

            • 60. Minervini G, Franco R, Crimi S, et al. Pharmacological therapy in the management of temporomandibular disorders and orofacial pain: a systematic review and meta-analysis. BMC Oral Health. 2024 Jan 13;24(1):78.[Abstract][Full Text]

            • 61. Ouanounou A, Goldberg M, Haas DA. Pharmacotherapy in temporomandibular disorders: a review. J Can Dent Assoc. 2017 Jul;83:h7.[Abstract][Full Text]

            • 62. Kulkarni S, Thambar S, Arora H. Evaluating the effectiveness of nonsteroidal anti-inflammatory drug(s) for relief of pain associated with temporomandibular joint disorders: a systematic review. Clin Exp Dent Res. 2020 Feb;6(1):134-46.[Abstract][Full Text]

            • 63. Montinaro F, Nucci L, d'Apuzzo F, et al. Oral nonsteroidal anti-inflammatory drugs as treatment of joint and muscle pain in temporomandibular disorders: a systematic review. Cranio. 2022 Feb 7:1-10.[Abstract]

            • 64. Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician. 2015 Mar 15;91(6):378-86.[Abstract][Full Text]

            • 65. Dammling C, Abramowicz S, Kinard B​. The use of pharmacologic agents in the management of temporomandibular joint disorder. Front. Oral Maxillofac. Med. 2022 Jun 10;4:17.[Full Text]

            • 66. 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 Jul;21(3):221-5.[Abstract]

            • 67. de Sousa BM, López-Valverde A, Caramelo F, et al. Use of antidepressants in the treatment of chronic orofacial pain caused by temporomandibular disorders: a randomized controlled clinical trial. [in spa]. Med Clin (Barc). 2024 Jul 26;163(2):74-7.[Abstract]

            • 68. ClinicalTrials.gov. Myofascial pain patients' response to the administration of low doses of amitriptyline and citalopram compared with the use of bite splint. ClinicalTrials.gov Identifier: NCT04777838. Mar 2021 [internet publication].[Full Text]

            • 69. Rajan R, Sun YM. Reevaluating antidepressant selection in patients with bruxism and temporomandibular joint disorder. J Psychiatr Pract. 2017 May;23(3):173-9.[Abstract]

            • 70. Kimos P, Biggs C, Mah J, et al. Analgesic action of gabapentin on chronic pain in the masticatory muscles: a randomized controlled trial. Pain. 2007 Jan;127(1-2):151-60.[Abstract]

            • 71. Sidebottom AJ, Salha R. Management of the temporomandibular joint in rheumatoid disorders. Br J Oral Maxillofac Surg. 2013 Apr;51(3):191-8.[Abstract]

            • 72. National Institute for Health and Care Excellence. ​Total prosthetic replacement of the temporomandibular joint. Aug 2014 [internet publication].[Full Text]

            • 73. American Society of TMJ Surgeons. ​Surgical management of TMJ disorders [internet publication].​[Full Text]

            • 74. Fisch G, Finke A, Ragonese J, et al. Outcomes of physical therapy in patients with temporomandibular disorder: a retrospective review. Br J Oral Maxillofac Surg. 2021 Feb;59(2):145-50.[Abstract]

            • 75. Delcanho R, Val M, Guarda Nardini L, et al. Botulinum toxin for treating temporomandibular disorders: what is the evidence? J Oral Facial Pain Headache. 2022 Winter;36(1):6-20.[Abstract][Full Text]

            • 76. Saini RS, Ali Abdullah Almoyad M, Binduhayyim RIH, et al. The effectiveness of botulinum toxin for temporomandibular disorders: a systematic review and meta-analysis. PLoS One. 2024;19(3):e0300157.[Abstract][Full Text]

            • 77. Thambar S, Kulkarni S, Armstrong S, et al. Botulinum toxin in the management of temporomandibular disorders: a systematic review. Br J Oral Maxillofac Surg. 2020 Jun;58(5):508-19.[Abstract]

            • 78. Machado D, Martimbianco ALC, Bussadori SK, et al. Botulinum toxin type A for painful temporomandibular disorders: systematic review and meta-analysis. J Pain. 2020 Mar-Apr;21(3-4):281-93.[Abstract][Full Text]

            • 79. Fink M, Rosted P, Bernateck M, et al. Acupuncture in the treatment of painful dysfunction of the temporomandibular joint - a review of the literature. Forsch Komplementarmed. 2006;13:109-15.[Abstract]

            • 80. Cho SH, Whang WW. Acupuncture for temporomandibular disorders: a systematic review. J Orofac Pain. 2010;24:152-62.[Abstract]

            • 81. Fernandes AC, Duarte Moura DM, Da Silva LGD, et al. Acupuncture in temporomandibular disorder myofascial pain treatment: a systematic review. J Oral Facial Pain Headache. 2017 Summer;31(3):225-32.[Abstract][Full Text]

            • 82. Peixoto KO, da Silva Bezerra A, Melo RA, et al. Short-term effect of scalp acupuncture on pain, sleep disorders, and quality of life in patients with temporomandibular disorders: a randomized clinical trial. Pain Med. 2021 Apr 20;22(4):905-14.[Abstract][Full Text]

            • 83. Şen S, Orhan G, Sertel S, et al. Comparison of acupuncture on specific and non-specific points for the treatment of painful temporomandibular disorders: a randomised controlled trial. J Oral Rehabil. 2020 Jul;47(7):783-95.[Abstract][Full Text]

            • 84. Grillo CM, Canales Gde L, Wada RS, et al. Could acupuncture be useful in the treatment of temporomandibular dysfunction? J Acupunct Meridian Stud. 2015 Aug;8(4):192-9.[Abstract][Full Text]

            • 85. La Touche R, Angulo-Diaz-Parreno S, de-la-Hoz JL, et al. Effectiveness of acupuncture in the treatment of temporomandibular disorders of muscular origin: a systematic review of the last decade. J Altern Complement Med. 2010;16:107-12.[Abstract]

            • 86. La Touche R, Goddard G, De-la-Hoz JL, et al. Acupuncture in the treatment of pain in temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials. Clin J Pain. 2010;26:541-50.[Abstract]

            • 87. Ernst E, White AR. Acupuncture as a treatment for temporomandibular joint dysfunction: a systematic review of randomized trials. Arch Otolaryngol Head Neck Surg. 1999;125:269-72.[Abstract]

            • 88. 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;7:109-15.[Abstract]

            • 89. Melis M, Di Giosia M, Zawawi KH. Low level laser therapy for the treatment of temporomandibular disorders: A systematic review of the literature. Cranio. 2012;30:304-12.[Abstract]

            • 90. Ahmad SA, Hasan S, Saeed S, et al. Low-level laser therapy in temporomandibular joint disorders: a systematic review. J Med Life. 2021 Mar-Apr;14(2):148-64.[Abstract][Full Text]

            • 91. Ren H, Liu J, Liu Y, et al. Comparative effectiveness of low-level laser therapy with different wavelengths and transcutaneous electric nerve stimulation in the treatment of pain caused by temporomandibular disorders: a systematic review and network meta-analysis. J Oral Rehabil. 2022 Feb;49(2):138-49.[Abstract]

            • 92. Racich MJ. Orofacial pain and occlusion: is there a link? An overview of current concepts and the clinical implications. J Prosthet Dent. 2005;93:189-96.[Abstract]

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