Diagnosis and Treatment Methods for Temporomandibular Joint Disorders

<< Diagnosis of Temporomandibular Joint Disorders >>

• To accurately evaluate a patient with a temporomandibular joint disorder, a standardized comprehensive assessment system is needed. For this, the "Temporomandibular Joint Disorders: Guidelines for Classification, Assessment, and Treatment" prepared by the American Academy of Orofacial Pain can be especially helpful to clinicians.

• Some of the main items in a brief questionnaire for diagnosing temporomandibular joint disorders

• Do you feel discomfort or pain when opening your mouth, such as when yawning?

• Has your jaw ever become immobile, failed to open, or dislocated?

• Do you have pain inside the ear or around the ear, at the temples, or in the cheek area?

• Does your bite feel strange, or do you feel discomfort when closing your teeth?

• Do you often have headaches or neck pain?

• Have you ever heard a sound from the temporomandibular joint?

• Comprehensive medical history review: To diagnose a temporomandibular joint disorder, a comprehensive medical history review is performed, including the current illness history, past psychiatric history, past dental history, and personal history, as shown below.

• Imaging tests: To differentiate and diagnose structural disorders of the head, neck, mandible, temporomandibular joint, teeth, and periodontal tissues, imaging tests of these areas may be necessary.

• Psychological and behavioral factors review: intermittent, inappropriate, and vague pain complaints / exaggerated description of symptoms / symptoms that change in relation to life events / significant pain lasting more than 6 months / intermittent response to medication / evidence of secondary gain, etc.

<< Treatment of Temporomandibular Joint Disorders >>

1. Exercise therapy - Exercise therapy includes six components: the tongue resting position, temporomandibular joint rotational exercises, neck exercises, neck joint resting position, neck exercises, and shoulder posture. It can be performed anywhere, but do not do one exercise for more than 1 minute.

2. Behavioral therapy - Behavioral therapy, also called behavior modification or conditioning therapy, is based on learning psychology theory. In other words, based on objective and measurable results obtained experimentally regarding human behavior, symptoms appearing in an individual are regarded as the manifestation of unconscious problems. Rather than dealing with them indirectly, they are regarded as learned behaviors, and this therapy directly changes or modifies problem behaviors through a behavioral psychology approach.

Temporomandibular joint disorder is a functional disease caused by damage to the tissues related to mandibular movement, namely the temporomandibular joint, masticatory muscles, and surrounding maxillofacial tissues, and its main symptoms are pain and functional impairment. Damage to tissues related to temporomandibular joint disorders can occur due to momentary trauma such as impact, but it is believed that the main cause is microtrauma to the tissues resulting from chronic fatigue caused by poor chewing habits, poor oral habits and jaw movement habits, and poor head and neck posture. In addition, psychological tension can also cause tissue sensitization and muscle tension, so it is regarded as an important cause of temporomandibular joint disorders.

Because temporomandibular joint disorders usually present as chronic physical disabilities, it is important to calm the patient psychologically, help them develop a positive mindset, and encourage them to cooperate with treatment on their own.

3. Physical therapy - Physical therapy is one of the most commonly used treatments, along with occlusal appliances, for the successful treatment of temporomandibular joint disorders. The goal of physical therapy is primarily to restore the mobility and function of the temporomandibular joint and cervical spine, and further to correct postures that may cause dysfunction, and to stretch, strengthen, or coordinate the muscles attached to the mandible.

Types - cryotherapy, thermotherapy, electrotherapy, laser therapy, biofeedback therapy7

4. Medication therapy - The range of medications used to treat pain associated with temporomandibular joint disorders or orofacial pain varies from short-term use of nonsteroidal anti-inflammatory drugs to long-term use of antidepressants and anticonvulsants for nonspecific pain. Medication therapy is generally carried out in combination with other treatments, and appropriate medication regimens are administered after an accurate diagnosis.

Types - anti-inflammatory drugs/antidepressants/anticonvulsants/muscle relaxants/anxiolytics/antihistamines/weak analgesics/local anesthetics

5. Occlusal appliance therapy - Occlusal appliance therapy is often used to treat internal derangement of the temporomandibular joint and myofascial pain. It may be used alone, but is generally used together with other treatments such as physical therapy, behavioral therapy, and medication therapy. Occlusal appliances are also called occlusal splints, and are also referred to as interocclusal appliances, orthopedic appliances, night guards, bruxism appliances, and so on.

Occlusal appliances are removable resin devices that cover the teeth entirely. They are used to reduce bruxism and parafunction, prevent tooth wear and mobility, normalize occlusion by changing the structural relationship of the temporomandibular joint, redistribute occlusal force, and treat masticatory muscle pain and mandibular dysfunction.

6. Other irreversible treatments

• For temporomandibular joint disorders, it is preferable to prioritize reversible treatments such as physical therapy, medication therapy, and appliance therapy, which can return to their original state immediately if treatment is stopped. However, in special cases, irreversible treatments that cannot be reversed even if treatment is stopped must be performed. These include occlusal treatment and surgical treatment.

Occlusal treatment includes occlusal adjustment and restorative occlusal treatment, and in some cases restorative and orthodontic treatment may need to follow. Surgical treatments include temporomandibular joint lavage, arthroscopy, temporomandibular joint surgery, and orthognathic surgery. The selection of such procedures should be based on an accurate diagnosis grounded in the patient's condition, and consultation with a dentist who specializes in treating temporomandibular joint disorders is essential.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal