Temporomandibular Joint Disorders

Temporomandibular disorders (TMDs) have signs and symptoms that are common and are generally self-limiting. Between 3.6% and 7% of the general population have TMDs that are severe enough that patients seek treatment. Masticatory muscle myofascial pain is more common than temporomandibular joint (TMJ) arthralgia. TMD chronic pain has neuroplastic and/or nociplastic etiologies and often involves systemic comorbidities. Management of TMDs should include the identification of contributing factors. Advances in the management of TMDs are based on improved knowledge in the areas of TMJ and muscle physiology and the newest findings as relates to dysregulated central nervous system sensory processing. Treatment often requires a multidisciplinary approach utilizing a team of professionals including orofacial pain specialist, primary care physician, neurologist, rheumatologist, sleep medicine therapist, mental health provider, and physical therapist working in conjunction with the patient. With respect to disorders of the TMJ, management strategies have evolved into less invasive approaches. Surgical management is reserved for cases where restoration of structural loss of the mandibular condyle is needed. The only TMJ surgical procedure with sufficient outcomes data to validate use is total joint replacement, where the best outcomes occur in patients experiencing severe loss of condyle architecture due to rheumatologic conditions that have deformed the joint.