Temporomandibular Joint Dysfunction Treatments Question and Answers

Temporomandibular Joint Important Notes

1. Myofascial pain dysfunction syndrome

  • Masticatory muscle tenderness
  • Pain in TMJ
  • Limitation of motion
  • Clicking noise present

Temporomandibular Joint Long Essays

Question 1. Describe the etiology, clinical features, differential diagnosis, and treatment of myofascial pain dysfunction syndrome.

Myofascial pain dysfunction syndrome

  • It is a disorder characterized by facial pain limited to the mandibular function, muscle tenderness, joint sounds, absence of significant organic and pathologic changes in TMJ
  • It may be due to functional derangement of dental articulation, psychological state of mind, or physiological state of the joint
  • Coined by Laskin


  • Extrinsic factors
    • Occlusal disharmony
    • Trauma
    • Environmental influences
    • Habits
  • Intrinsic factors
    • Internal derangement of TMJ
    • Anterior locking of disc
    • Trauma

myofascial pain dysfunction syndrome  Features:

  • Unilateral preauricular pain
  • Dull constant sound
  • Muscle tenderness
  • Clicking noise
  • Altered jaw function
  • Absence of radiographic changes
  • Absence of tenderness in ext. auditory meatus

myofascial pain dysfunction syndrome Management:

  • Reassurance
  • Soft diet
  • Occlusal correction: 7 ‘R’s
    • Remove-extract the tooth
    • Reshape grind the occlusal surface
    • Reposition orthodontically treated
    • Restore conservative treatment
    • Replace by prosthesis
    • Reconstruct TMJ surgery
    • Regulate control habits
  • Isometric exercises
    • Opening and closing of mouth 10 times a day
  • Medicaments
    • Aspirin: 0.3-0.6 gm/ 4 hourly
    • NSAIDS: For 14-21 days
    • Pentazocine: 50 mg/ 2-3 times a day

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  • Heat application
    • It increases circulation
  • Diathermy
    • Causes heat transmission to deeper tissues
  • LA injections
    • 2% lignocaine into trigger points
  • Steroid injection
    • As anti-inflammatory
  • Anti-anxiety drugs
    • Diazepam-2-5 mg * 10 days
  • Tens
  • Acupuncture

Question 2. Define trismus. Discuss various causes and management of trismus.
Define trismus. Discuss various causes and differential diagnoses of trismus.



It is a condition in which muscle spasm prevents the opening of the mouth

trismus Causes:

  • Orofacial infection
  • Trauma
  • Inflammation
  • Myositis
  • Tetany
  • Tetanus
  • Neurological disorders
  • Drug-induced
  • Extra articular fibrosis
  • Mechanical blockage


Injection of inferior alveolar nerve block

Bleeding at the site




trismus Differential Diagnosis:

  • Internal derangement of TMJ
  • Fracture of mandibular condyle
  • TMJ dislocation
  • Septic arthritis
  • Osteoarthritis
  • Ankylosis
  • Hematoma
  • Acute infections

trismus Treatment:

  • May resolve on its own
  • Manipulation of the jaw by jaw stretcher

Temporomandibular Joint Short Essays

Question 1. Articular disc disorders of the temporomandibular joint.


Articular disc disorders of the temporomandibular joint

In osteoarthritis, an articular disc of TMJ is affected


Oral Medicine Temporomandibular Joint Etiopathogenesis

temporomandibular joint Types:

  1. Primary: Due to wear and tear
  2. Secondary: Due to local and systemic factors

temporomandibular joint Clinical Features:

  • Age: Older age
  • Site: common in TMJ

temporomandibular joint Presentation:

Unilateral painful joint

Interference in biting and
mandibular movements

Sensitive to palpation

Crepitation of joint

Spasm of muscle

Limitation of joint movements

temporomandibular joint Management:

  • Elimination of cause
  • Relief of pressure
  • Physiotherapy
  • Myotherapy
  • Doxycycline

Question 2. Internal dearangement of temporomandibular joint.


temporomandibular joint Definition:

It is the anteromedial displacement of the interarticular disc associated with the posterosuperior displacement of the condyle in the closed jaw position

temporomandibular joint Features:

  • Pain on biting
  • Clicking sound over the joint
  • Deviation of mandible
  • Restricted mouth opening due to pain

temporomandibular joint Management:

1. Anterior repositioning appliances

  • Placed on occlusal surfaces

2. Supportive therapy

  • NSAIDs to relieve pain
  • Heat application

3. Occlusal correction

Question 3. Ankylosis of temporomandibular joint.


Temporomandibular Joint Classification:

  • False or true ankylosis
  • Extra articular or intra articular
  • Fibrous or bony
  • Unilateral or bilateral
  • Partial or complete


  • Trauma Congenital
  • Infections -Osteomyelitis
  • Inflammation osteoarthritis
  • Rare causes measles
  • Systemic diseases typhoid
  • Other causes of prolonged trismus

Temporomandibular Joint Pathogenesis:


Extravasation of blood into joint space

Calcification of joint space

Obliteration of joint space

Immobility of joint

Ankylosis of joint

Temporomandibular Joint Features:

  • Unilateral:
    • Deviation of the chin on the affected side o Fullness of the face on the affected side
    • Flatness on the unaffected side
    • Crossbite
    • Angle’s class malocclusion
    • Condylar movements absent on the affected side
  • Bilateral:
    • Inability to open mouth
    • Neck chin angle reduced
    • Class 2 malocclusion
    • Protusive upper incisors
    • Multiple carious teeth

Temporomandibular Joint Management:

1. Condylectomy

  • Pre auricular incision given
  • Horizontal osteotomy cut given over condylar neck
  • The condylar head is separated
  • Smoothened the remaining structures
  • Close the wound in layers
  • If required bilateral condylectomy done

Oral Medicine Temporomandibular Joint Condylectomy Surgicak procedure

  1. Exposure of the condylar head via a preauricular incision
  2. Sectioning of condylar head,
  3. Breaking the fibrous adhesions
  4. Condylectomy complete
  5. Suturing the capsule
  6. Final skin suturing

1. Gap arthroplasty:

  • Two horizontal cuts are given
  • Removal of a bony wedge between the glenoid fossa and ramus

Oral Medicine Temporomandibular Joint Gap and Gap arthroplasty with coronoidectomy

  1. Interposition arthroplasty
    • Creation of gap
    • Insertion of barrier (autogenous or alloplastic)

Kaban’s Protocol:

  • Early surgical intervention
  • Aggressive resection
  • Ipsilateral colectomy
  • Contralateral colectomy
  • The lining of the glenoid fossa with temporalis fascia
  • Reconstruction of ramus with a costochondral graft
  • Early mobilization
  • Regular follow up

Kaban’s Protocol

Kaban’s  Complications:

  • Frey’s syndrome
  • Parotid fistula
  • Facial palsy

Question 6. Clinical features and management of degenerative arthritis.


degenerative arthritis Clinical Features:

  • Age and sex: Older aged women are more affected
  • Site: Many joints are affected but it is not found often in TM]

Degenerative Arthritis Features:

  • Unilateral pain over the joint
  • It is sensitive on palpation
  • Pain on movement or biting
  • Pain aggravates during the evening
  • There is the deviation of the jaw towards affected side
  • The affected joint is swollen and warm to touch
  • There is the presence of crepitation of the joint
  • There is a limitation of jaw movements
  • It results in stiffness and locking of the jaw

Degenerative Arthritis Management:

  • Elimination of the causative agent:
    • Occlusal adjustment or grinding of teeth
    • Replacement of missing teeth
    • Replacement of ill-fitted denture
    • Treatment of caries and periodontal problems
  • Drugs
    • Analgesics and anti-inflammatory drugs are given.
  • Physiotherapy
  • Myotherapy
  • Arthroscopic lavage
  • A low dose of doxycycline
  • Others
    • Glucosamine
    • Chondroitin sulfate

Question 7. Rheumatoid arthritis.


Rheumatoid arthritis

It is a systemic disease that usually affects many joints including the TMJ and the disease is characterized by progressive destruction of the joint structures

Rheumatoid arthritis Clinical Features:

  • Age and sex: women from 20-50 years of age are affected
  • Site: small joints of fingers and toes
  • Presentation
    • Bilateral stiffness
    • Crepitus
    • Tenderness and swelling over the joint
    • Fever, malaise, fatigue
    • Weight loss
    • Polyarthritis affecting large and weight-bearing joints
    • Formation of subcutaneous nodules on the pressure points
    • The joint may become red, swollen, and warm to touch
    • Muscle atrophy around the jaw
    •  Bursitis
  • TMJ involvement
    • Bilateral stiffness of the joint
    • Deep-seated pain and tenderness on palpation
    • Swelling over the joint
    • There is a limitation of mouth opening
    • Pain on biting is referred to the temporal region, ear, and angle of the mandible
    • There is a deviation of the jaw on opening
    • Inability to perform lateral movements
    • Anterior open bite
    • Fibrous ankylosis of the joint

Rheumatoid arthritis Complications:

  • Subluxation
  • Secondary arthritis
  • Muscular atrophy
  • Bird-like face

Rheumatoid arthritis – Radiographic Features:

  • Joint space is reduced
  • There is a flattening of the head of the condyle
  • Erosion of the condyle
  • Hollowing of the condylar cartilage
  • Bony destruction of the articular eminence
  • The condylar outline is irregular and ragged
  • Synovial lining resembles a “sharpened pencil” or “mouthpiece of the flute”
  • Subchondral sclerosis and flattening of articular surface may occur

Rheumatoid arthritis Management:

  • Supportive treatment:
    • Provide adequate rest
    • Advice soft diet
  • Medical
    • Local injection of methyl prednisone acetate
    • 20-80 mg for large joint
    • 4-10 mg for small joint
  • Salicylates for pain relief
  • NSAIDs
    • Phenylbutazone, indomethacin
  • Anti rheumatic
    • Hydroxyl chloroquine sulfate sulphasalazine: 500 mg/day
  • Local therapy
    • Diathermy
    • Jaw exercises
    • Mouth stretchers
  • Surgical
    • Synovectomy: for removal of synovial membrane

Oral Medicine Temporomandibular Joint Short Answers

Question 1. Myositis ossificans.


Myositis ossificans

  • It is a condition in which fibrous tissue and hetero-tropic bone forms within the interstitial tissue/ muscle as well as in associated tendons and ligaments

Myositis ossificans Types:

  • Localized
  • Progressive

Oral Medicine Temporomandibular Joint Myositis ossificans Features, Localized and Proressive

Question 2. Laskins criteria for MPDS.


  • Four cardinal signs
    • Unilateral pain – dull ache in the ear or preauricular area or angle of the mandible
    • Muscular tenderness
    • Clicking noise in TMJ
    • Limitation of jaw movements
  • Negative characteristics
    • No radiographic changes
    • No tenderness in TMJ on palpation

Oral Medicine Temporomandibular Joint Viva Voce

  1. Temporalis and geniohyoid are most often involved in MPDS

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