Clinical features

The three cardinal features of the disorder are (1):

• orofacial pain - most common presenting complain, it may be (1)
  • described as a dull, unilateral or bilateral pain (2,3)
  • frequently seen immediately in front of the tragus of the ear
  • pain may involve the temporal, cervical and occipital regions (2) but pain radiating to the ear, temple, cheek, and along the mandible is highly suggestive of TMD (1)
• joint noise - clicking or popping noise (3)
  • grating, grinding, or crunching - in osteoarthritis (3)
  • can be detected either by palpation or by a stethoscope placed over the temporomandibular joint
• restricted jaw function
  • can be described as a “generalised tight feeling” commonly due to a myofacial disorder or as a sensation that the jaw suddenly 'catches', 'gets stuck', or 'locks' usually resulting from internal derangement (1)
    • locking of the jaw can be - open (inability to close fully) or closed (inability to open fully)
  • often the joint may deviate to the affected side of the mandible during opening of the mouth

Other non specific features may be present:

• headache.
• earaches
• neck and shoulder pain
• tinnitus
• underlying stress, anxiety, depression (1,3)

Radiography may reveal degeneration of the temporomandibular joint.

Serological investigations are required if a systemic joint disease is suspected.

Reference:

• (1) Dimitroulis G. Temporomandibular disorders: a clinical update. BMJ. 1998;317(7152):190-4
• (2) American Association of Oral and Maxillofacial Surgeons 2010.  Statement by the American Association of Oral and Maxillofacial Surgeons Concerning the Management of Selected Clinical Conditions and Associated Clinical Procedures. Temporomandibular Disorders
• (3) Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008;359(25):2693-705
• (4) Jennifer J. Buescher. Temporomandibular Joint Disorders. Am Fam Physician 2007;76:1477-82, 1483-84