From the Guidelines
Patient presents with left-sided temporomandibular joint (TMJ) symptoms, and the most appropriate initial assessment includes a thorough extraoral and intraoral examination, as well as a review of associated factors such as taste, salivary flow, clenching, bruxing habits, locking or clicking of jaw joint, altered sensation, nasal, eye, or ear symptoms 1. The physical note for the chart should include the following key points:
- Tenderness to palpation over the left TMJ
- Limited jaw opening and crepitus during movement
- Patient's report of pain, including severity and exacerbating factors
- Presence of morning stiffness or other associated symptoms
- Results of extraoral examination, including visual inspection and palpation of the head and neck region
- Results of intraoral examination, including examination of the hard tissues, teeth, and oral mucosa The treatment plan should prioritize a multidisciplinary approach, including:
- Pharmacological management with NSAIDs, such as ibuprofen 400mg three times daily with food for 7-10 days, for pain and inflammation
- Non-pharmacological interventions, such as application of moist heat for 15-20 minutes twice daily, and soft diet for 2 weeks
- Jaw rest and avoidance of wide opening, gum chewing, and hard foods
- Home exercises, including gentle jaw stretching 3-4 times daily
- Consideration of nighttime occlusal splint if bruxism is suspected These interventions target inflammation reduction, muscle relaxation, and prevention of further joint stress, and are supported by recent clinical practice guidelines 1. Follow-up in 2 weeks to assess improvement is recommended, and if symptoms persist, consideration of referral to an oral maxillofacial specialist for further evaluation and possible imaging studies is necessary.
From the Research
TMJ Left Sided Symptoms
- Temporomandibular joint disorder is defined by pain and/or loss of function of the temporomandibular joint and its associated muscles and structures 2
- The diagnosis and management of temporomandibular disorders (TMD) require both clinical and imaging examinations of the temporomandibular joint (TMJ) 3
- Imaging modalities for TMJ disorders include magnetic resonance imaging (MRI), computed tomography (CT), cone beam CT, ultrasonography, and conventional radiography 3, 4
Imaging Techniques
- MRI is a noninvasive technique, considered to be the gold standard in imaging the soft tissue components of the TMJ 3, 5
- Cone beam CT provides high-resolution multiplanar reconstruction of the TMJ, with a low radiation dose, without superimposition of the bony structures 3
- High-resolution ultrasonography is a noninvasive, dynamic, inexpensive imaging technique, which can be useful in diagnosing TMJ disc displacements 3
Treatment and Management
- Treatments for TMJ disorders include noninvasive pharmacologic therapies, minimally invasive muscular and articular injections, and surgery 2
- Conservative therapies include nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants 2
- Minimally invasive injections include botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose 2