About Temporomandibular Disorders: What is A ‘TMD’?

The term ‘temporomandibular disorders’ (TMD) covers a constellation of conditions. There have been many attempts to categorise these conditions but all have shortfalls. Some classify by anatomy, some by aetiology and some by frequency of presentation. We should be aware, however, that there is considerable overlap in any classification system because these are often not clinically appropriate. No one system, therefore, satisfies all the criteria.

Temporomandibular disorders affect the articulatory system, consisting of the temporomandibular joints, mandibular muscles and the occlusion.

Any factor that has an effect on one part of the system is likely to influence other parts of the system, so it is important to avoid tunnel vision when considering possible signs and symptoms of a TMD.

As a dentist in practice you will inevitably encounter patients with symptoms of a TMD, who may present with facial pain, earache, toothache, jaw joint sounds or limited movement.

It is estimated that between 50% and 70% of the population will at some stage in their life exhibit some sign of a TMD. This may be subclinical and the patient might not relate the signs to a jaw problem.

In about 20%, these signs will develop into symptoms, which implies that the patient will take notice of hitherto ignored signs, and about 5% of the population will seek treatment. This will happen if the symptoms become intrusive in day-to-day life. It is important for you, as a dentist, to identify these patients and recognise their particular needs and treatment requirements.

The patient may attend complaining of toothache because their natural assumption would be that a tooth was causing the problem, but your role as a clinician is to diagnose the actual cause of the symptoms.

A patient presenting with a TMD may have symptoms, in any combination, which might include preauricular or facial pain, restriction or alteration of the range of mandibular movement, muscle pain that is worse with function, localised jaw joint pain, jaw joint sounds such as clicking or crepitation, unexplained tooth sensitivity, tooth or restoration fracture, and chronic daily headache. You must be able to diagnose what is and what is not appropriate for you to treat.

About the Book

In modern dental schools, there is a shift from traditional teaching to more interactive methods. In classical didactic textbooks, readers are frequently seen as passive recipients of information, without any engagement in the learning process. Problem-based learning increases the effectiveness of delivering information and makes learning a more memorable experience for the reader.