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Temporomandibular disorders (TMDs) is a collective term for a group of heterogeneous musculoskeletal and neuromuscular conditions involving the temporomandibular joint (TMJ) complex, masticatory muscles, and surrounding osseous structures. TMDs affect 5% to 12% of the US population, with a peak incidence at ages 45 to 65 years. Common clinical manifestations include facial pain, ear pain, headache, TMJ discomfort, and adventitious sounds. The etiologies of TMDs are multifactorial and include behavioral, social, emotional, and occlusive factors. Common causes of TMDs are myofascial pain and dysfunction, articular disk displacement, and degenerative joint conditions. In most cases, the diagnosis can be made based on the history and physical examination. In the absence of trauma, imaging typically is reserved for patients with chronic TMDs. Initial management includes education, self-management, behavioral therapy, and physical therapy. Occlusal devices are recommended for management of sleep bruxism or diurnal clenching. Adjunctive pharmacotherapies include nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, antidepressants, and anticonvulsants. (This is an off-label use of some NSAIDs and an off-label use of benzodiazepines, antidepressants, and anticonvulsants.) Intra-articular injections have been used alone or with arthrocentesis. Patients who do not benefit from these therapies should be referred to an oral and maxillofacial surgeon.

Case 2. Liza is a 32-year-old woman with a history of anxiety. Today she comes to your office with a 2-month history of bilateral jaw pain near the ears. Her symptoms are most noticeable on waking and worsen with chewing or yawning. She has associated headaches and occasional ringing in the ears.

Liza reports significant stress because of her work. She has not undergone recent dental work or experienced any trauma, and does not experience locking when opening or closing the jaw. The findings of her most recent dental examination 6 months ago were normal. She says she has taken acetaminophen a few times for the jaw pain and has experienced slight improvement.

Temporomandibular disorders (TMDs) are characterized by craniofacial pain involving the temporomandibular joint (TMJ), masticatory muscles, and the musculoskeletal structures of the head and neck.27 TMDs are the most common nondental cause of pain in the maxillofacial region.28

Population-based studies have shown prevalence rates ranging from 11% to 50% in adults.29 The National Institute of Dental and Craniofacial Research (NIDCR) found an incidence of 5% to 12% in the US population.30 The incidence peaks between ages 45 to 65 years.31 Only 5% of patients seek treatment, and the majority of these patients are women ages 20 to 45 years.32 Chronic TMDs are more common in women than in men, but acute forms have an approximate equal distribution between women and men.31

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