Temporomandibular Joint Disorder (TMD)

🔍 When to Suspect

Jaw pain, often radiating to the ear or temples, worsened by chewing or yawning, with associated clicking, locking, or trismus

From the full topic in The Ocean Library: Temporomandibular Joint Disorder (TMD)

🧭 When to suspect

A temporomandibular disorder (TMD) is the umbrella term for a group of musculoskeletal conditions affecting the temporomandibular joint (TMJ), the muscles of mastication, and the associated structures. It is the second most common cause of orofacial pain after toothache, affects around 1 in 15 of the UK population, and typically presents in the 20–40 age group, slightly more often in women.

Suspect TMD in a patient with pain in the preauricular (jaw joint) area that may radiate to the ear, temple, cheek or neck, and is worse on jaw movement – chewing, yawning or talking. It is frequently accompanied by joint noises (clicking, popping or crepitus), restricted or deviated mouth opening, or locking, and is strongly associated with bruxism (clenching or grinding), stress and disturbed sleep. The reassuring headline is that TMD is rarely sinister – fewer than 1% of TMD-like presentations conceal serious pathology, and the majority (75–90%) improve with simple, reversible self-management.

The key primary-care skill is twofold: recognise the broad clinical pattern (muscular versus joint), and screen for the red-flag mimics – particularly giant cell arteritis and head and neck malignancy – in every patient.

Myogenous (muscle) TMD	Arthrogenous (joint) TMD
• Pain in the masseter and temporalis muscles, often bilateral and aching. • Aggravated by clenching, grinding and chewing; closely linked to stress and parafunction. • The most common pattern; generally a good prognosis.	• Pain localised to the joint, with clicking, popping or crepitus. • May include locking, deviation, or restricted opening (disc displacement, degenerative joint disease). • Usually stable – only about 1 in 7 progress.

Source: RCS Faculty of Dental Surgery

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