What you need to know about Temporomandibular Joint Syndrome for the Boards and Clinic

An internal medicine topic seen on the USMLE, ABIM boards and in the clinic–Temporomandibular joint (TMJ) syndrome–appeared in a Pickles comic strip series last week.

TMJ Syndrome Comic

In the strip, even though Grandpa is wrong about what TMJ stands for, he is correct in conveying that bruxism (teeth grinding) is a cause of the syndrome.

TMJ Syndrome Comic2

Other risk factors include trauma, arthritis, orthodontic treatment and excessive use of the muscles of mastication. Anxiety and stress are often seen in patients and can worsen symptoms.

The diagnosis is made clinically, based on the history and physical examination. TMJ syndrome usually presents with any one of three signs or symptoms: Clicking, Pain, or Limited movement (locking) of the TMJ. No imaging tests need to be ordered. However, if patients visit the dentist, they may have a panoramic radiograph done to rule out any dental pathology.

Fortunately, TMJ syndrome is self-limited. Treatment involves the following:
  • Joint rest
  • Stress management
  • Warm, moist cloth to the jaw for 10 to 20 minutes at a time
  • Cognitive behavioral therapy
  • Splints and/or bite guards
  • Jaw exercises
  • Eat easy-to-chew or pureed foods like yogurt, smoothies, soap.
  • Avoid tough or excessively chewy foods (e.g jerky, breads, gum, carrots)

Credit: Pickles comic strip. Brian Crane. http://www.gocomics.com/pickles/2015/09/07. September 7-8, 2015.

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