Temporomandibular Disorders
What you must know
Use the DC/TMD framework: Axis I (muscle disorders, disc displacement disorders, joint disorders including degenerative and subluxation, and headache attributed to TMD) and Axis II (pain-related psychosocial factors). Know the cardinal presentations: myalgia (diffuse muscle pain on palpation, often with limited opening), disc displacement with reduction (clicking, reciprocal click, normal opening), disc displacement without reduction (history of click then loss of click, limited opening, deviation to the affected side), and degenerative joint disease (crepitus, coarse imaging changes).
Assessment and management
Palpation of masseter and temporalis, joint loading, and measurement of maximum opening and lateral excursions are core. Imaging is reserved for suspected bony or disc pathology. Conservative management is first-line: education and self-management, jaw behavior modification, physical therapy, occlusal appliances for selected patients, and short-term pharmacotherapy. Irreversible procedures (occlusal adjustment, aggressive surgery) are rarely indicated for pain.
Traps
Clicking alone is not a disorder unless it is associated with pain or functional limitation. Limited opening with deviation toward the affected side suggests disc displacement without reduction, not a muscle disorder. Crepitus suggests bony change, not a simple click. Do not attribute TMD pain to malocclusion without evidence.
Worked example
A 28-year-old has a history of a click that disappeared, now cannot open beyond 32 mm, and deviates toward the right with right joint pain. This fits right disc displacement without reduction; first-line care is conservative with soft diet, NSAIDs, and physical therapy - not immediate surgery.
Rule of thumb
Muscle pain = diffuse, palpation-provoked; joint pain = localized, loading-provoked; disc problem = movement-related noise or locking.