Temporomandibular joint disorders

Synonyms are : Myoarthropathy of the manducatory apparatus,  Temporomandibular Disorders.

It basically consists of a dysfunction of the manducatory apparatus, usually caused by the masticatory muscles (myopathy), sometimes caused by the temporomaxillary joint (arthropathy) or both (myoarthropathy).

The most frequent symptom is pain. In addition, some patients might feel painless cracking sounds around the temporomandibular joint and some might have difficulties opening their mouth widely. 


Around 8% of the population experiences myoarthropathy symptoms and only 3% seeks a treatment. Children rarely complain about this syndrome but the prevalence increases during adolescence. Women aged between 25 and 50 years-old are the mainly concerned, as is the case for the majority of painful diseases.  After menopause, signs diminish and completely disappear as the aging process continues.

Clinical signs

The large number of symptoms makes the diagnosis complicated. The masticatory muscles and/or the temporomandibular joint are painful when masticating. Other symptoms might be a limited mouth opening, cracking sounds of the joints, pain in the teeth, mouth, face, ears, head…


The causes of the myoarthropaty are numerous. So far, etiological factors have not been clearly determined. However, it seems that the overload of the manducatory apparatus structures, caused by teeth clenching, plays an important role. These parafunctions, are due to lack of stress management or bad habits.

The risk factors that may predispose, generate or perpetuate this syndrom can have a biological, psychological or social origin :

+ Parafunction such as nocturnal bruxism or teeth clenching during the entire day
+ Trauma caused by an accident
+ Emotional disorder (stress)
+ Anxiety and depression 
+ Other psychological disorders


For diagnosis, the following are necessary :

1. A careful medical interview with adapted questionnaires.

2. Clinical examination of the oral cavity, the masticolatory muscles, the temporomandibular joint and the fill-ins.

3. Extraoral and if necessary panoramic maxillary x-ray to exclude dental and maxillofacial pathologies.

4. One or many psychometric questionnaires to assess psychological disorders and comorbidities.

In some cases, the specialist may use complex technical, psychological or radiological techniques and other medical discipline's to analyse. 

Differential diagnosis

Many pathologies may provoke pain in the head and mouth which does not necessarily come from a dental problem. A differential diagnosis is thus essential.  


To cure these pathologies, the treatment is conservative and cautious. Various therapeutic techniques can be used individually, depending on the gravity of the pathology.

+ Communicating with the patient about his syndrome and diagnosis is the first step towards a friendly and reassuring therapeutic relationship. For example, patients should not worry if they feel cracking sounds of the joints.

+ In many cases, simple advice to modify the behaviour can greatly improve the symptoms : soft food, hot and cold treatment, physical therapy, stretching, relaxation techniques, strategies to diminish stress.

+ A bite guard pad is often recommended to relax muscles and decompress the ATM. Studies have shown that 80% of the patients have benefited from this method. A correction of dental occlusion is rarely advocated.

+ Analgesic, anti-inflammatory or muscle relaxant medication is sometimes necessary to stop the process of a painful chronofication.  

+ Other treatments, such as the infiltration of the facial muscle trigger points can help diminish the symptoms.

+ Invasive dental, orthodontics or surgical treatments must only be taken into account for particular cases. 


In most cases, Myoarhtopathy is a benign disease with a tendency to spontaneous healing. For 10% of the patients, the various risk factors lead to a painful chronification of the syndrome. These patients require a multidisciplinary treatment, at both  diagnostic and therapeutic levels.