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Temporomandibular joint dysfunction

Temporomandibular joint dysfunction is an umbrella term for a spectrum of disorders relating to pain and dysfunction of the muscles of mastication and the temporomandibular joints. The major common presenting symptoms are pain, alterations in the range of mandibular movement, and/or noises from the temporomandibular joints (TMJ) during function. Although TMD is not life-threatening, it can be detrimental to quality of life, especially in the form of chronic pain.

Classification
TMD is considered by some to be one of the four major symptom complexes in chronic orofacial pain, along with burning mouth syndrome, atypical facial pain and atypical odontalgia. TMD has been considered as a type of musculoskeletal, or rheumatological disorder. It is hypothesized that there is a great deal of similarity between TMD and other pain syndromes like fibromyalgia, irritable bowel syndrome, interstitial cystitis, headache, chronic lower back pain and chronic neck pain. Definitions and terminology Frequently, TMD has been treated as a single syndrome, but the prevailing modern view is that TMD is a cluster of related disorders with many common features. whereas many other sources use the term 'temporomandibular disorder' synonymously, or instead of the term 'temporomandibular joint dysfunction'. In turn, the term 'temporomandibular disorder' is defined as "musculoskeletal disorders affecting the temporomandibular joints and their associated musculature. It is a collective term which represents a diverse group of pathologies involving the temporomandibular joint, the muscles of mastication, or both". Another definition of temporomandibular disorders is "a group of conditions with similar signs and symptoms that affect the temporomandibular joints, the muscles of mastication, or both." 'Temporomandibular disorder' is a term that creates confusion since it refers to a group of similarly symptomatic conditions, whilst many sources use the term temporomandibular disorders as a vague description, rather than a specific syndrome, and refer to any condition which may affect the temporomandibular joints (see table). The temporomandibular joint is susceptible to a huge range of diseases, some rarer than others, and there is no implication that all of these will cause any symptoms or limitation in function at all. Only 33% of those with signs of TMD will have symptoms. The preferred terms in medical publications is to an extent influenced by geographic location. For example, in the United Kingdom, the term 'pain dysfunction syndrome' is in common use. Axis II assessments allows clinicians to evaluate the impact of TMD on quality of life in the process of diagnosis, and treatment planning. It has been suggested that TMD may develop following physical trauma, particularly whiplash injury, although the evidence for this is not conclusive. This type of TMD is sometimes termed "posttraumatic TMD" (pTMD) to distinguish it from TMD of unknown cause, sometimes termed "idiopathic TMD" (iTMD). By duration Sometimes distinction is made between acute TMD, where symptoms last for less than three months, and chronic TMD, where symptoms last for more than three months. Not much is known about acute TMD since these individuals do not typically attend in secondary care (hospital). ==Signs and symptoms==
Signs and symptoms
Signs and symptoms of temporomandibular joint disorder vary in their presentation. The symptoms will usually involve more than one of the various components of the masticatory system, muscles, nerves, tendons, ligaments, bones, connective tissue, or the teeth. The three classically described, cardinal signs and symptoms of TMD are: or other types of facial pain including migraine, • Sensation of malocclusion (feeling that the teeth do not meet together properly). ==Causes==
Causes
TMD is a symptom complex (i.e. a group of symptoms occurring together and characterizing a particular disease), which is thought to be caused by multiple, poorly understood factors, In the specialized literature that has evolved around TMD research, arthrosis is differentiated from arthritis by the presence of low and no inflammation respectively. Many suggest that sleep bruxism can be a causative or contributory factor to pain symptoms in TMD. Indeed, the symptoms of TMD overlap with those of bruxism. Others suggest that there is no strong association between TMD and bruxism. A systematic review investigating the possible relationship concluded that when self-reported bruxism is used to diagnose bruxism, there is a positive association with TMD pain, and when more strict diagnostic criteria for bruxism are used, the association with TMD symptoms is much lower. Self-reported bruxism is probably a poor method of identifying bruxism. Other parafunctional habits such as pen chewing,