Temporomandibular Joint Disorders

Geriatric Essentials

• Although less common with aging, temporomandibular joint disorders should not be overlooked in the elderly as a cause of pain and difficulty chewing.

The temporomandibular joint (TMJ) is located between the maxillary glenoid fossa and the condylar process of the mandible (see Figure 104-2). Temporomandibular disorders include arthritides (eg, TMJ osteoarthritis); displacement of the TMJ disk (articular cartilage located between the mandibular condyle and the glenoid fossa); and myofascial pain of the masseter, temporal, and pterygoid muscles. TMJ disorders begin in younger adulthood, and women are affected more frequently. Incidence decreases with aging, but many elderly people have pain and difficulty chewing because of disorders of the TMJ and associated structures.

Symptoms and Signs

Pain, the most common symptom, can include pain during chewing and jaw movements, otalgia, temporal and neck pain, and pain referred to otherwise healthy teeth. Clinical signs include jaw clicking, popping, and crepitus, and a reduction in mandibular range of motion (when attempting to open the mouth as widely as possible, the distance between the lower anterior teeth and upper anterior teeth, known as the interincisal distance, is < 40 mm). Sharp, debilitating pain suggests an extracranial or intracranial disorder (eg, trigeminal neuralgia, temporal arteritis).

Diagnosis

Often, osteoarthritis can be detected based on crepitus when the mouth is opened and degenerative changes seen on panoramic x-rays and CT scans.

Treatment

Treatment should provide support to the affected structures and minimize or eliminate aggravating factors such as teeth clenching or grinding (bruxism). Treatment may consist of an interocclusal appliance, short-term physical therapy, behavior modification, and NSAIDs. A soft diet, muscle relaxants, and moist heat may help.

This topic was last updated September 2005.