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Emergencies of Patients with Temporomandibular Disorders
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Temporomandibular disorder is a musculoskeletal disease with complex, multifactorial etiology regarding improper functioning of the stomatognathic system (masticatory muscles, temporomandibular joints, and surrounding structures). Here presents medical emergencies occurring among patients treated for temporomandibular disorders, which tend to constitute a severe difficulty for practitioners during their clinical practice. Examples of the most common emergencies of this type are disc displacement without reduction and a sudden contraction of the inferior part of the lateral pterygoid muscle. The latter occurs in cases of uncontrolled and incorrect use of the anterior repositioning splints and the hypertrophy of the coronoid process of the mandible. 

emergencies temporomandibular disorders TMD management of TMD
Subjects: Rehabilitation
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View Times: 47
Revisions: 2 times (View History)
Update Date: 29 Jan 2023
Table of Contents

    1. Introduction

    Temporomandibular disorders (TMD) constitute an increasingly common disorder that affects the functioning of the masticatory muscles, temporomandibular joints, and surrounding structures in the stomatognathic system. TMD most often affects people in their third and fourth decade of life; however, nowadays, adolescents are increasingly susceptible to such health conditions [1][2][3]. Moreover, the increase in the occurrence of significant pain in the masticatory system is observed, which results in hindering everyday functioning and the performance of professional duties. One of the main etiological factors is excessive stress causing occlusal parafunctional activities, that is, pathological habits of prolonged teeth clenching, grinding, and tapping [2].
    The specificity of the anatomical structure of temporomandibular joints, and especially soft tissue structures, is conducive to the morphological consequences of excessive pressure exerted on the condyle, occurring during occlusal (biting, clenching the teeth) and non-occlusal parafunctions (nail biting, cheek biting, chewing on objects). A very precise system of reflex regulatory mechanisms, together with soft tissue proprioceptors, the impulse conduction system of the second and third branch of the trigeminal nerve, the activity of the sensory nucleus, and the participation of the reticular formation, thalamus, and cerebral cortex, and consequently the activity of the motor nucleus, as a response to previous impulses from the oral cavity, ensure efficient regulation of physiological conditions, but also inform about disorders occurring within all structures of the musculoskeletal system of the masticatory organ [1][2][3][4][5][6].

    2. Sudden and Acute Contraction of the Inferior Lateral Pterygoid Muscle—Myospasm

    Uncontrolled and prolonged use of an anterior repositioning splint may lead to a complication in the form of a sudden, reversible contraction of the inferior lateral pterygoid muscle [7]. This condition should be differentiated from the inflammation of the pericardial tissues. It is manifested by the sudden inability to connect the teeth in the lateral section of the dental arch on the side of contraction, difficulties in opening the mouth wide, spontaneous pain, and tenderness on palpation in the area of the inferior lateral pterygoid muscle. The degree of contraction of this muscle may vary, yet the pain that occurs is most often referred to as excruciating [1][2][3][8].
    Therapeutic procedures aim to relax the pterygoid muscle and return it to its regular length. When using the anterior repositioning splint, the mandible is moved anteriorly and the inferior lateral pterygoid muscles are stiff. The relaxation of these muscles is carried out by moving the lower jaw back under the pressure of the fingers placed in the area of the chin. The second method proposed by Wright E. and Klasser G. [1] is the above-described manipulation with the position of the thumb on the lateral teeth and the remaining fingers under the mandible, as well as intraoral compression therapy in the palate area behind the eighth upper teeth. If, as a result of the myospasm of the inferior lateral pterygoid muscle, the prolonged and uncontrolled use of the anterior repositioning splint takes place, a temporary break in the use of this appliance should be recommended.

    3. Attack of Fibromyalgia, When the Disease Previously Undiagnosed

    Fibromyalgia syndrome (FMS) is a little-known disease, classified as a group of diseases in the field of “functional” pain. It is characterized by chronic, generalized pain in muscles and joints, and the occurrence of the so-called tender (trigger) points, i.e., places on the human body which are excessively sensitive to pressure (from 11 to 18 places). Many symptoms may resemble other musculo-articular disorders. The patient reports a state of constant fatigue and the fact that sleep does not bring the feeling of rest [9][10][11]. It most often affects people in the third and fourth decade of life. The symptoms are very bothersome: they significantly deteriorate the quality of life and hinder everyday functioning of the patient.
    Fibromyalgia is associated with abnormal pain sensation of unknown etiology; moreover, central sensitization is possible—excessive excitability of pain-conducting structures in the spinal cord and brain. When suffering from fibromyalgia, the pain in muscles and bones is very distressing; it can be diffuse, chronic, piercing, throbbing, and prickly. Patients coping with fibromyalgia are characterized by having abnormal levels of substances involved in pain sensation (e.g., decreased serotonin levels) and struggling with a deep sleep disorder, which could explain fatigue and an inability to recover during the night. Moreover, genetic susceptibility, psychological factors (chronic stress, depression, mobbing, occupational crises), infectious diseases (Lyme disease, HIV), and autoimmune diseases (rheumatoid arthritis, lupus erythematosus, Hashimoto’s disease) are mentioned in the context of fibromyalgia [9][11].

    4. Acute Inflammation of the Temporomandibular Joints; Specific Inflammation

    Acute arthritis can affect all joint structures, periarticular tissues, and the joint capsule. Most often it is associated with the aftermath of an injury, blood-borne infection in the course of infectious diseases, rheumatic disease, or by continuity from surrounding tissues: parotid glands, skin boil, jawbone, or the inner and outer ear. Diagnostics are based on body temperature tests, CRP and ESR levels. In the process of differential diagnosis, such factors should be considered: complex extraction of wisdom teeth, parotitis, otitis media, parotid and rumen abscess, osteitis of the ramus of mandible. Treatment includes mandible immobilization, administration of antibiotics, painkillers, and anti-inflammatory drugs [12][13].

    5. Myofascial Pain Dysfunction Syndrome—MPDS

    This syndrome is characterized by the sudden onset of pain in the masticatory muscles, head, and neck area on one side of the body. This indicates the interdisciplinary and complex nature of these ailments. In the etiology of many facial pain syndromes, the role of psychoemotional factors and depression is indicated. The possible neurogenic or vascular origin of this pain is emphasized. The prevalence of orofacial pains is assessed for at least 10% of the adult population and 50% of the elderly population [1][2][12].
    In addition, the sensitivity of the tissues during the palpation of the muscles occurs, together with the excessive tension and frequent contractions of muscles associated with stress, patient anxiety, frequent parafunctional activity, or craniofacial injuries. This may be accompanied by acoustic symptoms within the temporomandibular joints. Furthermore, the comorbidity of MPDS and fibromyalgia is possible. The development of trigger points in the masticatory muscles is often observed. The diagnosis is based on a clinical examination and analysis of the reported symptoms and the elimination of the possibility of the dental origin of pain (pulpitis, increased dentin sensitivity, caries, periapical inflammation, and periodontopathies) [1][2][6][13].

    6. Secondary Trigeminal Neuralgia

    Contrary to the very characteristic symptoms of the primary trigeminal neuralgia (sudden, short-term, stabbing pain on one side of the face; additionally, very intense convulsions may occur, except for the bedtime), the secondary form is characterized by the pain of a different nature: constant muscle pain (which may become stronger with time) occurring suddenly, but lasting without interruption. It may be a consequence of many local causes (dental or sinus diseases, cysts, complications after the extraction of wisdom teeth) and general causes (diseases of the posterior cranial fossa, cerebellopontine angle tumors) [14][15][16][17].
    If the character of such a disease is bilateral, tumors at the base of the brain or skull may be the cause. The symptoms intensify when the pathological areas are exposed to heat. The results of magnetic resonance imaging or computed tomography of focal lesions (aneurysms, tumors, osteophytes, focal demyelination in multiple sclerosis) are essential in the process of diagnosis of secondary neuralgia. Treatment for the secondary form involves the elimination of the primary lesion and the use of pharmacotherapy, including antiepileptic drugs (carbamazepine), which stabilize nerve impulse conduction. Moreover, the following procedures are performed: skin rhizotomy, electrophoresis, acupuncture, microvascular decompression, or stereotaxic radiosurgery [15][18].

    7. Subluxation of the Temporomandibular Joint

    The subluxation of the temporomandibular joint can be caused by the trauma or flaccidity of the muscles responsible for lowering the jaw. When the patient is unable to close the mouth from the maximal open position, it means that the head of the mandible is in front of the articular tubercle. Subluxation is diagnosed when the patient is able to overcome the problem oneself, whereas luxation is diagnosed when the patient needs someone else’s help to return the condyle to the proper position within the joints [17]. The reasons for this condition may be found in: craniofacial trauma (most often in the chin area), removal of wisdom teeth, a sudden act of biting a hard object, congenital laxity of the soft tissues of the temporomandibular joints, and flaccidity of the muscles responsible for lowering the jaw. The rehabilitation of patients coping with polyarticular laxity and disorders connected with collagen structure, such as osteogenesis imperfecta, should be carried out under special supervision [1][6][19][20][21]. The consequence is the displacement of the condyle in front of the articular tubercle. In the case of unilateral subluxation, the lower jaw deviates to one side. A characteristic symptom is an inability to connect the jaws in the central occlusion position [22][23].
    Therapeutic treatment includes adjustment and immobilization of the mandible for a period of 10 days with the use of a chin cap or intermaxillary traction. In addition, sclerotizing agents, designed to induce inflammatory reactions and secondary contraction of the joint capsule can be injected; moreover, acupuncture can be performed [1][2][6][19][24][25][26].

    8. Injuries of the Temporomandibular Joints

    Injuries of the temporomandibular joints are primarily contusions; their characteristic symptom is the occurrence of spontaneous pain (which intensifies during the movements of the mandible), joint swelling, and deviation when lowering the mandible. The above-mentioned symptoms may be accompanied by limitation of the jaw opening range, intraarticular hemorrhages, rupture of the joint capsule or intraarticular disc, condylar fracture, or chondromalacia of the articular surfaces. Usually, treatment includes immobilization of the mandible for a few days and then unloading the joint with the use of occlusive splints [21][22][23][24][25].


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    Subjects: Rehabilitation
    Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to : ,
    View Times: 47
    Revisions: 2 times (View History)
    Update Date: 29 Jan 2023
    Table of Contents


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      Pihut, M.;  Kulesa-Mrowiecka, M. Emergencies of Patients with Temporomandibular Disorders. Encyclopedia. Available online: (accessed on 20 March 2023).
      Pihut M,  Kulesa-Mrowiecka M. Emergencies of Patients with Temporomandibular Disorders. Encyclopedia. Available at: Accessed March 20, 2023.
      Pihut, Malgorzata, Malgorzata Kulesa-Mrowiecka. "Emergencies of Patients with Temporomandibular Disorders" Encyclopedia, (accessed March 20, 2023).
      Pihut, M., & Kulesa-Mrowiecka, M. (2023, January 19). Emergencies of Patients with Temporomandibular Disorders. In Encyclopedia.
      Pihut, Malgorzata and Malgorzata Kulesa-Mrowiecka. "Emergencies of Patients with Temporomandibular Disorders." Encyclopedia. Web. 19 January, 2023.