Managing temporomandibular joint syndrome.
Pain in the temporomandibular joint is primarily responsible for the morbidity often associated with this syndrome. Of the 448 cases in this study, 48% presented as ear pain and 46% complained of either headache, sinus pain, or neck pain. Temporomandibular joint pain and mastication muscle tenderness elicited with palpation were frequent physical findings. In this review, temporomandibular joint syndrome was successfully managed in 75% of 448 cases with conservative treatment consisting of patient education, heat, massage, non-narcotic analgesics, and occlusal splints. Seventeen percent were referred to dentists for restorations or orthodontics. The success rate for the 6% who underwent diagnostic arthroscopy and/or open joint surgery with disc replacement was 67%. Therefore, patients with ear pain or head and neck pain require an objective evaluation of medical history and physical examination to obtain the correct diagnosis and subsequent correct treatment and pain relief. Early diagnosis helps to prevent changes in the joint that can become irreversible with intractable pain. Surgery is reserved for those patients who fail to respond to conservative management.