Document Detail


Temporomandibular pain and dysfunction syndrome. History, physical examination, and treatment.
MedLine Citation:
PMID:  8844909     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A stepwise method for treating TMPDS is presented. Step 1-start patient on a regimen of chloroethane or chlorofluorocarbon spray and exercise. Step 1A--if a clicking joint is the chief complaint, start with click exercise. Step 1B--if restricted mouth opening is the chief complaint, start with range of motion exercise; employ exercises sequentially, not simultaneously. Step 2--if pain is moderate to severe, start with amitriptyline 10 mg at bedtime, increasing the dose in 10-mg increments to 40 mg. Step 3--for nonresponders, add injections of tender points with lidocaine and consider a trial of a different tricyclic. Step 4--for nonresponders, consider a trial of tender point injections combining dexamethasone with local anesthetic. Start by injecting the three most painful tender points with 0.5 mL of a solution of 1 mg of dexamethasone combined with two thirds bupivacaine and one third lidocaine to reach the desired volume. Repeat injections, varying the sites as required. Do this once weekly for 4 to 6 weeks for an adequate trial. This regimen can be continued for an extended period of time with appropriate precautions in place. The value of judgment-free psychosocial support cannot be overemphasized. Patients with TMPDS are faced with long-term problems of pain management. An understanding clinician can provide the sustained support required to prevent the cycle of ever more invasive treatments with their potential for harm.
Authors:
J J Marbach
Related Documents :
8470499 - Dynamic properties of feed back control of human posture in subjects with vestibular ne...
12188409 - Effect of the "sitting pelvic tilt exercise" during the third trimester in primigravida...
21946399 - Are ultrasound, laser and exercise superior to each other in the treatment of subacromi...
24617269 - The impact of exercise performance dissatisfaction and physical exercise on symptoms of...
2914489 - Left ventricular dysfunction in symptomatic mitral valve prolapse.
24535729 - Exercise for depressive symptoms in stroke patients: a systematic review and meta-analy...
11147779 - Exercise-stimulated glucose turnover in the rat is impaired by glucosamine infusion.
16275799 - Effect of pectus excavatum deformity on cardiorespiratory fitness in adolescent boys.
2596329 - The metabolic relation between hypoxanthine and uric acid in man following maximal shor...
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  Rheumatic diseases clinics of North America     Volume:  22     ISSN:  0889-857X     ISO Abbreviation:  Rheum. Dis. Clin. North Am.     Publication Date:  1996 Aug 
Date Detail:
Created Date:  1996-12-30     Completed Date:  1996-12-30     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8708093     Medline TA:  Rheum Dis Clin North Am     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  477-98     Citation Subset:  IM    
Affiliation:
Department of Oral Pathology, University of Medicine and Dentistry of New Jersey, Newark, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Humans
Medical Illustration
Pain*
Temporomandibular Joint*
Temporomandibular Joint Dysfunction Syndrome* / diagnosis,  physiopathology,  therapy
Grant Support
ID/Acronym/Agency:
DE 05989/DE/NIDCR NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Management of the foot and ankle in rheumatoid arthritis.
Next Document:  Considerations in child and adolescent athletes.