Document Detail

Temporomandibular pain and dysfunction syndrome. History, physical examination, and treatment.
MedLine Citation:
PMID:  8844909     Owner:  NLM     Status:  MEDLINE    
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.
J J Marbach
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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    
Department of Oral Pathology, University of Medicine and Dentistry of New Jersey, Newark, USA.
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MeSH Terms
Medical Illustration
Temporomandibular Joint*
Temporomandibular Joint Dysfunction Syndrome* / diagnosis,  physiopathology,  therapy
Grant Support

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