Taking the mystique out of the diagnosis and treatment of craniomandibular (TMJ) disorders.

The temporomandibular joint (TMJ) is of great importance in the assessment, diagnosis and treatment of many craniofacial disorders. Frequently overlooked by medical practitioners as a source of patient discomfort, the key to understanding the joint and its role in abnormal conditions is the complex nature of its structure. Returning to biological fundamentals provides an essential foundation on which to build techniques for diagnosis and ultimately treatment regimens. In considering the aetiology of craniomandibular disorders many factors have to be sifted. These include predisposing factors such as size, shape and interrelation of the parts of the stomatognathic system. Precipitating causes may include trauma to the head and neck as well as stress to the individual, while perpetuating influences are manifested in the myospasm-pain-myospasm cycle. The complexity of the joint system is reflected in the range and diversity of the thorough examination which the clinician is required to perform. Listening to the patient's description of their symptoms is of crucial importance in the initial stages to provide guidance for the ensuing examination procedures. Relief of pain, generally caused by muscle spasm, is the primary treatment objective. Many modes of treatment are available in the long-term resolution of the disorders and these range from medicinal, nutritional and psychological therapies to occlusal equilibration and physiotherapy.