Performing Arts Medicine, 3rd ed.Medical Problems of Performing Artists

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Temporomandibular Joint Disorders, Facial Pain, and Dental Problems in Performing Artists

James A. Howard
From: Performing Arts Medicine, 3rd ed.: Chapter 9 © 2010; page: 151

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Abstract: Disorders of the temporomandibular joint (TMJ) are invoked in the diagnosis of a variety of symptoms including headache, facial pain, neck pain, tinnitus, and other otologic complaints. This overlap creates a diagnostic dilemma for the clinician, and even when the diagnosis is clear, criteria have not been established for the selection among the diverse treatments advocated for TMJ dysfunction. This chapter surveys TMJ disorders and their related conditions, exploring their prevalence, the developmental anatomy and biomechanics of the joint, common signs and symptoms and their history in the patient, and the clinical screening examination. Risk factors may serve in predisposing, precipitating, and perpetuating roles and involve habits, recreational activities, trauma, dental procedures or malocclusion, and sleep disturbances and parafunction.
Among the differential conditions to be considered for orofacial and TMJ pain are congenital and developmental disorders of the jaw, systemic conditions such as musculoskeletal and connective tissue disorders (joint hypermobility, fibromyalgia, Sjogren's syndrome), eating disorders, craniofacial pain conditions such as giant cell arteritis or trigeminal neuralgia, cephalgias (headaches), and neuropathic pain. Orofacial, dental, and TMJ problems are considered that specifically affect wind instrumentalists: the embouchure, instrument selection, mouthpieces, dental occlusion, lip form, and tooth-related problems. Similar considerations are reviewed for vocalists and for violinists/violists. Treatment options include modification of hobbies and habits, physical therapy, trigger point injections, temporary jaw immobilization, intraoral appliances, occlusal therapy, pharmacotherapy, behavioral therapy, and TMJ surgery.

Last Updated: 7 / 2010

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