Appropriate Management of Temporomandibular Disorders in the Elderly

The ability to comfortably chew, swallow, speak and perform facial movements is dependent upon an asymptomatic craniomandibular complex. The normal function of this intricate complex is dependent upon the precise interplay between the paired muscles of mastication, the bilateral temporomandibular joints (TMJs) and the dental occlusion. The most frequently used term to collectively define the clinical problems involving these structures is temporomandibular disorder (TMD).1 The American Academy of Orofacial Pain has defined TMD as being characterized by pain in the muscles of mastication, the preauricular region and/or TMJ that is usually aggravated by function or manipulation.2 A limited range of mandibular motion or asymmetric motion is frequently seen, as are joint sounds or “jaw locking”. Inadequate training of health care providers in TMD management is widespread. Furthermore, appropriate management depends upon correct diagnosis which can be difficult due to frequently complex and confusing patient symptomatology. Thankfully, the majority of TMDs are self limiting and easily managed by conservative means. However, surgery does have a small but important role, as approximately 5% of patients presenting with TMD will not have resolution of their symptoms with conservative means alone. This paper will discuss the appropriate management of those conditions affecting the temporomandibular joint in the older patient.