Temporomandibular Disorders in Pediatric Patients (TMD): Evidence-Based Evaluation and Management

Temporomandibular disorders (TMD) in pediatric patients are increasingly recognized as a significant cause of orofacial pain and functional limitation. Although traditionally associated with adults, children and adolescents can develop TMD due to growth-related, behavioral, and psychosocial factors.

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Early identification and appropriate management are essential to prevent chronic pain and functional impairment during craniofacial development.

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✅ Understanding Pediatric Temporomandibular Disorders
TMD refers to a group of conditions affecting the temporomandibular joint (TMJ), masticatory muscles, and associated structures. In pediatric patients, these disorders may present differently than in adults due to ongoing growth and neuromuscular adaptation.
Common contributing factors include:

▪️ Parafunctional habits (bruxism, nail biting)
▪️ Malocclusion or occlusal instability
▪️ Psychological stress and anxiety
▪️ Trauma or microtrauma
▪️ Growth-related joint remodeling

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✅ Clinical Evaluation of TMD in Children
A thorough clinical examination remains the cornerstone of diagnosis. The evaluation should be age-appropriate and minimally invasive.
Key diagnostic components include:

▪️ Detailed medical and dental history
▪️ Assessment of jaw pain, clicking, or locking
▪️ Measurement of mandibular range of motion
▪️ Palpation of TMJ and masticatory muscles
▪️ Evaluation of occlusion and oral habits

Imaging studies such as panoramic radiographs or MRI are reserved for persistent, severe, or progressive cases.

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✅ Evidence-Based Management Strategies
Current guidelines emphasize conservative and reversible treatments as first-line therapy in pediatric TMD.
Common management approaches include:

▪️ Patient and parent education
▪️ Behavioral modification and habit awareness
▪️ Physiotherapy and jaw exercises
▪️ Occlusal splints (used cautiously in growing patients)
▪️ Stress management and psychological support

Pharmacologic therapy is limited and typically restricted to short-term use of analgesics or anti-inflammatory agents.

📊 Comparative Table: Conservative Management Approaches for Pediatric TMD

Aspect	Advantages	Limitations
Patient Education	Improves compliance and habit awareness	Requires parental involvement and consistency
Physiotherapy	Enhances muscle function and reduces pain	Effectiveness depends on patient cooperation
Behavioral Therapy	Addresses stress-related contributing factors	Limited access in some clinical settings
Occlusal Splints	Reduces parafunctional activity and muscle overload	Must be monitored due to craniofacial growth
Pharmacologic Therapy	Short-term pain relief	Not suitable for long-term management

💬 Discussion
The literature consistently supports that most pediatric TMD cases are self-limiting or respond well to conservative care. Aggressive or irreversible interventions are discouraged due to the risk of interfering with normal craniofacial growth.
Psychosocial factors play a significant role in symptom perception and persistence, highlighting the importance of a multidisciplinary approach when necessary.

✍️ Conclusion
Temporomandibular disorders in pediatric patients require early recognition and conservative management. Evidence-based evaluation and non-invasive therapies provide favorable outcomes while safeguarding normal growth and development.

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🔎 Clinical Recommendations
▪️ Prioritize conservative and reversible treatments
▪️ Avoid irreversible occlusal or surgical interventions in children
▪️ Educate parents and caregivers on habit control
▪️ Monitor growth and symptom progression regularly
▪️ Refer to specialists when symptoms persist or worsen

📚 References

✔ American Academy of Pediatric Dentistry. (2023). Temporomandibular disorders in children and adolescents. The Reference Manual of Pediatric Dentistry, 487–494. https://www.aapd.org/research/oral-health-policies--recommendations/temporomandibular-disorders/
✔ De Leeuw, R., & Klasser, G. D. (2018). Orofacial pain: Guidelines for assessment, diagnosis, and management (6th ed.). Quintessence Publishing.
✔ List, T., & Jensen, R. H. (2017). Temporomandibular disorders: Old ideas and new concepts. Cephalalgia, 37(7), 692–704. https://doi.org/10.1177/0333102416686302
✔ Manfredini, D., Winocur, E., Guarda-Nardini, L., Paesani, D., & Lobbezoo, F. (2011). Epidemiology of bruxism in children and adolescents. Journal of Oral Rehabilitation, 38(6), 418–429. https://doi.org/10.1111/j.1365-2842.2010.02190.x
✔ Michelotti, A., & Iodice, G. (2010). The role of orthodontics in temporomandibular disorders. Journal of Oral Rehabilitation, 37(6), 411–429. https://doi.org/10.1111/j.1365-2842.2010.02087.x

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Temporomandibular Joint (TMJ) Disorders: Structure, Symptoms, Causes, and Treatment

Temporomandibular joint (TMJ) disorders are among the most frequent causes of orofacial pain and functional limitations in dentistry. Understanding the anatomy, etiology, clinical presentation, and management of TMJ pathologies is crucial for effective patient care.

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✅ Introduction
The temporomandibular joint (TMJ) is a complex bilateral synovial articulation that connects the mandible to the temporal bone of the skull. It plays a vital role in essential functions such as mastication, speech, and swallowing. TMJ pathologies, commonly referred to as temporomandibular disorders (TMD), involve muscles, ligaments, or joint structures, and can significantly affect quality of life.

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✅ Anatomical Components of the TMJ
The TMJ consists of several components that allow coordinated and smooth mandibular movements.

📊 Comparative Table: Components of the Temporomandibular Joint (TMJ)

Aspect	Description	Clinical Relevance
Articular Disc	Fibrocartilaginous structure between condyle and temporal bone	Cushions joint movement and absorbs mechanical stress
Mandibular Condyle	Rounded process articulating with the temporal fossa	Responsible for rotational and translational movement
Synovial Membrane	Lines the joint capsule and produces synovial fluid	Lubricates and nourishes joint tissues
Articular Capsule	Fibrous tissue enclosing the TMJ	Provides protection and stability during movement

✅ Common TMJ Pathologies
TMJ disorders encompass a variety of conditions that affect the joint, muscles, or associated structures.

1. Myofascial Pain Dysfunction Syndrome
Characterized by muscle tenderness, fatigue, and restricted mandibular movement, often related to stress, bruxism, or malocclusion.

2. Internal Derangement
Involves displacement of the articular disc, leading to clicking, locking, or deviation during mouth opening.

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3. Osteoarthritis and Rheumatoid Arthritis
Degenerative and inflammatory processes can cause joint surface erosion, crepitation, and pain during function.

4. Ankylosis
A fusion of the articular surfaces, either bony or fibrous, results in severe restriction of jaw movement.

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✅ Symptoms and Clinical Signs
Typical manifestations of TMJ disorders include:

▪️ Pain in the preauricular region
▪️ Clicking or popping sounds
▪️ Limited mouth opening (less than 35 mm)
▪️ Mandibular deviation on opening
▪️ Headache, otalgia, and neck muscle tension

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✅ Etiology and Risk Factors
The causes of TMJ pathologies are multifactorial, including:

▪️ Trauma or microtrauma (bruxism)
▪️ Malocclusion and occlusal interferences
▪️ Psychological stress and muscle hyperactivity
▪️ Systemic diseases (e.g., arthritis)
▪️ Hormonal and genetic predispositions

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✅ Diagnosis
A comprehensive clinical examination supported by imaging (MRI, CT, panoramic radiographs) is essential to determine the underlying pathology. Functional assessment of mandibular movements, joint sounds, and muscle palpation aid in differential diagnosis.

✅ Treatment and Management
Management of TMJ pathologies depends on the etiology and severity:

▪️ Conservative therapy: rest, soft diet, moist heat, occlusal splints, and physical therapy.
▪️ Pharmacological management: use of NSAIDs, muscle relaxants, or short-term benzodiazepines.
▪️ Behavioral interventions: stress reduction, biofeedback, and patient education.
▪️ Surgical approaches: indicated for severe disc displacement, ankylosis, or degenerative changes unresponsive to conservative therapy.

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💬 Discussion
Early diagnosis and multidisciplinary management improve outcomes for TMJ disorders. Studies show that 80–90% of patients respond to conservative treatment (Scrivani et al., 2008). The integration of occlusal, psychological, and physiotherapeutic approaches offers better long-term stability.

✍️ Conclusion
Temporomandibular disorders (TMD) represent a significant source of orofacial discomfort. Understanding the anatomy, pathophysiology, and management strategies of the TMJ enables dental professionals to deliver effective, patient-centered care. Early intervention and comprehensive evaluation remain key to preventing chronic dysfunction.

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🔎 Recommendations
▪️ Implement routine TMJ evaluation during dental check-ups.
▪️ Educate patients on parafunctional habits and stress management.
▪️ Prioritize non-invasive treatment before surgical alternatives.
▪️ Encourage multidisciplinary collaboration for complex cases.

📚 References

✔ Okeson, J. P. (2020). Management of Temporomandibular Disorders and Occlusion (8th ed.). Elsevier.
✔ Scrivani, S. J., Keith, D. A., & Kaban, L. B. (2008). Temporomandibular disorders. New England Journal of Medicine, 359(25), 2693–2705. https://doi.org/10.1056/NEJMra0802472
✔ Manfredini, D., Guarda-Nardini, L., Winocur, E., Piccotti, F., Ahlberg, J., & Lobbezoo, F. (2011). Research diagnostic criteria for temporomandibular disorders: A systematic review. Journal of Oral Rehabilitation, 38(10), 723–737. https://doi.org/10.1111/j.1365-2842.2011.02207.x

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What is temporomandibular disorder? - Concept, diagnosis and current treatment

The temporomandibular joint is formed by the mandibular and the temporal bone of the skull, which together with muscular structures allow movements such as opening, closing, laterality, protrusion and mandibular retrusion.

The etiology of temporomandibular disorders are complex and varied, and it is a challenge for the evaluation, diagnosis and management of this pathology. Treatment can be conservative or surgical.

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Learn about the clinical manifestations, causes and consequences of temporomandibular disorders, in addition to the management and treatment of this pathology.

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👇 READ AND DOWNLOAD THE ARTICLE "Temporomandibular Disorders: Current Concepts and Controversies in Diagnosis and Management" IN PDF 👇


Li, D.T.S.; Leung, Y.Y. Temporomandibular Disorders: Current Concepts and Controversies in Diagnosis and Management. Diagnostics 2021, 11, 459. https://doi.org/10.3390/diagnostics11030459

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Temporomandibular disorders (TMD) in children - Clinical examination and treatment

Temporomandibular disorders involve the muscles of mastication and the temporomandibular joint, causing pain and difficulty in chewing. These disorders are not common in children and adolescents, but it is necessary to know the signs and symptoms to be able to identify them.

Diagnosis is through clinical and radiographic examinations, and treatment aims to eliminate pain, improve chewing, and reduce risk factors. In some cases, treatment is multidisciplinary.

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The article recommends how to perform a clinical examination and recognize the signs and symptoms of temporomandibular disorders in children, as well as offering treatment options in pediatric patients.

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Diagnosis of temporomandibular joint (TMJ) ankylosis in children

👉 READ AND DOWNLOAD "Temporomandibular disorders (TMD) in children - Clinical examination and treatment" IN FULL IN PDF👈

American Academy of Pediatric Dentistry. Acquired temporomandibular disorders in infants, children, and adolescents. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2021:426-34.

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Is there a relationship between headache and temporomandibular disorder?

Headache is one of the most common ills in society, and in some cases it is associated with temporomandibular dysfunction (TMD). The article that we share this time carries out a study of the relationship between headaches and TMD.

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Temporomandibular dysfunction is evidenced by sharp pain in the temporomandibular joint and the chewing muscles. These pains can increase over time if it is not treated in time.

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In conclusion, the findings from this review and the two reported cases suggest that TMD encompasses a collection of clinical entities that are often very painful and disabling, with a major contribution of headache to patient symptoms.

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However, they are self-limiting and generally respond to conservative therapy. Basic management strategies for pain control and restoration of the range of motion can decrease the level of disability and often contribute to relief from primary headaches.



° Abouelhuda, A. M., Kim, H. S., Kim, S. Y., & Kim, Y. K. (2017). Association between headache and temporomandibular disorder. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 43(6), 363–367. https://doi.org/10.5125/jkaoms.2017.43.6.363

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What Are The Causes Of TMJ Related Headaches?

The articulation of the jaw with the skull base is known as TMJ, and it can suffer a series of alterations, these are known as temporomandibular dysfunction (TMD).

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The chewing muscles and the joint are affected by TMD, and it prevents various actions such as: talking, yawning, eating and even breathing. Headache is another symptom of TMD.

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Treatment for TMD may consist of medication, massage to the affected area, and use of occlusal splints. Go to your trusted dentist for an evaluation and treatment.

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VIDEO: Signs and symptoms of TMJ disorders

The temporo mandibular joint is one that joins the jaw with the skull. Muscles, tendons and bones are involved in this complex joint. Treatment is effective once the cause is found.

Temporomandibular joint syndrome is the lesion or localized pain that the patient presents in the joint.

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The reasons for the injury can be varied: dental malocclusions, blows to the jaw or joint, bruxism, stress, arthritis, etc. Additionally, other medical conditions not related to the TMJ may cause perceived pain in the jaw area.

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