Intended for healthcare professionals

Rapid response to:

Clinical Review ABC of adolescence

Fatigue and somatic symptoms

BMJ 2005; 330 doi: (Published 28 April 2005) Cite this as: BMJ 2005;330:1012

Rapid Response:

Temporomandibular Joint dysfunction as a Differential Diagnosis in ME/CFS patients

I accidently came across this article by Viner & Christie while
doing some research. I have also read the responses with great interest.
There is a cursory mention of temporomandibular joint (TMJ) disorders in the article. My experience
of treating many patients with CFS is that this aspect must always be
excluded in the differential diagnosis as it gives similar symptomatology
as many other causal relationships. Asking the patient if they have any
jaw pain is not sufficient.

Palpation of the Lateral Pterygoid muscle by running a gloved finger
on the buccal aspect of the upper molar teeth backwards and upwards will
often produce acute pain in most patients. The pain might be worse on one
side than the other. Evidence of jaw clicking, limited mouth opening
(Normal 50mm), deviation of the lower jaw on slowly opening the mouth,
tooth grinding and jaw clenching while asleep should be enquired into. A
history of orthodontic or wisdom tooth extractions is also often
indicative of TMJ dysfunction. Dental splints over the teeth provide
limited and symptomatic relief and should not be percieved as "TMJ
treatment under control" as the proper dental management of such patients
is far more complex. I shall be grateful if this can be brought to the
attention of those in medicine that the patients so depend on. It might
even give some an alternative to "psychosocial" relationships.

Competing interests:
TMJ treatment

Competing interests: No competing interests

05 September 2006
Mohamed Amir
Dental Surgeon
Putney, London SW15 1JT