Transcript Temporomandibular Joint Disorder - Clinical Jude

TMJ and
Temporomandibular
Joint Disorder
Dr. Soukaina Ryalat
Basic Anatomy
Basic Structure

Mandibular condyle

Temporal bone

Meniscus

Coronoid proces
TMJ Anatomy continued


Primary articulation is formed by the mandibular
condyle and the mandibular fossa
It is considered a “sliding” hinge joint and
allows movement in only one plane, forward
and backward movement
TMJ Articular Disc Function



Transmits forces, protects,
lubricates the articulating
surfaces
Divided into 3 portions,
anterior, intermediate and
posterior
Movement is mediated by
lateral pterygoid
attachment on the anterior
disc, retrodiscal tissue on
the posterior disc and the
amount of synovial fluid in
the joint capsule
Anterior
TMJ Disc Facts

The intermediate portion is the thinnest and has very
little or no innervation or vascularity. Its nutrition
comes from the synovial fluid pressed into it by the
properly aligned condyle and fossa during closure

The anterior and posterior portion is highly
vascularized and innervated and also receives some
nutrition from synovial fluid
Facts on TMJ



Most soft clicking noise are not an indicator of joint
dysfunction and are of no clinical significance
Loud clicking while opening, with deviation present on
opposite side, clinically significant of possible anterior
condyle displacement.
Loud clicking while closing, with deviation present on
opposite side, clinically significant of possible posterior
condyle displacement. Signs/Symptoms of TMD
More TMJ Facts

40% of population have some type of joint
noise, indicating the existence of possible disc
problems

24% have some head, neck and/or face pain

12% report pain when opening
TMJ Disorders
 Temporomandibular
joint and muscle disorders,
commonly called “TMJ” or TMD are a group of
conditions that cause pain and dysfunction in the
jaw joint and the muscles that control jaw
movement.
TMJ Disorder

dysfunctional conditions involving the
masticatory system

“TMJ syndrome” previous teminology
TMJ Disorders
 For
most people, pain in the area of the jaw joint
or muscles does not signal a serious problem.
Generally, discomfort from these conditions is
occasional and temporary, often occurring in
cycles. The pain eventually goes away with little
or no treatment. Some people, however, develop
significant, longterm symptoms.
TMJ Muscles




Temporalis - closes jaw and retracts mandible
Masseter – closes jaw
Internal or medial Pterygoid – closes jaw
External or lateral Pterygoid – opens jaw, moves
jaw side to side and protrudes mandible
TMJ Disorder
• dysfunctional conditions involving
the masticatory system
• “TMJ syndrome” previous
teminology






TMD reflects possibilities of involvement of
other factors, not just the joint capsule
Occlusal factors
Intrajoint dysfunction
Psychological factors
Biochemical factors
Skeletal misalignments
What are TMJ Disorders?
TMJ disorders fall into three main categories:
 Myofascial
pain, the most common temporomandibular disorder, involves discomfort or pain in
the muscles that control jaw function.

Internal derangement of the joint involves a
displaced disc, dislocated jaw, or injury to the
condyle.

Arthritis refers to a group of degenerative or
inflammatory joint disorders that can affect the



The most common type of TMJ disorder is
myofascial pain and dysfunction, usually as a
result of bruxism and jaw clenching
Related to stress, anxiety, depression or chronic
pain
3 cardinal features of TMJ are orofacial pain,
restricted jaw function and noise in the jaw

TMD is characterized by many symptoms

Headache
Burning or tingling sensation
Tenderness and swelling
Clicking or popping
Reduced ROM
Ear pain w/o infections
Neck and or facial pain











Grinding teeth at night
Pain that worsens with stress
Pain with opening of your mouth
Teeth that meet differently from time to time
Pain while chewing
Summary of Symptoms:
• History of trauma, blow to jaw, MVA ( motor vehicle
accident), dental malocclusions
• Pain and tenderness of the TMJ
• Head and/or ear pain
• Sore and stiff jaw muscles
• Locking of the jaw in a shut or open position
• Frequent headaches and/or neck aches
• Pain that worsens when teeth are clenched
•
Assessment of TMJ





Intercuspid alignment
Mandibular gait pattern
Screening (3 finger test)
Palpate joint and soft tissues
Adjustive procedure
Distraction technique
 Translation technique

TMJ Examination:
History:
Bare the area
Bilateral observation
Bilateral palpation
Active ROM
Passive ROM
Ortho/neuro
X-ray ?
Normal opening should be enough to fit 3 fingers into
mouth. Have the patient use their own fingers.
C and S Curve Examination
Normal
Watch for deviation from center when patient
slowly opens and closes mouth
While having
the patient
slowly open
the mouth
feel for the
movement
of the
condyles
Alternate Procedure:
Inferior Misalignment
How are TMJ Disorders Treated?
 Because
more studies are needed on the safety
and effectiveness of most treatments for jaw
joint and muscle disorders, experts recommend
using the most conservative and reversible
treatments when possible.
 Reversible treatments do not cause permanent
changes in the structure or position of the jaw or
teeth. Even when TMJ disorders have become
persistent, most patients still do not need
aggressive types of treatment.
How are TMJ Disorders Treated?
 Treatment
by a Prosthodontist may be needed
for other reasons such as to restore severely
worn, damaged, or diseased teeth or to replace
teeth for the purpose of improving chewing,
providing enhanced support for your lips or
cheeks, or improving the appearance of your
smile.
 Extensive prosthodontic treatment should only
be provided after the TMJ disorder has been
adequately diagnosed and its pain successfully
managed.
Conservative Treatments
 Most
jaw joint and muscle problems are
temporary and do not get worse.
Treatment is based on a proper diagnosis
which should be conservative and
reversible.
Self-Care Practices
Pain Medications
Stabilization Splints
Self-Care Practices
Your Prosthodontist may
recommend steps that you can
take that may be helpful in easing
symptoms, such as:
• eating soft foods,
• applying ice packs to recommended areas,
• avoiding extreme jaw movements (such as wide
yawning, loud singing, and gum chewing),
• learning techniques for reducing stress,
• practicing gentle jaw stretching and relaxing
exercises that may help increase jaw movement.
Pain Medications
 For
many people with TMJ
disorders, short-term use of
over-the-counter pain medicines
or nonsteroidal anti-inflammatory drugs (NSAIDS),
such as ibuprofen, may provide
temporary relief from jaw
discomfort.
 When
necessary, your dentist or
doctor can prescribe stronger
pain or antiinflammatory
medications, muscle relaxants,
Stabilization Splints
 Your
Prosthodontist may
recommend an oral appliance,
also called a stabilization splint
or bite guard, which is a plastic
guard that fits over the upper or
lower teeth. Stabilization splints
are the most widely used
treatments for TMJ disorders.
 If a stabilization splint is
recommended, it should be used
only for a short time and should
not cause permanent changes in
the way your teeth bite together
when the splint is removed from
Prosthodontic Treatment
 Occlusal
splints may
also be used to
reestablish the bite
prior to
prosthodontic
treatment.
 It is used when the
bite is not contacting
evenly due to missing
or worn teeth and