TMJ and Temporomandibular Joint Disorder

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TMJ and Temporomandibular Joint Disorder

• Dr. Soukaina Ryalat

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Basic Anatomy
Basic Structure

• Mandibular condyle
• Temporal bone
• Meniscus
• Coronoid proces

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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

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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
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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

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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

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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

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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.

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TMJ Disorder

• dysfunctional conditions involving the
  masticatory system
• TMJ syndrome previous teminology

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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.
  

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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

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TMJ Disorder

• dysfunctional conditions involving the
  masticatory system
• TMJ syndrome previous teminology

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• TMD reflects possibilities of involvement of
  other factors, not just the joint capsule
• Occlusal factors
• Intrajoint dysfunction
• Psychological factors
• Biochemical factors
• Skeletal misalignments

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What are TMJ Disorders?

• TMJ disorders fall into three main categories  
• Myofascial pain, the most common temporo-
  mandibular 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
  temporomandibular joint

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• 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

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• 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

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• 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

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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

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Assessment of TMJ

• Intercuspid alignment
• Mandibular gait pattern
• Screening (3 finger test)
• Palpate joint and soft tissues
• Adjustive procedure
• Distraction technique
• Translation technique

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TMJ Examination

• History
• Bare the area
• Bilateral observation
• Bilateral palpation
• Active ROM
• Passive ROM
• Ortho/neuro
• X-ray ?

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Normal opening should be enough to fit 3 fingers
into mouth. Have the patient use their own
fingers.
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C and S Curve Examination
Normal
Watch for deviation from center when patient
slowly opens and closes mouth
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While having the patient slowly open the mouth
feel for the movement of the condyles
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Alternate ProcedureInferior Misalignment
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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.

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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.

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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
• Prosthodontic Treatment

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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.

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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, or
  antidepressants to help ease symptoms.

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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
  your mouth.

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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 may relax the
  muscles.

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