Prepared by : Amilia Bt Sharifoedin (A 98750) Nadiah Bt Abd Kamar (A 98771) Supervisor :

1. Prepared by : Amilia Bt Sharifoedin (A 98750) Nadiah Bt AbdKamar (A 98771) Supervisor : Dr AdiRahmadsyah Management of Temporomandibular Joint Disorders (TMD)in UniversitiKebangsaan Malaysia Dental Polyclinic from 2000-2008

2. INTRODUCTION • Temporomandibular joint (TMJ)

3. INTRODUCTION • Temporomandibular joint disorders (TMD) is a collective term that include clinical disorders involving the masticatory muscles, the TMJ and the adjacent structures (Baskan and Zengıngul,2006).

4. AETIOLOGY • The main aetiology for TMD has not been found yet. • The risk factor is numerous and cannot be clearly clarified in patients suffering from TMD • Risk factors include : • anatomical abnormalities • malocclusion • psychological stress • parafunctional habit • trauma

5. SYMPTOMS • The common symptoms are pain, joint sound, limitation of jaw opening. • A variety of other symptoms • history of lockjaw • headache • otalgia • neck pain or stiffness

6. TREATMENT • Characteristics of TMD will influence the type of treatment by the clinician. • Therapies include conservative treatment or surgical intervention. • Treatment can be carried out either single or in combination.

7. AIM AIM : To analyze the management of temporomandibular joint disorders in Universiti Kebangsaan Malaysia dental polyclinic.

8. OBJECTIVES OBJECTIVES : • To study the prevalence of patients with temporomandibular joint disorders in UKM dental polyclinic from year 2000 until 2008. • To identify specific signs and symptoms of patients with temporomandibular joint disorder. • To assess the management of TMD patients in dental polyclinic.

9. MATERIALS & METHODS

10. Figure 1: Prevalence of TMD according to gender

11. Figure 2 : Age distribution of subjects with TMD

12. Figure 3 : Occurrence of TMD according to race

13. Figure 4 : Risk factors associated with TMD

14. Figure 5 : Presenting sign and symptom of TMJ

15. Figure 6 : Presenting sign and symptom of the muscles of mastication

16. Figure 7 : Presenting sign and symptom of mouth opening

17. Figure 8 : Type of treatment received by the subjects

18. Figure 9 : Percentage of subjects who have been reviewed after receiving treatment

19. DISCUSSION • Prevalence of TMD is more in female. • reflects review of TMD by Poveda-Roda et al (2007). • similar to study done by Ozan et al (2007). • Peak age for TMD occurrence is between 20 to • 29 years old. • similar result to study by Ozden et al (2000) and Keiko et al (1999). • Racial distribution may be influenced by patient • attendance to the polyclinic.

20. DISCUSSION • The most common risk factor for TMD is psychological stress. • age factor • psycho-physiological theory of myofacial pain by Daniel Laskin, 1969 where stress is defined as a major causal factor. • stress induces muscle hyperactivity •  fatigue and muscle spasm

21. DISCUSSION • 100% of the subjects were managed by means of conservative treatment. • American Academy of Orofacial Pain (AAOP), conservative management proven to be safe and effective in the majority of TMD cases.

22. DISCUSSION • Only half of the subjects been reviewed. • 2 subjects were reported to have no sign or symptom while 11 reported that the symptoms have reduced while in the other 5 subjects, the symptom still persists. • Factors influencing treatment outcome cannot be clearly determined • not all patients were reviewed • not sufficient data recorded in the patients’ case notes

23. CONCLUSION • In UKM dental polyclinic, TMD is more prevalent in female than in male.The signs and symptoms of the subjects include TMJ pain or sound, muscle tenderness, limitation of mouth opening, headache and history of lockjaw.

24. CONCLUSION • Patients were treated only by conservative methods. • Most of the outcome of treatment cannot be determined because not all patients were reviewed. • Among the subjects who had been reviewed the signs and symptoms of temporomandibular joint disorders still persist to a certain extend.

25. LIMITATION • Data might not represent the whole patient population of the UKM polyclinic. • The number of subjects in this study is relatively small in comparison with other studies.

26. RECOMMENDATION • Include all patients of UKM dental polyclinic, not just from Oral Medicine clinic. • Recruit more subjects, i.e. from Hospital Kuala Lumpur or Pusat Perubatan Universiti Kebangsaan Malaysia. • Improve on methodology. • Subjects reviewed retrospectively

27. REFERENCES • Baskan S, Zengingul A, Temporomandibular Joint, Disorders And Approaches, Biotechnol. & Biotechnol. Eq. 20/2006/2 • Poveda-Roda R, Bagan JV, Diaz-Fernandez JM, Hernandez-Bazan S, Jimenez-Soriano Y, Review of Temporomandibular Joint Pathology. Part I : Classification, Epidemiology and Risk Factors. Med Oral Pathol Oral Cir Bucal 2007; 12 : E292-8 • Ozan F, Polat S, Kara I, Kucuk D, Polat HB, Prevalence Study Of Signs And Symptoms Of Temporomandibular Disorders In A Turkish Population. The Journal of Contemporary Dental Practice, Volume 8, Number 4, May 1 2007. • Ozden AN, Ersoy AE, Kisnisci RS, Clinical Aspects Of Temporomandibular Disorders. Turk J Med Sci 30 (2000) 77-81 • Keiko O, Takuya S, Ayaki N, Akiko A, Masanor F, Kanji I, Clinical Survey Of The Signs And Symptoms Of TMD Patients In The Department Of Fixed Prosthodontics, Iwate Medical University Dental Hospital For The Last 5 Years. Dental Journal of Iwate Medical University, VOL.24;NO.3;PAGE.176-182(1999)

28. ACKNOWLEDGEMENT • Dr. Adi Rahmadsyah, supervisor. • Lecturers in the Dental Public Health Department • All lecturers and staff of Faculty of Dentistry, Universiti Kebangsaan Malaysia.

29. THANK YOU