TMJ and Temporomandibular Joint Disorder

1. TMJ and Temporomandibular Joint Disorder Dr. Soukaina Ryalat

2. Basic Anatomy • Mandibular condyle • Temporal bone • Meniscus • Coronoid proces Basic Structure

4. 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

5. 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

6. 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

7. 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

8. 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

13. 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.

14. TMJ Disorder • dysfunctional conditions involving the masticatory system • “TMJ syndrome” previous teminology

15. 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.

16. 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

19. TMJ Disorder • dysfunctional conditions involving the masticatory system • “TMJ syndrome” previous teminology

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

21. 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 derangementof 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

22. 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

23. 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

24. 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

25. 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

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

31. TMJ Examination: History: Bare the area Bilateral observation Bilateral palpation Active ROM Passive ROM Ortho/neuro X-ray ?

33. Normal opening should be enough to fit 3 fingers into mouth. Have the patientusetheir own fingers.

34. C and S Curve Examination Normal Watch for deviation from center when patient slowly opens and closes mouth

35. While having the patient slowly open the mouth feel for the movement of the condyles

38. Alternate Procedure:Inferior Misalignment

40. 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.

41. 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.

42. 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

43. Self-Care Practices • 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. Your Prosthodontist may recommend steps that you can take that may be helpful in easing symptoms, such as:

44. 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.

45. 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.

46. 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.