Download Temporomandibular Disorders

Temporomandibular
joint Disorders
Dr Abdallah M. Ibrahim
Removable prosthodontics
Definition of TMD
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A Temporomandibular disorder (TMD) is a
generic term used for any problem concerning
the jaw joint.
Injury to the jaw, temporomandibular joint, or
muscles of the head and neck can cause
TMD.
Definition of TMD
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3 Main Categories;
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pain dysfunction syndrome (jaw muscles,
neck muscles, shoulder muscles)
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Internal derangement of the joint (dislocated
joint, displaced disk, condylar trauma)
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Degenerative joint disease (arthritis)
Anatomy of tempromandibular
joint
Epidemiology
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TMD is seen most commonly in people
between the ages of 20 and 40 years,
occurs more often in women than in men.
Etiology
1)
2)
3)
4)
5)
Injury to the jaw, temporomandibular joint,
or muscles.
grinding or clenching the teeth, which puts
a lot of pressure on the TMJ.
dislocation of the disc.
presence of osteoarthritis or rheumatoid
arthritis in the TMJ.
stress, which can cause a person to
tighten facial and jaw muscles.
Etiology
6)
7)
8)
9)
Different types of functional malocclusion.
The functional unilateral posterior
crossbite.
Juvenile chronic arthritis .
aging.
The position of the TMJ disc in three different conditions: a
healthy joint, anterior disc displacement with reduction
(ADDWR), and anterior disc displacement without reduction
(ADDWOR).
Clinical Manifestations
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Pain
Joint clicking
Restricted jaw range of motion
Other symptoms are not specific to TMD:
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Headache, ear ache, neck and shoulder pain
Treatment guidelines
Treatments for the various TMJ disorders range
from :
 physical therapy and nonsurgical treatments
to various surgical procedures.
 Usually the treatment begins with
conservative, nonsurgical therapies first, with
surgery left as the last option.
 The majority of TMD patients can be
successfully treated by non surgical therapies
Treatment guidelines
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Phase I: Conservative and Reversible
Patient education
 Physical Therapy.
 Medications
 Bite splint/Occlusal Splint
 Stress management
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(Multidisciplinary approach)
 Phase II: surgery (Arthroscopy ,Discectomy,
Joint Replacement)
only after conservative measures exhausted
Treatment: Patient Education
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About TMD
Avoid painful activities
Avoid clenching grinding
Normal resting position of jaw
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Tongue up, teeth apart, lips together
Moist heat/ice
Gentle stretching
Physical therapy
Physical therapy is often used by TMD
patients to keep the synovial joint lubricated,
and to maintain full range of the jaw motion.
 open the mouth to a comfortable fullyopen position and then to apply slight
additional pressure to open the mouth
fully.
 Another exercise includes stretching the
jaw muscles by making various facial
expressions
Treatment: Pharmacologic
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NSAIDS-scheduled dosing
Muscle relaxants
Tricyclics
Opioids
Steroid injection
occlusal Splints
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Splints are plastic mouthpieces that fit
over the upper and lower teeth. They
prevent the upper and lower teeth from
coming together, lessening the effects of
clenching or grinding the teeth.
The splints also correct the bite by
positioning the teeth in their most correct
and least traumatic position
occlusal Splint
Indications:
 used as a short-term treatment during
orthodontic management.
 Bruxism is believed to cause the TMJ
dysfunction due to tooth attrition and
subsequent malocclusion
Worn only at night.
Dental guard or splint.
Phase II: surgery
Arthrocentesis
is the simplest form of
surgical intervention into the
TMJ performed under general
anesthesia for sudden-onset,
closed lock cases (restricted
jaw opening) in patients with
no significant prior history of
TMJ problems.
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Discectomy
Discectomy is a surgical treatment, which is
often performed on individuals with severe
TMD, to remove the damaged and very
often dislocating articular disc without going
to a more extreme treatment such as a joint
prosthetic.
Joint replacement
Joint replacement is a
surgical procedure in
which the severely
damaged part of the TMJ
is removed and replaced
with a prosthetic device.
Local Resource
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UW TMD Clinic: 263-7502
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Lisa M. Dussault, OTR, John F. Doyle DDS
Imaging as indicated
Referral to specialists as indicated
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Rehab Med psychologist, Oral/craniofacial
surgery, speech/swallow, etc