Temporomandibular joint Disorders Dr Abdallah M. Ibrahim Removable prosthodontics

Definition of TMD A Temporomandibular disorder (TMD) is a generic term used for any problem concerning the jaw joint. 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. Injury to the jaw, temporomandibular joint, or muscles of the head and neck can cause TMD.

Definition of TMD 3 Main Categories; 3 Main Categories; pain dysfunction syndrome (jaw muscles, neck muscles, shoulder muscles) pain dysfunction syndrome (jaw muscles, neck muscles, shoulder muscles) Internal derangement of the joint (dislocated joint, displaced disk, condylar trauma) Internal derangement of the joint (dislocated joint, displaced disk, condylar trauma) Degenerative joint disease (arthritis) Degenerative joint disease (arthritis)

Anatomy of tempromandibular joint

Epidemiology TMD is seen most commonly in people between the ages of 20 and 40 years, TMD is seen most commonly in people between the ages of 20 and 40 years, occurs more often in women than in men. occurs more often in women than in men.

Etiology 1) Injury to the jaw, temporomandibular joint, or muscles. 2) grinding or clenching the teeth, which puts a lot of pressure on the TMJ. 3) dislocation of the disc. 4) presence of osteoarthritis or rheumatoid arthritis in the TMJ. 5) stress, which can cause a person to tighten facial and jaw muscles.

Etiology 6) Different types of functional malocclusion. 7) The functional unilateral posterior crossbite. 8) Juvenile chronic arthritis. 9) 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 Pain Pain Joint clicking Joint clicking Restricted jaw range of motion Restricted jaw range of motion Other symptoms are not specific to TMD: Other symptoms are not specific to TMD: Headache, ear ache, neck and shoulder pain 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. 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. 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 The majority of TMD patients can be successfully treated by non surgical therapies

Treatment guidelines Phase I: Conservative and Reversible Phase I: Conservative and Reversible Patient education Patient education Physical Therapy. Physical Therapy. Medications Medications Bite splint/Occlusal Splint Bite splint/Occlusal Splint Stress management Stress management (Multidisciplinary approach) Phase II: surgery (Arthroscopy,Discectomy, Joint Replacement) Phase II: surgery (Arthroscopy,Discectomy, Joint Replacement) only after conservative measures exhausted

Treatment: Patient Education About TMD About TMD Avoid painful activities Avoid painful activities Avoid clenching grinding Avoid clenching grinding Normal resting position of jaw Normal resting position of jaw Tongue up, teeth apart, lips together Tongue up, teeth apart, lips together Moist heat/ice Moist heat/ice Gentle stretching 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 fully- open position and then to apply slight additional pressure to open the mouth fully. open the mouth to a comfortable fully- open 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 Another exercise includes stretching the jaw muscles by making various facial expressions

Treatment: Pharmacologic NSAIDS-scheduled dosing NSAIDS-scheduled dosing Muscle relaxants Muscle relaxants Tricyclics Tricyclics Opioids Opioids Steroid injection Steroid injection

occlusal Splints occlusal Splints 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. 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 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. used as a short-term treatment during orthodontic management. Bruxism is believed to cause the TMJ dysfunction due to tooth attrition and subsequent malocclusion Bruxism is believed to cause the TMJ dysfunction due to tooth attrition and subsequent malocclusion Worn only at night.

Dental guard or splint. Dental guard or splint.

Phase II: surgery Arthrocentesis 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. 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.

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 UW TMD Clinic: UW TMD Clinic: Lisa M. Dussault, OTR, John F. Doyle DDS Lisa M. Dussault, OTR, John F. Doyle DDS Imaging as indicated Imaging as indicated Referral to specialists as indicated Referral to specialists as indicated Rehab Med psychologist, Oral/craniofacial surgery, speech/swallow, etc Rehab Med psychologist, Oral/craniofacial surgery, speech/swallow, etc