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Bangkok Dental Spa By Dr.lily
27 Methawattana Building 2nd
Sukhumvit soi-19,
Bangkok, Thailand
2 min. walk from Asoke BTS station
Hot Line! (662)-651-0807
(662)-651-0730
Fax. (662) - 651- 0729
Bangkok Office
9.30 am. - 18.30 pm. Mon -Sat
( close on Sunday )
If you have any suggestions or comments, please e-mail us at
healthysmiles
@bangkokdentalspa.com
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 International -
News -
Article -
Magazine
TEMPOROMANDIBULAR DISORDERS (TMD)
By Professor Suknipa, Chulalongkorn University
 Epidemology Of Temporomandibular
Etiology Of Temporomandibular
Trauma And Temporomandibular
Pyschological Factors
Anatomic Factors And Temporomandibular
Management Of Temporomandibular
TMD is a collective term embracing a number of clinical
problems that involve the masticatory musculature, the
Temporomandibular joint.
(TMJ) and associated structure or Temporomandibular disorders
have both been identified as a major cause of nondental pain
in the orofacial region and are considered to be a sub
classification of musculoskeletal disorders.
Temporomandibular disorders are a cluster of related disorders
in the masticatory system that have many common symptoms. The
most frequent - presenting symptom is pain , usually localized
in the muscle of mastication, the preauricular area and / or
the TMJ .
The pain usually is aggravated by chewing or other jaw
functions.
In addition to complaints of pain , patients with these
disorders frequently have limited or a symmetrical mandibular
movement and TMJ sounds that are most frequently described as
clicking , popping, grating or criptus.
Common patients complaints include jaw ache ,ear ache,
headache ,and facial pain. Non painful masticatory muscle -
hypertrophy and abnormal occlusal wear
Associated with oral parafuncton such as bruxism(jaw clenching
and tooth grinding maybe related problems.
Epidemology Of Temporomandibular Disorders (TMDs)
Cross- sectional epidemiological studies of selected non
patients adult populations show a point prevelance from 40%-
75% in those populations having atleast one sign of joint
dysfunction - (movement abnormalities, joint noise, tenderness
on palpation , etc) Approximately 33% of persons have atleast
one symptom (face pain,joint pain,etc).
Some sign appear to be relatively common in populations of
relaxing persons . Joint sounds or deviations on mouth opening
occur in approximately 50% in such non patient populations.
Temporomandibular disorders are often remitting , self-
limiting, or fluctuating overtime . while knowledge of the
natural history or course of Temporomandibular disorder is
limited, there is increasing evidence that progression to
chronic and disabling intracapsular TMJ disease is an uncommon
occurrence.
Despite the large percentage of the population having signs or
symptoms ,only 3.6% - 7% of these individual are estimated to
be in need of treatment.
Etiology Of Temporomandibular Disorders (TMDs)
The identification of an unambiguous universal cause of
Temporomandibular disorder is yet ,lacking .For this reason,
most of the factors discussed in this section are not proven
casual factors, but factors having associations with
Temporomandibular disorder await future research to document
their etiologic significance.
Long term successful management usually depends on identifying
the possible contributing factors and is often proportionate
to the thoroughness and accuracy of the initial assessment.
Thus, a comprehensive diagnostic approach requires clinicians
to understand all the potential contributing factors relevant
to Temporomandibular disorder and chronic orofacial pain.
Many factors can affect the dynamic balance or equilibrium
between the components
Of the masticatory system .there are numerous factor driving
the equilibrium either towards normal adaptive physiologic
health and function or towards dysfunction and pathology.
Bone and TMJ soft tissue remodeling, as well as muscle tone
regulation are adaptive physiologic response to insult or
change . Loss of structural integrity , alterd function, or
biomechanical strains and stress in the system can compromise
pliability and increase the likelihood of dysfunction or
pathology.
Direct extrinsic trauma to any component of the masticatory
system can spontaneously initiate loss of structural integrity
and concomitant anatomic systemic, pathophysiologic and
psychologic factors that may sufficiently reduce the adaptive
capacity of the masticatory system and cause Temporomandibular
disorder.
Trauma And Temporomandibular Disorders
Trauma is described as any forced applied to the mastication
structures that exceeds that of normal functional loading both
intensity and duration need to be considered . Most trauma can
be divide into three types:
-
That which is the result of a sudden and usually isolated blow
to the structures(direct trauma )
direct trauma to the jaw or the TMJ produces injury via impact
and is accompanied in temporal proximity with the signs and
symptoms of inflammation. If the forces lead to structural
failure, loss of function may quickly follow - stretching,
twisting or compress forces during eating ,yawning ,yelling or
prolonged mouth opening have also been reported to trigger or
aggravated Temporomandibular disorder.
-
That associated with a sudden blow but without direct contact
to the affected
structures (indirect trauma)
Accelertion - deceleration injury (whiplash) with no direct
blow to the face can cause symptoms consisted with TMD. There
is some evidence that Temporomandibular disorder signs and
symptoms are more prevalent in those with a history of a hyper
tension- flexion injury than in a noninjury controlled
population. Symptoms in the jaw may referred from injured
controlled population .symptoms in the jaw may referred
cervical structures produced by an acceleration- deceleration
accident. However a direct casual relationship between jaw
symptoms and indirect trauma has yet to be established.
-
That which is the result of prolonged , repeated force
overtime(micro trauma) microtrauma has been hypothesized to
originate from sustained and repetitious adverse loadimg of
the masticatory system through postural imbalances or from
oral and parafunctional habits . it has been suggested that
postural habits such as forward head position or phone bracing
may create muscle and joint strain and lead to musculoskeletal
pain , including headache in the TMD patient.
Parafunctional habits such as teeth clenching , toothgrinding,
lipbiting , and abnormal posturing of the jaw are common and
usually do not result in TMD symptoms.However parafunctional
habits have been suggested as initiating or perpetuating
factors in certain subgroups of TMD patients,.
The intensity and frequency of parafunctional jaw activity may
be exacerbated by stress and anxiety , sleep disorders and
medications(neurology ,alcohol and other substance)
Anatomic Factors And Temporomandibular
Disorders
Skeletal relationships: severe skeletal malformation,
interarch discrepancies and post injuries to the teeth are
examples of possible structural factors.
The role of anatomic factors, however may be less strong then
previously believed.
Occlusal relationship: the dental profession historically has
viewed occlusal features such as working and nonworking
posterior contacts or discrepancies between the Retruded
contact position(RCP) and intercuspal position(ICP) have been
commonly identified as predisposing ,initiating and
perpetuating factors. However, reviews of the literature and
recent studies do not strongly support the role occlusion in
the etiology of TMD.
Pyschological Factors And Temporomandibular
Disorders
Psychological factors include individual , interpersonal , and
situation variables that impact the patient's capacity to
function adaptively, as a group, TMD and orofacial pain
patients are significantly dissimilar both culturally and
economically, so the relevant psychology factors present with
tremendous diversity, however individual TMD patients may have
personality characteristics or emotional conditions that make
managing or coping with life situation difficult.
Management Of Temporomandibular Disorders
Management goals for patients with TMD are similar to those
for other orthopedic or rheumatologic disorders. Those include
decreased pain, decrease adverse loading, restoration of
function and resumption of normal daily activities.
These treatment goals are best achieved by a well defined
program designed to treat the physical disorders and to reduce
or eliminate the effects of all contributing factors.
As in many musculoskeletal conditions , the sign and symptom
of TMD over time may be transient and self limiting ,
resolving without serious long term affect. Little is known
about which signs and symptoms will progress to more serious
condition in the natural course of TMD.
Therefore , special effort should be made to avoid early use
of aggressive irreversible - treatments such as complex
occlusal therapy or surgery.
Conservative (reversible ) treatment such as behavioral
modification physical therapy., medications and orthopedic
appliances is endorsed for the initial care of nearly all the
Tmdisorders.
OROFACIAL PAIN:guideline for assessment, diagnosis and
management
The American academy of orofacial pain
Edited by J.P. OKESON,quintessence publishing co.inc.
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