MindMap Gallery TMD

TMD

TMD: Definition, Prevalence, Etiology, Diagnosis, and Treatment

Edited at 2021-06-26 11:55:15

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TMD

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TMD

Definition

Group of musculoskeletal and neuromuscular

Functional disturbances of masticatory system

Prevalence

Major cause of nonodontogenic pain in orofacial region

prevalence of signs and symptoms increase with age

3-5 yr rare

12-19 yr most common

Girl > Boy

Estrogen hormone (Puberty)

Pain

Headache มักเกิดก่อน jaw pain

Etiology (Multiple factors)

Macrotrauma

Common occurrence in childhood

Falling, chin trauma, motor vehicle accidents, sport, physical abuse, forceful intubation, third molar extraction

Mandibular fracture: Unilateral/Bilateral Lateral intracapsular or condylar fracture

Whiplash injury

Closed reduction and prolonged immobilization

Ankylosis

Microtrauma

Parafunction habit: Bruxism, clenching, hyperextension

Repetitive stain: Playing wind instrument, fingernail biting

Anatomical factors (skeletal and occlusal) and ortho tx

Skeletal anterior open bite

Steep articular eminence of the temporal bone

Overjet greater than 6-7 mm

Class III malocclusion

Unilateral posterior crossbite

Posterior crossbite

Psychosocial factor

Somatization, anxiety, obsessive-compulsive feeling, psychologic stress

Emotional stress, clenching, bruxism

Diffuculty

Prolonged jaw opening

Eating hard/soft foods

Sleeping

Systemic and pathologic factors

Connective tissue diseases

Rheumatoid arthritis

Systemic lupus erythematosus

Juvenile idiopathic arthritis

Psoriatic arthritis

Joint mobility

Ehler Danlos syndrome

Pathologic hyperplasia

Condyle tumor

Genetic and hormonal factor

Estrogen hormone

Diagnosis TMD

ตรวจ

History taking

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Clinical and Physical examination

Muscle of mastication

Direct palpation

Functional Manipulation

Evaluation of jaw movement

Mandibular range of motion

Maximum unassisted/assisted opening

Maximum lateral excursion

Maximum protrusive excursion

Mandibular opening pattern

Deviation (return to midline)

Deflection (no return to midline)

Evaluation of TMJ

Inspection

facial symmetry/asym

palpation

ขณะ joint เคลื่อน/อยู่นิ่ง

Joint sound

Click (single sound of short duration)

Pop (single sound relatively loud)

Crepitus (Multiple gravel-like sound)

TMJ imaging

indication

Developing facial asymmetry

Painful symptom

Crepitus

Conservative treatment failure

imaging tech

Panoramic

Good screening of condyle

CBCT

To detect bony abnormalities and fractures To assess asymmetry of TMJ

MRI

Gold standard for evaluating soft tissue of the TMJ, especially disc position

Ultrasound

superficial lateral aspects of the TMJ

Mandibular radiograph: Oblique view

Arthrography

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อาการ

Pain

Headache

TMJ sound

TMJ locking

Ear pain

Diff dx

trigeminal neuralgia

central nervous system lesions

odontogenic pain

sinus pain

otological pain

developmental abnormalities

neoplasias

parotid diseases

vascular diseases

myofascial pain

cervical muscle dysfunction

Eagle’s syndrome

styloid process ยาว กด vessel, nerve

Other common medical conditions

Migraine

Diangnosis

TMJ disorder

Joint pain

Joint disorder

Joint disease

Mastcatory disorder

Treatment

Gold of tx

restoration of function decreased pain, decreased aggravating or contributing factors, and improved quality of life

In children

Conservative and reversible therapy

Reversible tx

Patient education

Physical therapy ex. jaw excercise, thermal/coolant tx

Behavior therapy ex. relaxing trainning, เลี่ยง habit ที่ทำให้เกิด

Prescirption medication: NASAID, Anxiolytic agent, muscle relaxer

Occlusal splint: hard/soft

Others: nerve block, acupunture, botox

Irreversible tx

Occlusal adjustment

Orthodontic

Surgery

Bruxism

Awake/ asleep

Etiology: mutifactorial ex. emotional stress, malocclusion

Complicaton

attrition

headace

TMD

soreness of masticatory muscle

In children

self-limiting and does not persist in adults

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