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TMD
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TMD: Definition, Prevalence, Etiology, Diagnosis, and Treatment
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Outline
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
OSA สัมพันธ์กับภูมิแพ้
