DH 308 final/quiz lec 6

Temporomandibular Disorders (TMDs)

• TMDs affect the masticatory system (muscles and joints involved in chewing)
• Extracapsular refers to disorders affecting the muscles.
• Intracapsular refers to disorders affecting the temporomandibular joint (TMJ).
• Causes of TMDs are multifactorial, involving stress, arthritis, psychological problems, and trauma (both single events and repetitive microtrauma).

Categories of TMDs

• Muscle and fascial disorders: Include myalgia, trismus, spasm, dyskinesia, bruxism, and other muscle problems
• Internal derangements: Conditions that disrupt the TMJ's mechanical function (e.g., displaced disc)
• Disorders of mandibular mobility: Ankylosis (joint fusion), muscular fibrosis, internal derangements, and joint adhesions
• Disorders of maxillomandibular growth: Neoplasms (tumors) and other non-neoplastic growth conditions

Common Symptoms of TMDs

• Pain & Tenderness:
  • In muscles of mastication
  • In the TMJ
• Clicking: Painful clicking of the joint during chewing
• Limited Mandibular Motion: Difficulty opening or closing the jaw

Additional Symptoms of TMDs

• Uncomfortable bite
• Jaw incoordination (dyskinesia)
• Ringing in the ears (tinnitus)
• Muscle swelling
• Dental signs: Tooth wear, tooth mobility, tooth pain (pulpitis)

TMJ Pain (Arthralgia)

• Pain originates from the soft tissues surrounding the joint, as articular surfaces are not innervated
• Sharp, sudden, and associated with jaw movement

Joint Sounds in TMDs

• Clicking or popping: Single sounds caused by abnormal joint movement.
• Crepitus: Grating sound, also indicative of abnormal joint movement.

Inflammatory Joint Disorders in TMDs

• Osteoarthritis and polyarthritis:
  • Pain is dull, aching, and constant, worsened by jaw movement.

Radiographic Evaluation for TMDs

• Periapical radiographs can show:
  • Widening of the periodontal ligament, due to bone resorption from excessive occlusal forces.

Behavioral Therapy for TMDs

• Stress and anxiety counseling
• Depression counseling
• Psychiatric therapy

Pharmacologic Therapy for TMDs

• Analgesic medications (pain relievers)
• Antianxiety drugs
• Antiinflammatory agents
• Muscle relaxants
• Local anesthetic medications

Irreversible Treatments for TMDs

• Surgical treatments:
  • Only indicated for a small percentage of patients.
  • Permanent alterations of the TMJ or disc.
• Occlusal adjustment:
  • Reshaping of teeth to treat malocclusion.
  • No evidence supports its effectiveness.

Dental Hygiene for TMD Patients

• Short, frequent appointments to minimize muscle and joint trauma.
• Use of bite-blocks to keep the mouth open, easing jaw fatigue and pain.
• Small-headed toothbrushes or interdental cleaning devices for easier hygiene with limited jaw opening.

Occlusal Trauma

• Primary Occlusal Trauma:
  • Injury to supporting tissues (periodontal ligament, cementum, bone) due to excessive forces on a tooth with healthy periodontium.
  • Examples: High restorations, faulty restorations, fixed or removable prostheses, bruxism, clenching
• Secondary Occlusal Trauma:
  • Normal occlusal forces exceed the capacity of already compromised periodontium (periodontal disease).
  • Examples: Severe periodontitis

Signs of Occlusal Trauma

• Tooth mobility
• Fremitus: Tooth vibration during chewing, detected by placing a finger on the tooth.
• Pain
• Tooth migration
• Attrition and abfraction (tooth wear)
• Muscle soreness, headache, neck and shoulder pain
• Widening of the periodontal ligament

Occlusal Therapy

• Selective grinding (Occlusal equilibration): Reshaping tooth surfaces to correct occlusal discrepancies.
• Control of habits (e.g., bruxism)
• Orthodontic tooth movement
• Splinting
• Restorative procedures
• Monitoring without treatment

Occlusal Trauma and Periodontal Disease

• Occlusal trauma does not cause gingivitis or periodontitis, but can accelerate periodontal destruction in the presence of inflammation.
• Secondary occlusal trauma can worsen bone loss.
• It's crucial to address both occlusal factors and inflammation for optimal periodontal health.

Checking for Occlusal Trauma

• Examine functional cusps on the mandible
• Check for fremitus
• Assess for recession, abfraction, muscle soreness, headache, neck pain, and shoulder pain.