2. 1.Inflammation
• Inflammatory conditions of TMJ includes capsulitis and synovitis.
• Capsulitis involve inflammation of the joint capsule.
• Synovitis involve inflammation of the synovial membrane.
• Rheumatoid arthritis is the most common cause of synovial
membrane inflammation and others such as gout, psoriatic arthritis,
ankylosing spondylitis, systemic lupus erythematosus, juvenile
chronic arthritis and calcium phosphate dehydrate deposition.
• Symptoms-Pain,oedema,stiffness,warmth,joint instability and joint
deformity.
7. 2.Capsular fibrosis
• Chronic inflammation of TMJ capsule cause over production of fibrous
connective tissue , which create capsular fibrosis.
• It leads to progressive damage and loss of tissue functions ,reduced
range of motion.
• Causes/aetiology
• Prolonged period of immobilization
• Direct or indirect trauma
• arthritis
9. 3.OSSEOUS MOBILITY CONDITIONS
• It include joint hypermobility and joint dislocation.
• Hypermobility or excessive motion is the result of laxity of joint capsule
,tendons and ligaments.
• It is the connective tissue disorder that involve all joint of the body.
• In hypermobility cases report that jaw goes out of place produce noise or
catches when the mouth is in fully opened position.
• Joint noise occurs at the end of mandibular depression and at the
beginning of mandibular elevation
• The clinician can palpate the clicking sound .
• Hypermobility of TMJ result in the deflection of mandible towards the
contralateral side with mandibular depression.
10. • In addition mandibular depression will exceed more than 40mm.
• In dislocation both the mandibular condyle and disc beyond the
articular tubercle of the temporal bone, thus sticking in the extreme
end range of position produce noise and pain.
• Dislocation of the TMJ is usually temporary and resolve with joint
immobilization.
11.
12. 4.Articular disc displacement
• The articular disc displacement (ADD) results 2 conditions
1.ADD with reduction
2.ADD without reduction
Disc displacement identified by using MRI scan or by using physical
examination.
Individual exhibiting the disc displacement with reduction experience
joint noise at two intervals ie,during mandibular depression and
elevation.
The joint noise is referred to as a reciprocal click.
13. • The reciprocal click is the gold standard sign to diagnose articular disc
displacement with reduction
• At rest the articular disc is anterior to the mandibular condyle. There
for the mandibular condyle is in contact with the retrodiscal tissue
rather than the disc.
• During mandibular depression the condyle translate anteriorly and
capture the inferior surface of the disc to obtain a normal relationship
with the disc.
• When the condyle slips under the disc an audible click is present.
• As the mandible elevates to close the mouth the condyle translate
posteriorly and slips out from the disc producing second audible click.
14. • The second click signifies that the condyle and the disc have lost the
normal condyle disc relationships.
• At the early phases of mouth opening it is not severe and in late or
end phase of opening it become more severe.
• The hypertrophy,atrophy,contracture of inferior belly of lateral
pterygoid muscle leads to ADD with reduction.
• ADD with reduction-the disc does not relocate on to the mandibulae
condyle.
• The ADD without reduction limited mandibular motion as a result of
the disc creating a mechanical obstruction to condylar motion.
• It means inability to fully depress the mandible as well as difficulties
to performing functional movements such as chewing, speaking etc.
15. 5.Degenerative conditions
• It includes osteoarthritis and rheumatoid arthritis.
• Osteoarthritis of TMJ-80-90% of population experience osteoarthritis after
the age of 60.
• It occurs unilaterally
• Minor trauma to the joint cause osteoarthritis.
Signs
Joint space narrowing
Joint erosion(gradual obstruction)
Osteophyte formation
Sclerosis(abnormal thickening and hardening)
Remodelling(change in shape)
Degeneration of posterior teeth
