This document discusses various disorders of the temporomandibular joint (TMJ), including myofascial pain/TMPDS, disc displacement disorders, degenerative joint diseases, dislocation, ankylosis, and fracture. It describes the causes, symptoms, diagnostic findings and treatment options for several common TMJ disorders such as TMPDS, anterior disc displacement with and without reduction, and ankylosis. Treatment may involve counselling, medications, physical therapy, splint therapy, injections, arthrocentesis and lavage, arthroscopy, and disc surgery depending on the specific disorder.

1. TMJ DISORDERS
Dr. Junaid Shakeel
REGISTRAR (SIR SYED DENTAL COLLEGE)
FCPS-II (THEORY)
B.D.S (DOW)

2. CLASSIFICATION
• MYOFACIAL PAIN / TMPDS
• DISC DISPLACEMENT DISORDERS
• DEGENERATIVE JOINT DISEASES
• TMJ DISLOCATION
• ANKYLOSIS
• FRACTURE

3. TMPDS
• MOST COMMON CAUSE OF MYOFACIAL PAIN
AND LIMITED FUNCTION.
• SOURCE OF PAIN IS MUSCULAR, WHICH
ALMOST ALWAYS CAUSES MUSCLE
TENDERNESS & HYPERACTIVITY.
• FREQUENTLY ASSOCIATED WITH CLENCHING &
BRUXISM, RESULTING FROM STRESS.

4. • SOMETIMES MAY BE ASSOCIATED WITH DISC
DISORDERS OR DEGENRATIVE JOINT DISEASES.

5. SYMPTOMS OF TMPDS
• MUSCLE TENDERNESS.
• USUALLY NO TMJ PAIN OR JOINT CLICK.
• RANGE OF MOTION MAY BE DECREASED & MAY
BE ASSOCIATED WITH DEVIATION TOWARDS THE
AFFECTED SIDE.
• WEAR FACETS ON TEETH.

6. RADIOGRAPHIC FINDINGS IN TMPDS
• USUALLY ABSENT.

7. TREATMENT
• COUNSELLING.
• MUSCLE RELAXANTS.
• ANTI DEPRESSANTS.

8. DISC DISPLACEMENT DISORDERS
• ANTERIOR DISC DISPLACEMENT WITH
REDUCTION .
• ANTERIOR DISC DISPLACEMENT WITHOUT
REDUCTION.

9. NORMAL JOINT

10. ANTERIOR DISC DISPLACEMENT
(WITH REDUCTION)

11. ANTERIOR DISC DISPLACEMENT
(WITH REDUCTION)

12. ANTERIOR DISC DISPLACEMENT
(WITH REDUCTION)
• DISC HAS MOVED ANTERIOR AND MEDIAL TO
CONDYLE IN CLOSED POSITION.
• DURING OPENING , CONDYLE MOVES OVER THE
POSTERIOR BAND OF DISC AND REST ON
RETRODISCAL TISSUE. THIS PRODUCES THE CLICK
SOUND.
• A RECIPROCAL CLICK MAY BE PRODUCED WHILE
CLOSING THE MOUTH.

13. EXAMINATION FINDINGS
• JOINT TENDERNESS, MUSCLE TENDERNESS
MAY ALSO EXIST.
• OPENING CLICK IS COMMON.
• IN SOME CASES, RECIPROCAL CLICK MAY BE
PRESENT.
• MAXIMAL OPENING MAY BE SLIGHTLY
REDUCED.

14. DIAGNOSIS
• HISTORY
• CLINICAL
• MRI
• ARTHROSCOPY
• ARTHROGRAPHY

15. TREATMENT
• PATIENT COUNSELLING.
• MEDICATION.
• PHYSICAL THERAPY.
• SPLINT THERAPY.
• IMF OR INTRA-ARTICULAR INJECTIONS
• ARTHROCENTESIS AND LAVAGE.
• ARTHROSCOPY.
• DISKECTOMY OR DISKOPLASTY.

16. PATIENT COUNSELLING
• TREATABLE.
• MEDICAL OPTIONS ARE PREFERRABLE.
• BEHAVIOUR MODIFICATION.
• COMPLIANCE OF PATIENT IS MANDATORY.
• LONG SPAN OF TREATMENT.

17. MEDICATIONS
• NSAIDS
• MUSCLE RELAXANTS.
• ANTI DEPRESSANTS.
• ANXIOLYTICS.

18. PHYSICAL THERAPY
• TO RELAX THE MUSCLES OF MASTICATION.

19. SPLINT THERAPY
• ANTERIOR REPOSITIONING SPLINT
• AUTO REPOSITIONING SPLINT

20. IMF

21. Intra lesional injections
• Steroids.
• Local anesthesia.

22. Arthrocentesis & lavage
• Minimally invasive technique that involves lavage
of joint space and release adhesions.
• 2 entry points or ports are created in upper joint
space, for injecting ringers lactate in joint.
• At the conclusion of procedure, a mixture of local
anesthesia and steroid, to reduce post operative
discomfort.

23. Arthrocentesis & lavage

24. arthroscopy
• Allow direct visualization of joint space .
• Endoscopic intervention.
• Bands can be released and biopsy samples can
be attained.

25. arthroscopy

26. Diskotomy / diskoplasty
• Removal of a wedge shape part of
interarticular disk and then repositioning it
over the condyle, laterally and posteriorly.

27. diskectomy
• Removal of interarticular disc.

28. Anterior disk displacement
(without reduction)
• Patient is unable to open the mouth
completely
• The disk is unable to slide over the condylar
surface and buckles up, preventing opening of
the mouth.

29. Anterior disk displacement
(without reduction)

30. Ankylosis

31. Ankylosis

32. Ankylosis
• Classicfication of tmj ankylosis
1. bony
2. fibrous
1. true ankylosis
2. false ankylosis
1. unilateral
2. bilateral

33. Ankylosis
• History of trauma or fall in childhood.
• Gradual reduction in mouth opening.
• Symptoms :
unilateral – asymmetry and deviation of jaw.
Shortening of jaw on affected side.
Bilateral – bird face appearance.
Limited mouth opening in both cases.

34. Diagnosis of ankylosis

35. Treatment of ankylosis
• Growth centre transplantation.

36. Treatment of ankylosis

37. Treatment of ankylosis