how to evaluate TMJ function? what is the effect of the parafunction on TMD ,Periodontitis and orofacial pain?

1. TMD and Parafunction
by Reza Yarmohammadi
student at Shahid beheshti dental school

2. Differential diagnosis of
Temporomandibular Disorders
• Masticatory muscle
• temporomandibular joint
• associated structures such as
Ears, eyes, nose, paranasal sinuses, throat, lymph nodes, salivary
glands, neck

3. Clinical Examination
temporomandibular joint
Masticatory muscle

4. Anatomy of TMJ

5. Anatomy of TMJ

6. Anatomy of TMJ

7. • anterior disk displacement with reduction
• anterior disk displacement without reduction
(close lock)
• TMJ disc subluxation (open lock)

8. Position and movement of the disk during jaw opening

9. Temporomandibular joint
examination

10. Observation and measurement of full ROM of the mandible
≥40mm

12. light palpation of each TMJ in its full ROM (tissue
deflection and tenderness)

13. Auscultation of each TMJ in its full ROM
Click or crepitus

14. Masticatory muscle
examination

15. Palpation the temporalis muscle (tenderness)

16. Palpation the multiple areas of the masseter muscle
(tenderness)

17. Imaging
MRI
CT scan (CBCT)

18. MRI of normal TMJ

19. MRI of anterior disk displacement with reduction

20. MRI of disk displacement without reduction

21. CBCT imaging.The right condyle is hypoplastic and there is secondary remodeling. The
articular surfaces of the condyle and anterior aspect of the glenoid fossa are flattened and the
superior joint space is thinner compared with the left. Left side of same patient showing normal
condyle.

22. CT imaging. Chondrosarcoma

23. TMJ arthrography

24. Classification of pain originating in
masticatory system structure
• TMJ pain
 Stretching of the retrodiscal tissues and collateral ligaments
 Capsulitis
 Synovitis
• Muscular pain (amplified by both occlusal parafunction and stress)
 Myofacial pain (referral pain)
 Myositis (trauma or infection)
 Myospasm (change in occlusion)
 Local myalgia (occlusal parafunction,…)
 Myofibrotic contracture (painless condition)

25. Treatment
• Pain Medications
• Acupuncture
• Occlusal adjustment
• acrylic occlusal splint
• Injections
• Surgery
 Radical
 conservative
• TMJ Implants

26. Parafunction

27. Terminology
• Bruxism(grinding)
 Clenching (more relevant to masticatory system
disorders,most destructive parafunction)
Bracing
Gnashing
• Sleep bruxism (non-REM)
 Grinding
 Clenching

28. Causes
• psychological factors
Anxiety, stress or tension
Suppressed anger or frustration
Aggressive, competitive
or hyperactive personality type
• Malocclusion (no evidence)

29. Signs and symptoms
Teeth that are worn down, flattened or
chipped
Worn tooth enamel, exposing the inside of
your tooth
Increased tooth sensitivity
Jaw pain or tightness in your jaw muscles
 Teeth grinding or clenching, which may be
loud enough to wake your sleep partner

31. complication
• TMJ dysfunction
• Orofacial pain
• Tooth hypermobility
• Periodontal attachment loss (probably)

32. Treatment
• Stress management
• Behavior therapy
• Biofeedback

33. Treatment
• Medication
Consultation with doctor to change
medication (SSRI like Prozac)
Botulinum toxin (Botox) injections (severe
bruxism)

34. Treatment
• Dental aproaches
Maxillary stabilization appliance
Occlusal adjustment (not proved)

35. Refrences
Carranza's Clinical Periodontology
White and pharoah oral radiology 6th edition
Management of Temporomandibular
Disorders and Occlusion, 7e – June 4, 2012 by
Jeffrey P. Okeson DMD

36. Thank you