Temporomandibular Joint Disorders

1. TEMPOROMANDIBULAR
DISORDERS
Dr. Hadi Munib
Oral and Maxillofacial Surgery Resident

2. Outline
 Anatomy
 Etiology, Epidemiology and Classification
 Assessment
 Specific Disorders Management
 References

3. Anatomy

4. Etiology, Epidemiology and Classification
 The lack of a clear single cause of TMDs has resulted in the proposal of a multifactorial
etiology.
1. Parafunctional Habits
2. Emotional Distress
3. Acute trauma to the jaw
4. Trauma from hyperextension
5. Instability of maxilla-mandibular relationships
6. Laxity of the joint
7. Comorbidity of other rheumatic or musculoskeletal disorders
8. Poor general health and an unhealthy lifestyle

5. Epidemiology
 65 and 85% of people in the US experience symptoms of TMDs during their lives.
 Approximately 12% experience prolonged pain that results in chronic symptoms.
 5 to 7% have symptoms severe enough to require treatment.
 Significant proportion is self-limiting
 Most prevalent between the ages of 20 and 40 years and more frequently affect women.

6. Classification
 Based on signs and symptoms.

7. Assessment
 Thorough History taking
 Clinical Examination
 Radiographic Investigations
 Diagnosis
 Treatment Plan

8. Symptoms
 Pain.
 Temporomandibular dysfunction
 Dizziness
 Nausea
 Fullness or ringing in the ears
 Altered Occlusion

9. Diagnostic Imaging
 Plain-film radiography
 Tomography; Osteo-Degenerative Disease
 Arthrography
 CT; Osteo- Degenerative Disease, ankylosis, fractures, tumors of bone
 MRI; imaging method of choice to assess disc form and position
 Single-photon emission computed tomography
 Radioisotope Scanning

12. General Principles of Treatment
 Patient Education
 Jaw Exercises
 Intra-Oral Appliance Therapy
 Medications; NSAIDs, Muscle Relaxants, Antidepressants and Analgesics

13. Myofascial Pain
 Muscle pain produced on palpation, also radiates or is referred when the muscle is
stimulated.
 Controlling symptoms and restoring range of movement and jaw function.
 Symptoms are intermittent and usually do not progress to chronic pain and
disability.
 Occlusal therapy continues to be recommended by some clinicians as an initial
treatment or as a requirement to prevent recurrent symptoms.

15. Articular Disc Disorders
 Abnormal relationship between the Mandibular condyle, Glenoid fossa and the Disc
 MRI has shown that 25 – 35% of asymptomatic patients have ADD
(1) Anterior disc displacement with reduction (clicking joint)
(2) Anterior disc displacement with intermittent locking
(3) Anterior disc displacement without reduction (closed lock).

16. Anterior Disc Displacement with Reduction
 Palpation and auscultation of the TMJ will reveal a clicking or popping sound during both
opening and closing mandibular movements (reciprocal click).
 Deflection of the mandible early in the opening cycle prior to the click with correction to the
midline after the click.
 Tenderness of the joint is accompanied by capsulitis or synovitis.

17. Anterior Disc Displacement without Reduction
 Closed lock
 Trauma or severe long-term nocturnal bruxism.
 More frequently in patients with clicking joints that progress to intermittent brief
locking and then permanent locking.
 Other findings include pain directly over the joint during mandibular opening
 The mandible deviates toward the affected side upon maximum opening.

19. Degenerative Joint Disease
 Osteoarthrosis, Osteoarthritis, and Degenerative arthritis
 Disorder of articular cartilage and subchondral bone, with secondary inflammation
of the synovial membrane.
 Localized Joint Disease without systemic manifestations
 Loaded articular cartilage that clefts and then fragments which leads to sclerosis of
underlying bone, subchondral cysts, and osteophyte formation.
 Microtrauma or pressure
 Primary DJD is of unknown origin, often asymptomatic and is most commonly in
patients above the age of 50 years.
 Secondary DJD results from a known underlying cause.

20. Clinical Features
 Begins early and has been observed in over 20% of joints in individuals over the age
of 20 years.
 Degenerative changes are found in over 40% of patients over 40 years of age.
 Some Degenerative changes are seen incidentally on Radiographs and some
degenerative changes may be underdiagnosed by conventional radiography
 Symptomatic patients experience pain directly over the affected condyle, limitation
of mandibular opening, crepitus, and a feeling of stiffness after a period of
inactivity.

22. Rheumatoid Arthritis
 Inflammatory disease affecting periarticular tissue and secondarily bone.
 TMJ involvement ranges from 40 to 80%, depending on the group studied and the imaging
technique used.
 The disease process starts as a vasculitis of the synovial membrane. it progresses to chronic
inflammation marked by an intense round cell infiltrate and subsequent formation of
granulation tissue. the cellular infiltrate spreads from the articular surfaces eventually to
cause an erosion of the underlying bone.
 The most consistent clinical findings include pain on joint palpation, limited mouth opening,
and crepitus.
 Anti-Inflammatory drugs

23. Ankylosis
 True bony Ankylosis of the TMJ involves fusion of the head of the condyle to the temporal
bone.
 Trauma to the chin is the most common cause, although infections also may be involved.
 Children are more prone to Ankylosis because of greater osteogenic potential and an
incompletely formed disc.
 Limited mandibular movement, deviation of the mandible to the affected side on opening,
and facial asymmetry may be observed.
 Treated by several surgical procedures.
 Gap arthroplasty using Interpositional materials between the cut segments is the technique
most commonly performed.

24. References
 Chapter 9: Temporomandibular Disorders

25. THANK YOU