TMJ disorders management

1. TEMPOROMANDIBULAR
JOINT (TMJ) DISORDERS
Fadi Al-Zaitoun
Rana Al-Dous
Mohammad Al-Tari
Elias Azar

2. TMJ Disorders
 Patients frequently consult a dentist
because of pain or dysfunction in the
temporomandibular region.

3. Etiology
The most common causes of
temporomandibular disorders (TMDs) are :
 muscular disorders, which are commonly
referred to as myofascial pain and dysfunction:
These muscular disorders are generally
managed well with a variety of nonsurgical
treatment methods.
 Could involve one or more of the TMJ elements.

4. Anatomy of TMJ.
TMJ as a functional joint consists of the
following elements :
1) Glenoid fossa of temporal bone.
2) Condyles of the mandible.
3) Joint capsule.
4) Disk of the joint.
5) Ligaments associated with the joint.

5. 1-Glenoid fossa
 It is a depression on
the temporal bone
posterior to the
auricular eminence.
 Its depth differ from
person to person.
 Covered with hard
layer of bone.

6.  This depression is
located 1 cm anterior
to the external
acoustic meatus.
 It is about very few
mm below the cranial
cavity.
 The bone in this area
maybe a 1mm in
thickness .
 It is posterior to the
articulating eminence.

7. 2- The disk
 The disk is consisted
of special stroma
tissue.
 Has a good blood
supply in children, to
reseed out in adults.
 This reduce its ability
to react to irritation
and trauma

8.  Its upper surface is
convex specially at
its crest.
 To concave at the
articulating
eminence.

9.  Its inferior surface
is adapted to the
bony surface of the
condyle.
 It is less concave in
the posterior part
comparing with its
superior part to
convex at its
anterior part.

10.  Interiorly it is connected
to a superior fibers of
the lateral pterygoid
muscle
 Posteriorly it is
connected to fibers that
is stretch during the
advancement of the
condyle with the disk
 Its outside surrounding
is attached to the
capsule of the joint

11. 3- The condyle
 The condylar process
consists of two parts Head
& neck.
 It is oval in shape, the long
excess is the transverse
one.
 Its posterior articulating
surface is broad comparing
with the anterior one.
 At its lateral end a small
process where the external
pterygoid ligament is
attached

12.  The neck
 It is narrow at the
anterior posterior
part.
 Supported with a
strong bony line at
its lateral side.

13.  This neck is convex
at its posterior part
to concave at its
anterior part to give
an attachment to
the external
pterygoid muscle.
 Few books name it
the pterygoid fossa

14. 4- The Ligaments
 TMJ is the most
flexible movable joint
in the human body
 For this it is
supported by
ligament to
coordinate this
movements
 Any distortion in
these ligaments will
end with a TMJ
dysfunctions

15. The Ligaments
There are three groups of them
1) Capsule
2) Intracapsular
3) Extra capsule
 The superior fibers of the pterygoid muscle as it
is attached to the disk plays an important part
coordinating these elements during the joint
movement.
 Dysfunction of this muscle has its effects on the
function of the joint.

16.  The posterior ones will stretch under the
effect of PT.M. during the advancement of
the condyle keeping the disk covering the
articulating surfaces.

17. Anterior disk displacement
 In this case the disk could not
return to its starting position
under the influence of the
intracapsular posterior
ligaments, It will stay anterior
to the condyle or return in a
delayed time.
 Anterior disk displacement
with reduction or without .if
become chronic will end with
distraction of the articulating
bony surfaces.

18.  This means ; the intra
capsular ligaments function
is to keep the disk with a
good relation with the
articulating surfaces during
the joint movement
 These ligaments are
attached to the border of the
joint fossa from one side
and to the disk from its
other side
 The anterior and posterior
ones are more active than
the others

19. Diagnostic Radiography
 The joint is situated
between many of the
cranio facial bones
 This make it difficult
to get a diagnostic
radiographs.
 This make us
depend upon more
than one view to
build our diagnosis

20. Lateral jaw view
 Will show the relation
between the bony parts
of the joint,
 Position of the condyle
to the articulating
surface
 It shows some time the
compression of the disk
 It shows also the
anterior posterior
displacement of
fractured condyle
 The severe distraction of
the condyle

21. The skull basal view
 Is used to view high
condylar fractures
 The medial or lateral
fracture displacements
 To compare the states of
both condyles

22. PA view
It is not a diagnostic
view because of the
overlapping specially
when it is taken and
the mouth is closed

23. CT scan view
Shows The Joint in
deferent sides and
levels

24. MRI views
It shows the state
and the relation of
soft and hard
tissues.

25. Management of TMJ disorders
Most cases of TMJ syndrome are
temporary; thus, treatment is usually
conservative.
Early therapy starts simply with resting the
jaw, using warm compresses (ice packs at
first if an injury is present), and pain
medication.

26. Management of TMJ disorders
Jaw rest can help heal temporomandibular
joints. Eat soft foods. Avoid chewing gum
and eating hard candy or chewy foods. Do
not open the mouth wide. Perform gentle
muscle stretching and relaxation
exercises. Stress-reduction techniques
may help manage stress and relax the jaw
along with the rest of the body.

27. Management of TMJ disorders
We may prescribe a splint or bite plate.
This is a plastic guard that fits over upper
and lower teeth, much like a mouth guard
in sports. The splint can help reduce
clenching and teeth grinding, especially if
worn at night. This will ease muscle
tension. The splint should not cause or
increase the pain. If it does, tell the patient
to stop using it.

28. Management of TMJ disorders
A more invasive procedure can be
performed in the doctor's office or clinic
under local anesthesia. This is carried out
by inserting two needles in the
temporomandibular joint to wash it out.
One needle is connected to a syringe filled
with a cleansing solution, and the fluid
exits via the other syringe.

29. Management of TMJ disorders
This procedure can be done in the office.
Most people find relief from the pain and
return to almost normal. Sometimes, pain
medication can be injected into the joint in
a similar procedure.

30. Management of TMJ disorders
Alternatively, a simple injection of
cortisone medication can be very helpful
in relieving inflammation and pain.

31. Management of TMJ disorders
A last option, surgery, is often irreversible
and should be avoided when possible. If
necessary, surgery can be used to replace
the jaw joints with artificial implants.