tmj pain dysfunction syndrome

1. Oral medicine
report
2020
SUPERVISOR : DR. RAWAA MAHMOUD

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Al-Rafidain University College
Dentistry Department
Oral medicine
TMJ pain dysfunction
syndrome
Ghadeer abdulbasit fat'hi
Grade:five
Group:A3

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ntroducionI
The temporomandibular joints are complex structures containing muscles,
tendons, and bones. Injury to or disorders of these structures can all result in
pain in the jaw area. Also depending upon the exact cause, the pain may
occur when chewing or may occur at rest. TMJ pain dysfunction
syndrome(its also called myofacial pain dysfunction syndrome) it’s a
muscular pain disorder its cause chronic pain and its least understood
.of movement ,painclicking ,limitationrefer to common triaddrome itsyn
It’s a pain disorder in which unilateral pain refer from the trigger
point(trigger point are localized tenders area within the bands of skeletal
muscles when simulated by micro-macro traumatic episodes )in myofacial
structures to the muscle of the head and neck pain is constant and dual and it
range from mild to exaggerated. It affected young adult 20-40 years about
20-50% of people has this syndrome .
syndrome :Etiology of TMJ pain dysfunction
There are several contributing factors include /1.muscular hyperfunction.
2.bruxism. 3.internal joint problems such as disk displacement disorder or
degenerative joint disease . 4.physical disorder . 5.injuries to the tissues.
6.para functional habits. 7.disuse (dereliction). 8.nutritional problems .
9.physiological stress. 10.sleep disturbances.
There are six distinct group of myofunctional pain disorder syndrome (TMJ
pain dysfunction syndrome) :
Trigger point
pain
Muscle
contracture
Muscle pain due to
connectivetissue
disorder
fibromyalgia
Myositis
Muscle spasm

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Clinical feature of TMD :
1.tenderness to palpation of the muscle of mastication.
2.limitation of mouth opening .
3.generally present at the end of tire some day.
4.trigger point are present .
5.presence of zone of reference.
6.chronic dual pain either mild or severe that lead to discomfort.
7.joint noises (grading ,clicking ….)
pear in in different systemsSymptom of TMD ap
including :
Neurologic{tingling ,numbness,blurred vision,trembling ,lacrimation].*
GIT {Nausea,vomiting ,diarrhea , indigestion ,dry mouth }.*
{fatigue ,tension ,tiredness ,weakness }Musculoskeletal*
Otologic {tinnitus,ear pain, vertigo,dizziness}.*
Pathophysiology of muscle pain :
Prolonged sustained and muscular contraction disruption of
delicate sarcoplasmic reticulum release of free calcium ion that
are stored within SR act on sarcomeres containing actin myosin
complex muscular shortening shorten muscle lead to
increase metabolic demand due to more actin and myosin depletion
of ATP actin and myosin binding intensified mechanical
interruption of blood flow throw this area in biomechanical derangement
vasoconstriction decrease of oxygen in affected muscular fibers
anaerobic metabolism lead to propagation of decreased PH and
accumulation of nocigenic and spasmogenic by product
activation of group III and group IV muscle nociceptive fibers PAIN
pain and further exaggerated central response create increase accumulation
of biogenic amines and intensified vasoconstriction local twich
response and jump signs of myofascial trigger point .

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Muscle involved :
1.masseter pre auricular , post auricular region and mandibular
body .
2.temporalis side of the head , masseter origin , orbit maxillary
teeth.
3.medial pterygoid retromandibular region .
4.lateral pterygoid ear and TMJ .
5.sternocliedomastoid muscles ear , mastoid and anterior cervical
region .
1.case history : mode of onset ,frequency ,duration ,site, reference point
,time of the day ,at which pain is most pronounced ,sleeping habits,
occupation ,previous trauma ,family history or emotional problem
,associated symptoms .
2.physical examination : include evaluation of the entire masticatory system
along with head and neck region .
3.amount of mouth opening (direction of opening ,pain associated with
opening ) .
4.palpation and tenderness :simultaneous palpation on both joint with index
finger laterally over the joint and through the external auditory meatus in
open and closed movement ,any area of tenderness on palpation should be
noted .
5.crepitation noise evaluation :early immediate or wide open zone of
condylar excrusion are noted ,it should be noted whether the sound is
opening ,closing or both.
6.auscultation if needed .
7.muscular examination :this include location of the muscle , evaluation of
muscle tone ,location of trigger point , evaluation of temperature changes
,location of swelling and identification of anatomical landmark .
Diagnosis

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8.dental /occlusal evaluation : gross occlual discrepancy ,prematurities or
any interference should be noted .if there is anterior openbite ,crossbite ,also
attrition ,abrasion mobility of teeth any missing teeth also typreof
malocclusion as skeletal ,dentofacial …etc.
9.in some cases x-ray ,CT scan and MRI may be needed for evaluation of
TMJ pathology .
Treatment of TMJ pain dysfunction syndrome include medication ,trigger
point injection or physical therapy :
A.MEDICATIONS : (aspirin ,piroxican ,ibuprofen ,pentazocine ,valium
,methocarbamol , amitriptyline )
B.PHYSICAL THERAPY :
1.heat application : hot packs paraffin and radiant hot moist application of
towels for 15-20 minutes for 4 times . or hydrocollator include pad filled
with clay and heated in water ,wrapped in a protected over the affected area
for 15-20 minutes.
2.diathermy either short wave diarthmy there will be increase in blood flow
increase in oxygenation for application for 10minutes or mega pulse rest
period between pulse raise allows dissipation of heat by blood flow the time
of application 10 minutes and the regime 3 times aweek for 4 week .
3.ultrasound :heat is placed on the skin which has to be coating with an
acoustic coupling gel and moved in parallel or circular overlapping sweeps
0.7-1 volt /cm2 for 10 minutes .its use for altered cell membrane
permeability , intracellular fluid absorption ,decreased collagen viscosity
,vasodilation , relax muscle and analgesia .
Treatment

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4.laser therapy :cold laser therapy has been investigated for wound healing
or pain relief .acold laser is thought to accelerate collagen synthesis ,
increase vascularity of of healing tissue , decrease the number of
microorganism and decrease pain and increase capillary permeability .
5. using of vasocoolent sprays :are use for relaxation of muscle and relief of
spasm ethyle chloride and fluromethan that’s applied to apainful area about
5 minutes .
6. electrogalvanic stimulations :delivered awide range of intensity to activate
the injured muscles . it stimulate local circulation and achieve excitability
and conductivity without painful heating .
7. manual therapy : *soft tissue mobilization *joint mobilization .* muscle
conditioning (passive muscle stretching , assisted muscle stretched ,
resistance exercise , postural training ) .
8.occlusal splint may use in some cases .
C.TRIGGER POINT INJECTION : use of botox : botulinum toxins
injections are currently the main stay of treatment for most focal dystonias .

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