TMJ and
Temporomandibula
r
Joint Disorder
Dr. Soukaina Ryalat
Basic Anatomy
Basic Structure
Mandibular
condyle
Temporal bone
Meniscus
Coronoid proces
TMJ Anatomy continued
Primary articulation is formed by the
mandibular condyle and the
mandibular fossa
It is considered a “sliding” hinge
joint and allows movement in only
one plane, forward and backward
movement
TMJ Articular Disc
Function
Transmits forces,
protects, lubricates the
articulating surfaces
Divided into 3 portions,
anterior, intermediate
and posterior
Movement is mediated
by lateral pterygoid
attachment on the
anterior disc,
retrodiscal tissue on
the posterior disc and Anterior
the amount of synovial
fluid in the joint capsule
TMJ Disc Facts
The intermediate portion is the thinnest and
has very little or no innervation or
vascularity. Its nutrition comes from the
synovial fluid pressed into it by the properly
aligned condyle and fossa during closure
The anterior and posterior portion is highly
vascularized and innervated and also
receives some nutrition from synovial fluid
Facts on TMJ
Most soft clicking noise are not an
indicator of joint dysfunction and are of
no clinical significance
Loud clicking while opening, with
deviation present on opposite side,
clinically significant of possible anterior
condyle displacement.
Loud clicking while closing, with deviation
present on opposite side, clinically
significant of possible posterior condyle
displacement. Signs/Symptoms of TMD
More TMJ Facts
40% of population have some type of
joint noise, indicating the existence
of possible disc problems
24% have some head, neck and/or
face pain
12% report pain when opening
TMJ Disorders
Temporomandibular joint and muscle
disorders, commonly called “TMJ” or
TMD are a group of conditions that
cause pain and dysfunction in the
jaw joint and the muscles that
control jaw movement.
TMJ Disorder
dysfunctional conditions involving
the masticatory system
“TMJ syndrome” previous
teminology
TMJ Disorders
For most people, pain in the area of the
jaw joint or muscles does not signal a
serious problem. Generally, discomfort
from these conditions is occasional and
temporary, often occurring in cycles.
The pain eventually goes away with
little or no treatment. Some people,
however, develop significant, longterm
symptoms.
TMJ Muscles
Temporalis - closes jaw and retracts
mandible
Masseter – closes jaw
Internal or medial Pterygoid – closes
jaw
External or lateral Pterygoid – opens
jaw, moves jaw side to side and
protrudes mandible
TMJ Disorder
• dysfunctional conditions involving
the masticatory system
• “TMJ syndrome” previous
teminology
TMD reflects possibilities of
involvement of other factors, not just
the joint capsule
Occlusal factors
Intrajoint dysfunction
Psychological factors
Biochemical factors
Skeletal misalignments
What are TMJ
Disorders?
TMJ disorders fall into three main categories:
Myofascial pain, the most common temporo-
mandibular disorder, involves discomfort or
pain in the muscles that control jaw function.
Internal derangement of the joint involves a
displaced disc, dislocated jaw, or injury to the
condyle.
Arthritis refers to a group of degenerative or
inflammatory joint disorders that can affect the
temporomandibular joint
The most common type of TMJ
disorder is myofascial pain and
dysfunction, usually as a result of
bruxism and jaw clenching
Related to stress, anxiety,
depression or chronic pain
3 cardinal features of TMJ are
orofacial pain, restricted jaw
function and noise in the jaw
TMD is characterized by many symptoms
Headache
Burning or tingling sensation
Tenderness and swelling
Clicking or popping
Reduced ROM
Ear pain w/o infections
Neck and or facial pain
Grinding teeth at night
Pain that worsens with stress
Pain with opening of your mouth
Teeth that meet differently from
time to time
Pain while chewing
Summary of Symptoms:
• History of trauma, blow to jaw, MVA ( motor vehicle
accident), dental malocclusions
• Pain and tenderness of the TMJ
• Head and/or ear pain
• Sore and stiff jaw muscles
• Locking of the jaw in a shut or open position
• Frequent headaches and/or neck aches
• Pain that worsens when teeth are clenched
•
Assessment of TMJ
Intercuspid alignment
Mandibular gait pattern
Screening (3 finger test)
Palpate joint and soft tissues
Adjustive procedure
Distraction technique
Translation technique
TMJ Examination:
History:
Bare the area
Bilateral observation
Bilateral palpation
Active ROM
Passive ROM
Ortho/neuro
X-ray ?
Normal opening should be enough to fit 3 fingers into
mouth. Have the patient use their own fingers.
C and S Curve Examination
Normal
Watch for deviation from center when patient
slowly opens and closes mouth
While having
the patient
slowly open
the mouth
feel for the
movement
of the
condyles
Alternate Procedure:
Inferior Misalignment
How are TMJ Disorders
Treated?
Because more studies are needed on the
safety and effectiveness of most treatments
for jaw joint and muscle disorders, experts
recommend using the most conservative and
reversible treatments when possible.
Reversible treatments do not cause
permanent changes in the structure or posi
tion of the jaw or teeth. Even when TMJ dis
orders have become persistent, most
patients still do not need aggressive types of
treatment.
How are TMJ Disorders
Treated?
Treatment by a Prosthodontist may be
needed for other reasons such as to
restore severely worn, damaged, or
diseased teeth or to replace teeth for the
purpose of improving chewing, providing
enhanced support for your lips or cheeks,
or improving the appearance of your smile.
Extensive prosthodontic treatment should
only be provided after the TMJ disorder
has been adequately diagnosed and its
pain successfully managed.
Conservative Treatments
Most jaw joint and muscle problems
are temporary and do not get worse.
Treatment is based on a proper
diagnosis which should be
conservative and reversible.
Self-Care Practices
Pain Medications
Stabilization Splints
Prosthodontic Treatment
Self-Care Practices
Your Prosthodontist may
recommend steps that you can
take that may be helpful in easing
symptoms, such as:
• eating soft foods,
• applying ice packs to recommended
areas,
• avoiding extreme jaw movements (such as
wide yawning, loud singing, and gum
chewing),
• learning techniques for reducing stress,
Pain Medications
For many people with TMJ
disorders, short-term use of
over-the-counter pain medicines
or nonsteroidal anti-
inflammatory drugs (NSAIDS),
such as ibuprofen, may provide
temporary relief from jaw
discomfort.
When necessary, your dentist or
doctor can prescribe stronger
pain or antiinflammatory
medications, muscle relaxants,
or antidepressants to help ease
symptoms.
Stabilization Splints
Your Prosthodontist may
recommend an oral appliance,
also called a stabilization splint
or bite guard, which is a plastic
guard that fits over the upper
or lower teeth. Stabilization
splints are the most widely used
treatments for TMJ disorders.
If a stabilization splint is
recommended, it should be
used only for a short time and
should not cause permanent
changes in the way your teeth
bite together when the splint is
removed from your mouth.
Prosthodontic Treatment
Occlusal splints may
also be used to
reestablish the bite
prior to
prosthodontic
treatment.
It is used when the
bite is not contacting
evenly due to missing
or worn teeth and
may relax the
muscles.
