TMJ Disorders

 TMJ Disorders

According to the American Academy Of Orofacial Pain, TMJ Disorder is defined as a collective term that encompasses a number of clinical problems that involves the masticatory muscles, or the joint itself or both.

CLASSIFICATION

Articular disorders (intra-articular)

Congenital or developmental disorders

·            Condylar hyperplasia

·            First and second brachial arch disorders

·            Idiopathic condylar resorption

Degenerative joint disorders

·          Inflammatory: capsulitis, synovitis, polyarthritides (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Reiter syndrome, gout)

·          Non-inflammatory: osteoarthritis

Disk derangement disorders

·         Displacement with reduction

·         Displacement without reduction (closed lock)

·          Perforation

Infection

Neoplasia

Temporomandibular hypermobility

·         Dislocation

·         Joint laxity

·         Subluxation

Temporomandibular hypomobility

·         Ankylosis: true ankylosis (bony or fibrous) or pseudoankylosis

·         Postradiation fibrosis

·         Trismus

Trauma

·         Contusion

·         Fracture

·         Intracapsular hemorrhage

Masticatory muscle disorders (extra-articular)

·         Local myalgia

·         Myofascial pain disorder

·         Myofibrotic contracture

·         Myositis

·         Myospasm

·         Neoplasia

DIAGNOSIS

·         Always take a good history from the patient

·         location

·         onset

·         frequency and duration

·         intensity ( 0-10)

·         quality

·         modifying factors

·         other associated symptoms

Criteria for Intracapsular Disorders

Disc displacement with reduction

·         patient reports clicking/popping/snapping while opening or closing /excursions

·         - verify in physical examination

·         may or may not be painful.

·         pain if present occurs with jaw function-verify in physical examination

Disc displacement without reduction with limited mouth opening

·         No current report of joint sounds

·         mouth opening <= 40mm

·         typically painful

·         pain occurs with jaw function -verify in physical examination

Criteria for Extra Capsular Disorders

·         Pain from muscle origin-complains of pain in front of the ear, jaw , temple

·         Pain changes during jaw function.

·         examination shows

·         verification of pain site in palpation

·         radiating pain

CENTRAL MEDIATED MYALGIA

·         REPORTS widespread pain

·         Examination will shows

·         verification of familiar pain sites

·         involves most of the masticatory and cervical muscles

·         patient may or may not withdraw from your hands

·         when you palpate pain may not come

Treatment

·         Education

·         conservative treatment

·         sleep hygiene instruction

·         appliances

·         trigger point injections

·         medicines

·         INTERDISCIPLINARY CARE 

                                       WITH BEHAVIOURAL THERAPY, 

PHYSICAL THERAPY, SURGERY.

by,

Dr.Renju T George,

India.