Temporomandibular Joint Disorder

Temporomandibular joint disorder, or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the lower jaw to the skull. The disorder and resultant dysfunction can result in significant pain and impairment. Because the disorder transcends the boundaries between several health-care disciplines—in particular, dentistry, neurology, physical therapy and psychology—there is a variety of quite different treatment approaches.

The temporomandibular joint is susceptible to all the conditions that affect other joints in the body, including ankylosis, arthritis, trauma, dislocations, developmental anomalies and neoplasia. Although treatment is often similar to other joints in the body, some variations exist. It is suggested that before the attending doctor commences any plan or approach utilizing medications or surgery a thorough search for inciting para-functional jaw habits must be performed. Correction of any discrepancies from normal can then be the primary goal.

An approach to eliminating para-functional habits involves the taking of a detailed history and careful physical examination. The medical history should be designed to reveal duration of illness and symptoms, previous treatment and effects, contributing medical findings, history of facial trauma and a search for habits that may have produced or enhanced symptoms. Particular attention should be directed in identifying perverse jaw habits such as clenching or teeth grinding, lip or cheek biting, or positioning of the lower jaw in an edge to edge bite. All of the above puts strain of the muscles of mastication and resultant jaw pain. Palpation of these muscles will cause a painful response.

Treatment is oriented to eliminating oral habits, physical therapy to the masticatory muscles and alleviating bad posture of the head and neck. A flat plane full coverage oral appliance, e.g. a non-repositioning stabilisation splint, often is helpful to control bruxism and take stress off the temporomandibular joint, albeit the fact that some individuals may bite harder on it resulting in a worsening of their conditions. The anterior splint with contact at the front teeth only may then prove helpful.

Mandibular Repositioning Devices can be worn for a short term to help alleviate symptoms related to painful clicking when opening the mouth wide but 24 hour wear for long term may lead to changes in the position of the teeth which can complicate treatment. A typical long term permanent treatment would be to convert the device to a flat plane bite plate fully covering either the upper or lower teeth and to be used only at night. Full mouth reconstruction, or building up of teeth to achieve the proper bite relation is not supported by strong evidence based studies.

...More at Wikipedia

Related Links:

• American Association of Oral and Maxillofacial Surgeons

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