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Temporomandibular Dysfunction (TMD) PDF Print E-mail
Temporomandibular Joint

The TM joints connect the lower jaw to the base of the skull just in front of the ears. These joints are unique because no other joints in the body function as they do. In normal function, they move out of their confining "sockets". Each joint has a disc that acts as a cushion to protect the lower jaw from rubbing on the base of the skull. Therefore, the joints have tremendous flexibility which allow us to speak, swallow, bite and chew normally with no difficulty. However, injury to these joints can result in severe discomfort within the joint. Breakdown and loss of function occurs if treatment is not undertaken. Early warning signs of TMD problems include:
  • Headaches
  • Joint Tenderness
  • Can’t Open Wide
  • Jaw Popping/Grinding
Causes of TMD:

Direct or indirect trauma to the jaw joint, prolonged muscular tension (MPD) due to an underlying bite problem or stress-induced problem (clenching, bruxism or jaw posturing habits); can lead to TMD. Posterior ligaments within the TM Joint act like a "rubber band" that pulls the disc back into the socket upon closing. If this rubber band is stretched too far, too often, it loses elasticity and the cushion (or disc) ends up being pulled by the muscles into a position in front of the jaw joint itself. This is called an anterior (forward) displacement of the disc.

The stretched posterior attachment (rubber band) will cause the jaw to pop or click onto the disc when opening. Maybe you have heard people who pop so loud you can hear them from across the table! Many times, in order to open the mouth, the patient will need to move their jaw toward the side of the joint displacement to be able to open the jaw completely. Upon closure they will hear another soft click as the disc again slides back into a forward displaced position. This cycle continues upon opening and closing. Imagine a car bouncing up onto a curb and then sliding back off. The loud opening pop or movement of the jaw onto the disc is the car hitting and moving up onto the curb. Obviously, one wouldn’t walk around on a dislocated ankle because of the damage it would cause to the ankle joint. However, many patients continue to function or try to function with a dislocated disc within the jaw joint for years. By the time treatment is sought, arthritis has set in which results in bone resorption and disc destruction. In a small number of advanced cases, surgery may be the only hope to stabilize the joint from further breakdown. Luckily, the body is a remarkable healer and most internal derangements can be taken care of with conservative treatment methods.

Treatment

Treatment for internal derangements include:
  • A recent medical exam by a physician to rule out underlying medical problems that have a direct effect on treatment.
  • Supporting medical records including x-rays of the TMJ’s (usually tomographic), plus head plates of the skull for upper and lower jaw positioning, study models of the teeth and jaw, photos of teeth, jaws and head/neck structure.
  • Should the x-rays indicate severe problems are present, then a magnetic resonance imaging (MRI) of the TMJ will be ordered.
  • Construction and placement of the jaw splint in order to change jaw/bite position so the displaced disc can move back to a correct position.
  • Physical therapy to help healing using ultrasound, trigger point injections, electrical muscle stimulation, muscle relaxation exercises and overall postural evaluation and treatment. Exercises to strengthen the surrounding jaw joint.
  • Diet/nutrition/exercise analysis to enable proper nutritional support for overall health and specifically to allow healing.
  • Biofeedback or stress management evaluation and treatment to train chronically contracted muscles to relax.
  • Supporting medications to relieve pain, relax muscles and reduce inflammation.
All of these supporting treatment modalities go hand in hand to achieve the desired results.

We are here to help MPD and TMD sufferers and are specially trained and experienced in diagnosing and treating these disorders. With the patient’s cooperation and commitment to get well, the success rate has been very high. Our office welcomes patients, and together we will strive to help correct specific problems as efficiently and economically as possible.

Source: TMData Resources
 


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