Temporomandibular Joint Pain dysfunction syndrome

Costen,syndrome TMJ syndrome TMJ pain dysfunction syndrome Myofacial pain dysfunction syndrome

Pathophysiology (aetiology) Psychogenic causes Parafunctional habits; Pipe smoking,teeth clenching,teeth grinding, lip licking, jaw thrusting, nail biting,constant chewing of tobacco and chewing gum

Occlusal Dishormony Inherent malocclusion---microtrauma Acquired malocclusion-fail to replace Iatrogenic; faulty restorations,

Internal derangements A. Disc displacement

a. With reduction b. Without reduction

B.

Structural incompatibility of the arti. surfaces

a. Adhesions b. Alterations in the form c. Rheumatoid arthritis

D.D.D.: The normal TMJ

D.D.D. with Reduction

D.D.D. without Reduction

Clinical features
Pain Clicking Limited mouth opening

HISTORY CLINICAL EXAMINATION

Extra oral Intra oral

RADIOGRAPHY
Panoramic radiography Tomograms Transcranial radiographs TMJ Arthrography Computed radiography CT SCAN Magnatic Resonance (MRI) Bone Scintigramnuclear imagingTechnicium-99 3hsSingle photon emission computerized tomography (SPECT)---Hot spots

TREATMENT
Counselling Medications
Aspirin ; 2 tabs 0.3 to 0.6 gm/6hourly Piroxicam; 10 to20mg/3-4 times a day Ibuprofen ; 200 to 600mg/3 times a day Valium ; 5 to 10mg/2-3 times a day Amitriptyline; 10 to 25mg/ 3 times a day or at bed time

Occlusal rehabilitation (7 rs)

Remove---Extract Reshape---- Grind Reposition Orthodontia/orthog.surgery Restore---Conservative dentistry Replace---prosthesis Reconstruct--- TMJ surgery Regulate Control habit and symptoms.

Physiotherapeutic modilities
Heat ;heating lamps, moist or dry heating pads,hot moist application of towels 15 to 20 minutes 4 times a day. Altrasound; Alters blood flow and metabolic activity.0.7 to 1.0 watts/cm2 10 minutes. Cryotherapy; Massage; inactivates trigger points. Active stretch exercises

Intra articular injection

Hydrocartisone mixed with 0.5 cc of 2 percent Lignocain.not as a routine, once in a month.

OCCLUSAL SPLINTS
1. To temporarily disengage the teeth 2. To create a balanced joint-tooth stabilization of the mandible. 3. To reduce spasm, contracture and hyperactivity of musculature. 4. To improve/restore vertical diamension. 5. To serve as safty or protective appliance.

TYPES OF SPLINTS Stabilization splint 12 to 18 hours for 4 to 6 months covers occlusal ant incisal surfaces Relaxation splints; short period(up to 4weeks), over max incisors.

TMJ Arthrocentesis (Lavage or irrigation of

the upper joint space) Indications; when conservative treatment fail to work. Objectives; To improve the disc mobility. To eliminate joint inflammation To remove the resistance to condyle translation. Early physiotherapy To eliminate pain

Advantages
Simple technique Minimum armamentarium Less invasive Inexpensive Highly effective Therapeutic benefit

TMJ Arthroscopy
Techniques
Diagnostic---single puncture Therapeutic as well as surgical--Double puncture technique

Indications
Disc dysfunction Osteoarthrosis Synovial disease Hypomobility due to disc problems Hypermobility associated with severe pain

Contraindications Regional infection Presence of tumour Usual medical contraindications t surgery

USES
lavage-arthrocentesis Lysis of adhesions Disc mobility improvement Disc suturing Retrodiscal cauterization Shaving of the articular surfaces Biopsy Photography-----record

COMPLICATIONS
Inadequate findings Costly equipment Complete or sensory loss hearing loss and severe vertigo Facial paralysis Instrument breakage Iatrogenic damage to the disc

Surgical Treatment Condylar shave Condylectomy Eminectomy Disc surgery