part 2 clined TMJ

Enumerate the main disorders of the TMJ

ARTHROGENIC TMDs

MYOGENIC TMDs

OTHER TMJ PROBLEMS

Enumerate the Arthrogenic TMDs

TMJ ARTHRALGIA

ARTHRITIS (SYNOVITIS, CAPSULITIS)

TMJ DISC DISPLACEMENT

DEGENERATIVE JOINT DISEASE

What condition is this?

● Pain of joint origin

● Pain & tenderness in the TMJ capsule and/or synovial lining

● Present in one or both joints

● (-)crepitus

● Capsulitis is commonly present

● SYMPTOMS:

○ Pain in the joint region

○ Pain during maximum unassisted opening, assisted opening lateral movements of the jaw

TMJ ARTHRALGIA

What condition is this?

● Pain of joint origin + inflammation or infection over the affected joint

● Pain on palpation over the superior pole and/or posterior part of the TMJ (acute or chronic stage)

● Pain on occlusion, yawning, or opening wide to bite

● Swelling within the joint/sense of fullness over the TMJ region (direct acute trauma)

● Ipsilateral spasm of masticatory muscles (esp masseter & M/L pterygoid)

ARTHRITIS (SYNOVITIS, CAPSULITIS)

What condition is this?

● Abnormal relationship between the mandibular condyle and the disc

TMJ DISC DISPLACEMENT

Enumerate the stages in Temporomandibular Disc Dysfunction

Stages 1-4

Temporomandibular Disc Dysfunction, what stage is this?

• Disc slightly anterior and medial on mandibular condyle

• Inconsistent click (may or may not be present)

• Mild or no pain

Stage 1

Temporomandibular Disc Dysfunction, what stage is this?

• Disc anterior and medial

• Reciprocal click present (early on opening, late on closing)

• Severe consistent pain

Stage 2

Temporomandibular Disc Dysfunction, what stage is this?

• Reciprocal consistent click present (later on opening, earlier on closing)

• Most painful stage

Stage 3

Temporomandibular Disc Dysfunction, what stage is this?

• Click rare (disc no longer relocates)

• No pain

Stage 4

What are the types of disc displacement?

A. DISC DISPLACEMENT WITH REDUCTION (DDwR)

B. DISC DISPLACEMENT WITHOUT REDUCTION (DDwoR)

C. DISC DISPLACEMENT WITHOUT REDUCTION WITHOUT LIMITED OPENING (DDwoRwoLO)

What type of disc displacement is this?

ETIOLOGY: direct/indirect trauma, microtrauma

SIGNS AND SYMPTOMS:

• clicking, popping, or snapping noise (opening & closing)

• Joint tenderness

• Joint pain increased with function

REDUCING DISK: a disc that is displaced and reduces back to its proper position on the condyle

RECIPROCAL CLICK: A click that is felt during both opening and closing phases, or either of the two

● A. DISC DISPLACEMENT WITH REDUCTION (DDwR)

What type of disc displacement is this?

• “CLINICAL CLOSED LOCK”

• UNILATERAL: mandible is deviated to affected side during mouth opening

• SIGNS AND SYMPTOMS:

  • Pain

  • Muscle spasm

  • Reduced function

• C/C: “My jaw clicked for 5 years, and then all of a sudden I woke up [or bit down on some popcorn or yawned], there was a big crack, and my jaw did not click any more, but I couldn’t open my mouth as far.”

● B. DISC DISPLACEMENT WITHOUT REDUCTION (DDwoR)

What type of disc displacement is this?

○ Same with DDWoR but without limited mouth opening

C. DISC DISPLACEMENT WITHOUT REDUCTION WITHOUT LIMITED OPENING (DDwoRwoLO)

What condition is this

• Deterioration of articular tissue of the joint with osseous changes in the condyle/articular eminence

• Osteoarthrosis or osteoarthritis?

• Hypomobility-> decreased synovial fluid in the articular cartilage-> induced degeneration

• MC AT AGE>40

• SIGNS AND SYMPTOMS:

  • Pain

  • Muscle spasm

  • Headaches

  • Change in function of the masticatory system

DEGENERATIVE JOINT DISEASE

Enumerate the Myogenic TMDs

MYALGIA

MYOSPASM

CONTRACTURE

What condition is this?

● Acute, local, noninflammatory pain in the masticatory muscles

● CAUSE: postexercise muscle soreness, muscle fatigue, trauma, and/or pain from ischemia

● LOM secondary to pain

MYALGIA

What are the 3 subclasses of Myalgia?

LOCAL MYALGIA

MYOFASCIAL PAIN

MYOFASCIAL PAIN WITH REFERRAL

This is a subclass of Myalgia

Localization of pain is only at the site of palpation

○ LOCAL MYALGIA:

This is a subclass of Myalgia

Pain of muscle origin with pain spreading beyond the site of palpation but within the boundary of the muscle

○ MYOFASCIAL PAIN:

This is a subclass of Myalgia

Referral of pain beyond the muscle being palpated

MYOFASCIAL PAIN WITH REFERRAL:

What condition is this?

● A sudden, involuntary, and reversible muscle contraction characterized by local pain and LOM of the jaw ● Usuallypresentfor short duration only

MYOSPASM

What condition is this?

● Painless shortening of a masticatory muscle d/t fibrosis in muscles and surrounding tissues (tendons, ligaments, etc) ● MCAFFECTED:masseterandmedialpterygoid

CONTRACTURE

Enumerate the Other TMJ Problems

Hypermobility

TMJ Ankylosis

Bruxism

What condition is this?

● Increased condylar translation at the beginning of mouth opening and reduced condylar rotation

HYPERMOBILITY

What condition is this?

● Complete fusion of the condyle to the temporal fossa (TRUE ANKYLOSIS) ● Causes restriction of opening and stress on the opposite joint; patient often presents symptoms from the opposite joint

TMJANKYLOSIS

What condition is this?

● Bruxism, teeth clenching, and jaw thrusting can add repetitive strain to the masticatory muscle and cause tenderness and pain ● Causeshyperactivity of masticatory muscles ● Can be done unconsciously or d/t body’s response to aggravating stimulus ● ETIOLOGY ○ Sleepdisturbances ○ Chemicalalterations in the brain ○ Useofmedication,cigarettes, or alcohol

BRUXISM