Who Gets tmj?

TMJ disorders are more common in women than in men, and more common in white people than in African-Americans. Other disorders or conditions that have been associated with TMJ include:

• rheumatoid arthritis

• degenerative joint diseases

• anxiety or other psychiatric disorders that lead to chronic jaw clenching or teeth grinding

• dental malocclusion

• tongue tie (ankylosis)

• bruxism

• some birth defects.

How Is TMJ Diagnosed? TMJ disorder is usually diagnosed by a dentist or an otolaryngologist (ENT). Many individuals seek the help of an ENT because pain from the jaw leads them to believe they have an ear infection. The doctor will perform a physical exam, which could include looking inside your mouth for signs of wear on your teeth from grinding and clenching; assessing your neck muscles for spasms; and signs of joint tenderness. The physician may also measure how far you are able to open your mouth. Sometimes, your doctor will request a CT or MRI scan to get a better look at any damage to the joint.

How Can A TMJ Problem Cause Problems Elsewhere In The Body? The TMJ has been called the most important joint in the body because of its profound influence on other aspects of the body. Your lower jaw is attached to the head and neck by numerous muscles. Therefore, any disturbance of the bite or function of the TMJ will affect the balance of the head, neck, and shoulders. In turn the posture and function of the rest of your body will be affected.

TMJ disorders lead to stress in the skull, spine, and connective tissues which house, protect, and nourish the nervous system. Though your skull may seem as one bone, it is pliable and made of many bones that move in relation to one another. Problems with the TMJ and the bite may cause distortion in the shape and movement of these bones.

This affects what is known as the cranial -sacral system (this is an integrated system connecting movements of the skull with those within the tailbone and pelvis). These effects on the muscles and supporting structures of the body create physical stress.Though the body has the ability to compensate for stress, eventually this ability deteriorates and symptoms develop.

TRISMUS

Trismus is a functional inability to open the mouth, and is a symptom rather than a disorder in its own right. The most

frequent cause is temporomandibular joint dysfunction, and it may also follow an inferior dental nerve block from trauma or

haematoma in the medial pterygoid muscle. Direct invasion of muscles by a carcinoma is another unremitting cause of trismus.

Disorders of the central nervous system in which trismus is an incidental feature include tetanus, motor neurone disease,

dyskinesia produced by phenothiazine drugs, and hysteria. Symptoms regress with the treatment of the underlying condition.

ANKYLOSIS

Permanent limitation of movement of the jaw may be caused by fibrous, bony ankylosis or mechanical obstruction of mandibular

movement. There may be an associated deficiency in mandibular growth if it occurs in childhood. The majority of patients have

surprisingly little difficulty in taking an adequate diet. Ankylosis is an uncommon condition in developed countries.

The majority of cases follow injury or occasionally infection in children under 10 years of age. Unilateral ankylosis causes deviation of the mandible to the affected side. In children, bilateral ankylosis results in a ‘bird face’, with a tiny, retruded mandible and compensatory growth of

the alveolar bone around the teeth in an attempt to maintain dental occlusion.

Management. In children, it is important to re-establish mandibular mobility and function; facial aesthetics are of secondary concern as they

maintain a potential for growth. Reconstructive procedures are delayed until the teenage years. In adults, once the ankylosis

has been convincingly eradicated (recurrence is common), reconstruction of the mandible is undertaken. In long-standing

ankylosis, it is necessary to remove both the coronoid processes to release the vice-like grip of the fibrotic temporalis muscles. Once

the segment of ankylosed bone is removed from around the condyle, a strip of temporalis muscle is rotated inferiorly to line

the glenoid area, and an interpositional graft is used to replace the condylar segment to maintain the vertical height of the

ramus. Early mobilization of the joint is encouraged to avoid reankylosis.

Rheumatoid arthritis

The temporomandibular joint is never involved alone: patients usually seek treatment for other affected joints. Surgical

intervention is rarely required in adults, but in Still’s disease the childhood condyle may lose its growth potential, leading to a bird face.

Osteoarthritis

Although the mandibular joint is not weight-bearing, degenerative changes are occasionally seen.

Suppurative arthritis

Suppurative arthritis is rare, as most infections are now promptly treated with antibiotics. The joint is swollen and painful, with marked trismus. Destruction of bone may lead to ankylosis if left untreated. Treatment is by antibiotics combined with bone and joint debridement.

Exams and Tests: you may need to see more than one medical specialist for your TMJ pain and symptoms, such as your primary care provider, a dentist, or an ear, nose, and throat (ENT) doctor, depending on your symptoms. A thorough examination may involve:

• A dental examination to show if you have poor bite alignment

• Feeling the joint and connecting muscles for tenderness

• Pressing around the head for areas that are sensitive or painful

• Sliding the teeth from side to side

• Watching, feeling, and listening to the jaw open and shut

• X-rays to show abnormalities

Sometimes, the results of the physical exam may appear normal. You will also need to consider other conditions, such as infections, ear infections, neuralgias, or nerve-related problems and headaches, as the cause of your symptoms.

How Is TMJ Treated? Treatment is based on the severity of the disorder. For minor cases, ice and rest may be the best bet, along with over-the-counter pain relievers such as ibuprofen and acetaminophen. People with a TMJ disorder should avoid chewing gum and, if possible, grinding their teeth and clenching their jaw. Sometimes a bite guard can help with this. Relaxation techniques at least 30 minutes a day can help. Some people may benefit from physical therapy, muscle relaxants, steroids, friction massage and ultrasonic treatment. In severe cases surgery may be necessary.

Treatment- simple, gentle therapies are usually recommended first.

• Learn how to gently stretch, relax, or massage the muscles around your jaw. Your doctor, dentist, or physical therapist can help you with these.

• Avoid actions that cause your symptoms, such as yawning, singing, and chewing gum. Try moist heat or cold packs on your face.

• Learn stress-reducing techniques. Exercising several times each week may help you increase your ability to handle pain. Read as much as you can, as opinion varies widely on how to treat TMJ disorders. Get the opinions of several doctors. The good news is that most people eventually find something that helps.

Medications we can use: short-term use of acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), or other nonsteroidal anti-inflammatory drugs. Muscle relaxant medicines or antidepressants Rarely, corticosteroid shots in the TMJ to treat inflammation

Mouth or bite guards, also called splints or appliances, have been used since the 1930s to treat teeth grinding, clenching, and TMJ disorders. While many people have found them to be useful, the benefits vary widely. The guard may lose its effectiveness over time, or when you stop wearing it. Other people may feel worse pain when they wear one. There are different types of splints. Some fit over the top teeth, while others fit over the bottom teeth. Permanent use of these items is not recommended. You should also stop if they cause any changes in your bite. Failure of more conservative treatments doe not automatically mean you need more aggressive treatment. Be cautious about any nonreversible treatment method, such as orthodontics or surgery, that permanently changes your bite. Reconstructive surgery of the jaw, or joint replacement, is rarely required. In fact, studies have shown that the results are often worse than before surgery.

7. Materials activization of students during the teaching lectures. Tasks for self-control: 1. The structure of the temporomandibular joint.

2.Features of the structure of the TMJ.

3. The connection between diseases of the joints and TMJ in therapy, rheumatology and dentistry.

4. Therapeutic treatment of TMJ.

5. Features of the complex treatment of TMJ.

6. Surgical treatment of TMJ - indications.

7. Possible complications in treatment of TMJ and their prevention.

Educational objectives the 3rd level (nonstandard tasks) :

8. Materials for students ' preparation for lectures. The theme of which is set out in the lecture. 1. Sukachev V. A. Atlas of reconstructive operations on the jaws. /VA Sukachev// M, Medicine, 1984, 120 p. 2. Surgical dentistry and maxillofacial surgery: підручник; in 2 so - So-1 /V.O. Маланчук, O. S. Воловар, І.Ю.Гарляускайте and others - K.: LOGO, 2011. - 672с. + 16 ст.кольор.вкл. 3. Plastic and reconstructive surgery of the face / Ed. by A.D. Пейпла// M.: BINOM. 2007. - 951с. Question and assignment: 1. Historical aspects of examination of TMJ. 2. Goals and tasks at the modern classifications. 3. The basic principles of examination of TMJ. 4. Classification by cause and symptoms. 5. Indications and contraindications to surgical method of treatment. 6. Positive and negative sides of operations. 7. Concepts of multudicipline approach in TMJ surgery. 8. Conditions for successful execution of the treatment of TMJ. 9. Prevention of complications. 10. Prevention of late complications. Materials for test control: 1. TMJ disorder may have some of the following symptoms: A. facial pain, jaw pain or tenderness of the jaw, pain while chewing. B. popping or clicking of the jaw, grating sound when opening or closing the mouth, dull, aching pain in the face.

C. headaches, earaches, tinnitus, difficulty opening and closing the mouth. D. biting or chewing difficulty or discomfort, locked jaw, reduced ability to open or close the mouth, generalized pain and tenderness, around the joint, a history of poor sleep or a diagnosed sleep disorder.

E. All listed. 2. The structure of TMJ include:

A. Cartilage disk at the joint.

B. Muscles of the jaw, face, and neck.

C. Nearby ligaments, blood vessels, and nerves, teeth. D. All of the answers correct. E. Correct answer is no. 3. The advantages of flat (laminar) implants does not apply: A. Small depth of immersion of the implant into the bone. B. Possibility with great accuracy instrumental create bone bed. C. Possibility to install along with the natural teeth and include them as supports for orthopedic constructions. D. All of the answers correct. E. Correct answer is no. 4. Rasmus implant is: A. Implant, which is fixed underperiosteum. B.Inmucous implant. C. Bioactive implant. D. Design with cushion system. E. Flat design that is recorded in three places lower jaw. 5. What are dental implants are used most frequently? A. In osseus implants. B. Subperiosteal implants. C. Combined implants. D. Over osseous implants. E. All the answers to be correct. (Correct answers: 1 - A, 2 - C, 3 - B, 4 - E, 5 - A, 6 - D.) The topic of the next lecture. Standards answers: 1, 2. - D, 3 -, 4 -, 5 -, 6. 9. The used literature:

1. Barnes I E, Surgical Endodontics corrected reprint (MTP Press: Lancaster 1991).

2. Howe G L, Minor Oral Surgery, 3rd edn (Wright: Bristol 1985).

3. MacGregor A J, The Impacted Lower Wisdom Tooth (Oxford University Press: Oxford 1985).

4. McGowan D A, Baxter P W and James J, The Maxillary Sinus(Wright: Oxford 1993).

5. Seward GR, Harris M, McGowan D A, Killey H C and Kay L W, An Outline of Oral Surgery (Wright: Oxford 1998).