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Temporomandibular joint dysfunction(TMD)

Recently, more and more adults have been seeking orthodontic care. However, apart from the anomalies of the teeth and jaws position the adults may have other problems, to a great extent complicating the orthodontic treatment, for example, dysfunction of the temporomandibular joint (TMJ).

Typically, patients complain of headache in the temple, ear pain, aching pain when eating. In this case, there is a need for accurate, specialized diagnosis of the disease. For the treatment of an adult’s bite compromise abnormalities the joint work of a whole team of doctors is required. Together they devise an elaborate plan of the patient’s treatment.

The most common symptoms of TMJ include:

  • Headache (often resembling a migraine), pain in the ears, pain and pressing sensation behind the eyes.
  • Snapping or clicking sound when you open or close the mouth.
  • Pain when you yawn, open your mouth wide or chew.
  • If the jaws "stick", they can not open, or "jump out".
  • Weakness of the jaw muscles.
  • Suddenly, the upper and lower jaws begin to close differently.
  • A limited mouth opening or disabled lower jaw when opening mouth.
  • The asymmetry of the face.

All of the above are the signs of myofascial pain syndrome (MPS), which is the result of:

  • disruption to the muscles in the vicinity of the TMJ;
  • the psycho-physiological state of the person;
  • a violation of the movement of the mandible.

The cause of the syndrome is muscle fatigue caused by habitual clenching or gnashing the teeth, that is by forms of behavior aimed at the relieving of strain under stress. During stressful situations, people’s activity of masticatory muscles significantly increases during sleep. This eventually leads to abrasion of hard tooth tissue, muscle dysfunction, changes in the TMJ.

One of the main causes of MPS is trouble with joining the teeth of the upper and lower jaws. For example, overcrowding of teeth, deformities in the mouth after a tooth extraction, too high filling, the inadequacy of the artificial crown and improper orthodontic treatment in the past.

On the basis of the complex of changes in the human body the approach to treatment should be integrated and implemented jointly by an orthodontist and an orthopedist who have enough qualification to diagnose and treat the TMJ dysfunction.

Beginning orthodontic treatment without the diagnosis and treatment of TMJ will result in the wrong planning of orthodontic treatment, which in its turn will lead to aggravation of the problem and a threat to the overall health of the patient.

What are the methods of diagnosis and treatment of TMJ dysfunction?

To diagnose and plan treatment, in addition to clinical examination, plaster models of jaws fixed in articulators, TMJ radiograph (see Diagnosis), electromyography and magnetic resonance imaging (MRI) are used. At present, MRI is the "gold standard" examination of temporomandibular joints. This method makes it possible to see all the cartilage and soft tissue elements of the joint, which are affected first.

  • conception of treating TMJ dysfunction

The purpose of treatment is to identify myotatic reflex, in order to achieve a perfect and correct position of the mandible and the TMJ, which is achieved first of all by relaxing the masticatory muscles.

For this the patient must wear around the clock a previously manufactured in the laboratory plastic mouth splint, usually on the upper jaw (michigan splint), with subsequent correction by the orthodontist.

This creates perfect contact with such a splint, lateral and anterior excursion of the mandible, signal about normalization of the masticator contacts comes gradually through the nerve-endings, which in turn will lead to a relaxation of the muscles and masticator muscles and determination of the genuine position of the joint in the mandible.

With such right position, we can safely begin orthodontic treatment. Otherwise we can aggravate the TMJ dysfunction.