What is TMD? - ️️TMD : A "collective term" embracing a number of clinical problems that involve the masticatory musculature, the TMJs, and associated craniofacial structures.
Etiology of TMD (causes) - ️️• Trauma
• Emotional stress
• Deep pain input
• Parafunctional activitie...
TMD 97 Quiz Questions Well Answered What is TMD? - ✔ ✔ TMD : A "collective term" embracing a number of clinical proble ms that involve the masticatory musculature, the TMJs, and associated craniofacial structures. Etiology of TMD (causes) - ✔ ✔ • Trauma • Emotional stress • Deep pain input • Parafunctional activities • Occlusal factors Role of occlusion in TMD - ✔ ✔ Occlusion and TMDs association by Costen in1934. • Claimed that the etiology was the loss of vertical dimension and deep bite • This study triggered the concept of occlusion as the main etiological factor in TMDs • Occlusa l interferences have been considered as a major risk factor for TMDs Occlusal equilibrations, for an ideal occlusion to treat TMDs Types of occlusion equilibration - ✔ ✔ Amelloplasty Full mouth crowns Ortho treatment What in the past was thought to cause T MD? - ✔ ✔ Anterior open bite Increased overbite Excessive overjet Premature contacts (occlusal interferences) Posterior cross bite Centric Relation (CR) and Centric Occlusion (CO) difference Claim of Posterior cross -bites may cause TMDs as a result of asymmetric muscle functions. What does evidence shows? - ✔ ✔ There is no conclusive data that suggest the posterior cross bites a risk factor for TMDs Claim of: Increased positive and negative overjet increases the risk of TMDs. What does evidence shows? - ✔ ✔ there is no evidence showing between increased negative or positive overjet and TMD Claim of Deep bite with minimal overjet limits the free anterior mandibular movement and therefore, cause TMD. What does evidence shows? - ✔ ✔ Deep bite patients in particular those with retroclined maxillary incisors, frequently reported jaw stiffness and muscle disorders and this may represent a risk factor for TMD Claim of : CR - CO slide may cause TMJ dysfunction. What does evidence shows? - ✔ ✔ CR-CO slide more than 4mm may be a risk factor 5 Claim of Canine guidance and anterior guidance may eliminate TMD symptoms. What does evidence shows? - ✔ ✔ There is no evidence showing the superiority of canine guided occlusion vs other types of functional occlusion (balanced occlusion, group function) Claim of: Anterior open bite prevent normal TMJ function and aggravate myofa scial pain. What does evidence shows? - ✔ ✔ Subject with similar occlusal conditions may not develop similar disorders because there are many contributing factors. What are the contributing factors for TMDs? - ✔ ✔ TRauma Emocional stress Deep pain imput Parafunctional activities. whys does Current understanding and evidence -based literature fail to demonstrate a causal relationship between these occlusal factors and TMD signs and symptoms - ✔ ✔ Because Ideal occlusion is seldom seen in real life patient may still function well, physiologically, in non ideal occlusion. Moreover, TMD may be observed in ideal occlusion Do you recommend ortho treatment for patients to treat TMD? - ✔ ✔ No, you should find the cause of tmd. How occlusion affect TMJ? - ✔ ✔ Acute ch anges in occlusion may cause muscular problems • Improper crown and filling • Changing occlusal vertical dimension • Improper occlusal appliances or splints what does Improper stabilization splint can cause? - ✔ ✔ Improper stabilization splint may create muscle pain and TMJ pain due to sudden non -adjusted contacts (the lecture showed a guard where the mandible was locked in CR and not freely movable= causing TMD) Improper stabilization splint characteristics: - ✔ ✔ Non -adjusted Splint: • Imprints of the u pper teeth on the splint • No occlusal adjustment • No mandibular movement freedom How can TMD affect occlusion? - ✔ ✔ • Capsulitis, synovitis and retrodiscitis : May cause open bite, occlusal discomfort • Osteorarthritis, Rheumatoid Arthritis: Open bite • Protective co -contraction of muscles: Perceived a change in the occlusion should we change the occlusion to treat TMD? - ✔ ✔ NO, Occlusal factors are not mostly related to TMDs and any attempt to change the occlusion to treat the TMD should be avoided. Acute occlusal changes may not be tolerated by the patients well. • TMD may cause occlusal changes. Therefore, any dental treatment should be performed after the problem is resolved. Types of Joint disorders - TMDs - ✔ ✔ • Disc Displacement with reduction
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