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HOW
WHY
Introduction
WHEn
temporomandibular joint disorder
Costen’s syndrome
Dr. Irfan Ahmed Shaikh
Introduction
defination
tmd
Conditions producing abnormal, incomplete, or impaired function of the temporomandibular joint(s) and/or the muscles of mastication
signs and symptoms
signs and symptoms
- Pain in the masseter muscle, TMJ, and/or temporalis muscle regions
- Mouth-opening limitation and
- TMJ sounds
correlation
TMD symptoms generally fluctuate over time and correlate significantly with
correlation
- masticatory muscle tension,
- tooth clenching, grinding, and
- other oral parafunctional habits.
- TMD symptoms are also significantly correlated with an increase in psychosocial factors, for example,
- worry,
- stress,
- irritation,
- frustration, and
- depression
symptoms beyond the masticatory musculoskeletal system
other symptoms
TMD can cause other symptoms that are nbeyond the masticatory musculoskeletal system, for example,
- tooth pain, nonotologic otalgia (ear pain that is not caused by the ear),
- dizziness,
- tinnitus, and
- neck pain
- TMD can contribute to migraine and tension headaches, muscle pain in the region, and many other pain complaints
CONCLUSION
Since TMD is a multifactorial disorder (having many etiologic factors), many therapies have a positive impact on any one patient’s symptoms.
prevalence
- TMD is the second most common musculoskeletal pain, with low back pain being the first.
- It is most often reported in individuals between the ages of 20 and 40.
- female–male patient ratio 3:1
- Approximately 33% of the population has at least one TMD symptom, and 3.6–7% of the population has TMD with sufficient severity to cause patients to seek treatment
Initial Evaluation
The goals of the initial examination are to identify a patient’s primary diagnosis;
contributing factors; and symptom patterns.
Evaluation
The primary diagnosis
The primary diagnosis
The primary diagnosis is the diagnosis for the disorder most responsible for a patient’s chief complaint
- This diagnosis can be of TMD origin
e.g., myalgia, TMJ arthralgia, or temporomandibular joint [TMJ] disc displacement without reduction with limited opening
- from a different source
e.g., pulpal pathosis, sinusitis,
Initial Patient Questionnaire
points
- Patients with nighttime parafunctional habits usually have an increase in pain when they first awake,
- whereas patients with daytime parafunctional habits have an increase in pain during the day or evening.
- increase in pain during or after driving, or when using the computer
- Throbbing pain may be referred pain from an acute pulpalgia.
- Historically, patients with odontalgia tend to report their pain wakes them at night, increases when they lie down, and/or increases when they drink hot or cold liquids.
- Poor sleep has been shown to correlate with an increase in muscle pain and can be a predictor of patients who will respond poorly to TMD therapy.
Clinical Examination
Clinical Examination
Objective:
gather additional information to help confirm or rule out structures involved in a patient’s complaints
palpation
The masticatory and cervical muscles and
TMJs are generally palpated with the fingertip
or palmar surface of the index or middle
finger.
simultaneously palpating both sides face the patient
face the patient
palpation
Range of Motion
“Open as wide as you can”
Lateral movements
protrusive movement
Range of Motion
Minimum of normal range is
40 mm opening (including the overlap)
7 mm right and left lateral,
and 6 mm protrusive
movements
range
TMJ Noise
Clicks
Pops
Crepitus
TMJ Noise
- These noises may occur with opening and/or closing
- palpate for the noise by placing the finger’s
- stethoscope
Clicking and popping are most commonly related to a disc displacement with reduction, while crepitus is most commonly related to roughness on the articular surface(s), which could be secondary to degenerative joint disease
occlusal examination
occlusal scheme
occlusal trauma
caries
tooth surface loss
linea alba
Intraoral Examination
IDEAS
Open your mind for new ideas
Healhty
diet?
No Thanks!
"You cannot have
a positive life and
a negative mind."
- Joyce Meyer