University Of AdenUniversity Of AdenFaculty of dentistryFaculty of dentistry

20122012

Oral MedicineOral MedicineDr .Muhgat AbdoDr .Muhgat Abdo

Oral & Dentofacial SurgeonOral & Dentofacial Surgeonwww.adendent-faculty.netmuhgatabdo@hotmail.demuhgatabdo@hotmail.de

What is the main function of What is the main function of CartilageCartilage??

What is the difference between What is the difference between TMJ articular cartilage and TMJ articular cartilage and cartilage of other synovial cartilage of other synovial jointsjoints??

What are the goals of non-What are the goals of non-surgical management of TMJ surgical management of TMJ disordersdisorders??

What are the indications to What are the indications to proceed with TMJ surgeryproceed with TMJ surgery??

Temporomandibular Joint Temporomandibular Joint (TMJ)(TMJ)

DisordersDisorders

Anatomy of TMJ:Anatomy of TMJ: Glennoid FossaGlennoid Fossa Mandibular CondyleMandibular Condyle Articular DiscArticular Disc Ligamentous Structurres:Ligamentous Structurres:1.1. Functional LigamentFunctional Ligament2.2. Accessory ligamentAccessory ligament

Temporomandibular Joint Temporomandibular Joint DisordersDisorders

Functional Movement of TMJ:Functional Movement of TMJ:1.1. ElevationElevation ( (Jaw ClosingJaw Closing))2.2. Depression Depression ((Jaw OpeningJaw Opening))3.3. ProtrusionProtrusion4.4. RetrutionRetrution5.5. LaterotrusionLaterotrusion

Temporomandibular Joint Temporomandibular Joint DisordersDisorders

ClassificationClassification

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))

Classification of TMJ Disorders:Classification of TMJ Disorders:1.1. Developmental Disorders of TMJDevelopmental Disorders of TMJ2.2. Degenerative Joint DiseaseDegenerative Joint Disease3.3. Inflammatory Disorders of the JointInflammatory Disorders of the Joint4.4. Traumatic Disorders of TMJTraumatic Disorders of TMJ5.5. Metabolic DisordersMetabolic Disorders6.6. Neoplastic DisordersNeoplastic Disorders7.7. TMJ Disorders Syndrome or Myofacial TMJ Disorders Syndrome or Myofacial

Pain Dysfunction SyndromePain Dysfunction Syndrome

Temporomandibular Joint Temporomandibular Joint DisordersDisorders

DefinitionDefinition EtiologyEtiology ClassificationClassification ExaminationExamination TreatmentTreatment PreventionPrevention

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))

Definition:Definition: When muscle spasm develops, dysfunction as well When muscle spasm develops, dysfunction as well

as pain occurs and the condition usually is as pain occurs and the condition usually is designated as MPDS.designated as MPDS.It is initiated as spasm of one or more masticatory It is initiated as spasm of one or more masticatory muscle.muscle.

Temporomandibular disorders are a group of Temporomandibular disorders are a group of maladies which can affect the TMJ, as well as the maladies which can affect the TMJ, as well as the associated muscles of the jaw, face and neck as associated muscles of the jaw, face and neck as well as related neurological and vascular well as related neurological and vascular structures.structures.

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))What symptoms are associated with Temporomandibular

disorders?What are the components of evaluation of the patient with Temporomandibular joint

symptoms?What symptoms are associated with myofacial pain dysfunction

syndrome?

Etiology:Etiology: Occlusal status:Occlusal status:Orthodontic viewpointOrthodontic viewpointProsthetic viewpointProsthetic viewpointPeriodontal viewpointPeriodontal viewpoint

Emotional status:Emotional status:Oral bad habitsOral bad habits

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))Etiology:Etiology: Psychophysiologic Psychophysiologic

theory:theory:

Bruxism:Bruxism:

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))Classification:Classification:11. Disc displacement. Disc displacement

2. 2. Structural incompatibility (Deviation, Structural incompatibility (Deviation, Adhesion, Hypermobility)Adhesion, Hypermobility)

3. 3. Inflammatory disorders (Synovitis/capsulitis,Inflammatory disorders (Synovitis/capsulitis,Arthritides)Arthritides)

4. Ankylosis4. Ankylosis

5. 5. Neoplasia Neoplasia

ClassificationClassification

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))Signs & Symptoms:Signs & Symptoms: Pain of the joint on palpation.Pain of the joint on palpation. Pain on movement of the joint.Pain on movement of the joint. Altered TMJ function, including trismus, Altered TMJ function, including trismus,

reduced opening, and mandibular deviation on reduced opening, and mandibular deviation on opening.opening.

Joint popping, clicking or crepitus.Joint popping, clicking or crepitus. Facial pain.Facial pain. Pain on palpation of the muscles of mastication.Pain on palpation of the muscles of mastication. Pain on opening. Pain on opening.

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))Examination:Examination: HistoryHistory Physical ExaminationPhysical Examination Radiologic Examination:Radiologic Examination:Radiography (Normal Radiography)Radiography (Normal Radiography)C T (Tomography)C T (Tomography)ArthrographyArthrographyElectrography (MRI)Electrography (MRI)ArthroscopyArthroscopy

Physical Examination: Palpation of MasticatoryPhysical Examination: Palpation of MasticatoryMuscles:Muscles:

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))

Observation of Mandibular Motion:Observation of Mandibular Motion:

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))

Palpation of the Joint:Palpation of the Joint:

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))

Radiographic Evaluation:Radiographic Evaluation:

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))

Treatment:Treatment:• Reversible Therapy (Patient education, Reversible Therapy (Patient education,

medication, physical therapy, and splint medication, physical therapy, and splint therapy. Occlusal adjustment.therapy. Occlusal adjustment.

• Irreversible Therapies that involve Irreversible Therapies that involve permanent changes in the function or permanent changes in the function or morphology of the masticatory system morphology of the masticatory system (Surgical treatment).(Surgical treatment).

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))

Treatment:Treatment: Patient education & self carePatient education & self care

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))Treatment:Treatment: MedicationMedication

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))Treatment:Treatment: PhysiotherapyPhysiotherapy

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))Treatment:Treatment: SplintSplint

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))Treatment:Treatment: Elimination the StressElimination the Stress

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))Treatment:Treatment: Dental CareDental Care

TMJ Dysfunction Syndrome (TMJ Dysfunction Syndrome (TMDTMD))Myofacial Pain Myofacial Pain Dysfunction Syndrome Dysfunction Syndrome

((MPDSMPDS))Prevention:Prevention: Eliminate oral habits such as teeth grinding and Eliminate oral habits such as teeth grinding and

yawing widely.yawing widely.

Dental treatment (orthodontic treatment, Dental treatment (orthodontic treatment, prosthetic restoration, orthognathic surgery and prosthetic restoration, orthognathic surgery and TMJ surgery).TMJ surgery).

Seek effective treatment for diseases such as Seek effective treatment for diseases such as osteoarthritis and fibromyalgia.osteoarthritis and fibromyalgia.

Early Diagnosis and therapy.Early Diagnosis and therapy.