Temporomandibular joint dysfunction

Temporomandibular joint ( Temporomandibular Dysfunction, CMD) is an umbrella term for structural, functional, biochemical and psychological dysregulation of muscle or joint function of the jaw joints. This dysregulation can be painful. The German Society for diagnosis and treatment CMD defined as a collective term for a number of clinical symptoms of the chewing muscles and / or temporomandibular joint and associated structures in the mouth and head area. Accordingly, the term has more the character of a finding and should be specified in the diagnoses Okklusopathie, myopathy and arthropathy. In a narrower sense, it involves pain of the masticatory muscles ( " myofascial pain " ), displacements of the articular disk in the temporomandibular joint ( " disk displacement " ) and inflammatory or degenerative changes of the TMJ ( " arthralgia, arthritis and osteoarthritis ").

  • 9.1 English

Terminology

In Germany the term has naturalized temporomandibular dysfunction, a collective name for various musculoskeletal disorders in the Craniomandibulärsystem ( masticatory ), besides also Cranio - Vertebral dysfunction ( CVD). In Switzerland the term TMPDS is preferred in the English language Temporomandibular Disorders or temporo- mandibular joint disease ( TMD, TMJ). The old term Costen's syndrome is obsolete. Principal representative of this clinical picture is the dentist, but affected many medical disciplines.

Classification systems

There are various classification systems, in which the international Research Diagnostic Criteria for Temporomandibular Disorders ( RDC / TMD) have been found dating back to 1992, the largest international distribution. Thus, one distinguishes between the following two areas ( " axes"):

Area I: Painful symptoms in the masticatory muscles (especially mouth opener and closer muscles mouth )

  • Ia: Myofascial Pain
  • Ib: Myofascial pain with limited mouth opening

Area II: Anterior displacement of the articular disc

  • IIa: Anterior disc displacement with reduction in jaw opening
  • IIb: Anterior disc displacement without reduction in jaw opening, with limited jaw opening.
  • IIc: Anterior disc displacement without reduction in jaw opening without limited mouth opening.

Area III: arthralgia, activated osteoarthritis, Osteoarthritis

  • IIIa: arthralgia
  • IIIb: activated osteoarthritis of the temporomandibular joint
  • IIIc: osteoarthritis of the temporomandibular joint
  • Pain -related impairment of daily activities
  • Depressed mood
  • Nonspecific somatic symptoms

Epidemiology

The frequency of CMD is about 8 % of the total population, with only about 3% are in need of treatment because of these symptoms. During infancy, CMD symptoms are rarely seen, but the incidence increases to up to puberty. Women of childbearing age are like other pain disorders much more frequently affected than men. After menopause, the symptoms can often after the age and the CMD is relatively rare.

Symptoms

A variety of symptoms can make diagnosis difficult. Often the jaw muscles or jaw joints ache when chewing. Other symptoms may include:

  • Limited jaw opening
  • Cracking or rubbing the jaw joint when opening or closing the jaw
  • Referred pain in the teeth, mouth, face, head, neck, shoulder or back, neck, spine shoulder problems, restricted rotation of the head, headache
  • Sudden problems with the alignment of the teeth to each other.
  • However, it can be a symptom unpleasant earache.
  • Tinnitus
  • Dizziness
  • Swallowing
  • Eye / impaired vision

Pathogenesis

It is made ​​in the pathogenesis of craniomandibular dysfunction of an ascending and descending symptoms. In the ascending chain, for example, Transmit lateral deviations of the spine to the neck and then to the TMJ. In the descending symptoms are dental problems, such as too high a crown, an incorrect bite or malocclusion of the jaw joint, from there transferred to the neck, shoulder and spine.

Since the causes are unclear in most cases, a multifactorial etiology is suspected. Predisposing, triggering and entertaining factors include biological, psychological and social elements. Below are listed some of them, with ever new aspects arise in clinical practice and research:

  • Gene
  • Hormones
  • Developmental disorders of jaws
  • Poor posture
  • Loss of vertical jaw relationship
  • Emotional stress
  • Previous pain experiences
  • Hypervigilance by sympathetic
  • Macro trauma from accidents
  • Micro- trauma caused by disorders of the bite
  • Gnashing of teeth
  • Sleep disorders, such as when obstructive sleep apnea syndrome
  • Reducing the activity of the descending Inhibitory Nociceptive Systems
  • Depression
  • Posttraumatic Stress Disorder
  • Malocclusion
  • Tooth extraction
  • Occlusion by prosthetic restoration ( eg, high crowns, etc.)
  • Orthodontic treatments

Diagnosis

For the diagnosis of CMD currently following procedure is recommended:

For complex diseases can elaborate apparatus, radiological or psychological methods in diagnosis and therapy are used as well as other disciplines are consulted.

Differential diagnosis

Due to a variety of causes of pain in the head area a multidisciplinary diagnosis is useful in cases of unclear diagnosis. Must be ruled out diseases from various medical specialties and intensive consiliary assessment is then essential.

Therapy

The basic idea in the treatment of CMD is a gentle and reversible procedure. This scientifically recognized therapeutic approaches are used depending on the severity and individually tailored to the patient.

Hypothesis Stress (biology) Bruxism Major depressive disorder Medical diagnosis Muscle relaxant Elsevier Journal of the American Dental Association
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