Temporomandibular disorders (TMD)

    Temporomandibular disorders (TMD)

    Temporomandibular disorders (TMD)

    Temporomandibular disorders include problems of joints and masticatory muscles. They are often associated with the gnashing of teeth (bruxism) problem. Clicking of the joints, diminished and painful mouth opening, pain in the in the temporal area and the signs of overloading of teeth and restorations is just a part of the complaints, specific to this pathology. The etiology of these diseases can very complex and require in-depth anamnesis, a thorough clinical examination and radiography (Picture 1.).

    In cases of joint disorders, when non-bone structures’ (articular disc) inspection is needed, nuclear magnetic resonance imaging (MRI) may be required (Picture 2). A variety of treatment methods, such as acrylic splints (Figure 3), dental restorations, physiotherapy etc. can be applied depending on the type of the disorder. During and after the treatment a special regime and diet is often recommended, thus requiring a very good cooperation with a patient. Often, no special treatment is required and only the diet and regime can solve the situation. In more severe cases neurologist’s, sleep specialist’s consultation, psychotropic drugs or even surgery may be required. Sometimes temporomandibular problems can be caused by other diseases, for example: rheumatoid arthritis and others.

    IMPORTANT: very often due to pathological processes in the neighboring areas, pain spreads to the joints or teeth (for instance: sinusitis, trigeminal neuralgia, neuropathic pain, migraine etc.), and the patient can have a realistic sensation of the pain in a joint or teeth area (pain referral mechanism). Therefore, it is important not to treat teeth when the cause of the pain is elsewhere. Often it is not easy to determine the source of the pain, and sometimes it remains unclear as not all mechanisms of the headaches are yet explained.

    Prosthodontists of ProDentum clinic consult and treat patients with TMD and, if needed, this is done in cooperation with specialists from other disciplines.

    Pic. 1 Computerized tomography (CT) shape of mandibular condyles could be seen.

    Pic. 1 Computerized tomography (CT) shape of mandibular condyles could be seen.

    Pic. 2 MRI study: anterior articular disc dislocation with reduction can be seen (during mouth opening articular disk regains its position), this is the cause of the joint clicking.

    Pic. 2 MRI study: anterior articular disc dislocation with reduction can be seen (during mouth opening articular disk regains its position), this is the cause of the joint clicking.

    Pic. 3 Hard acrylic, occlusion stabilization splint

    Pic. 3 Hard acrylic, occlusion stabilization splint