Ridha Rasyida Arif 021511133083 Juan Gabriel 021511133090

Mochammad Aldy Sudarminto 021511133084 Theresa Ardiyani Wijaya 021511133091

Rifda Raysyifa Anindita 021511133085 I Nyoman Dhana Sudiartha 021511133092
Sekar Firdhea Rizkifa Soetanto 021511133086 Indah Permatasari 021511133093
Erika Setyowati 021511133087 Primarinda Dwita Hapsari 021511133094
Ghina Anjani Faizahrizqitha 021511133088 Ardhyana Dea Maharani 021511133095
Ratri Karunia Puspita Arum 021511133089 Ratih Cahyaning Puri 021511133096
 CASE

A final 24-year-old male student came to dentist

practice with pain complaints since 3 months ago in
the front area of ​the left ear with the sound at the
time of opening the mouth. Pain is also felt in the
front of the right ear but without sound. The current
intensity of pain is increasing. Patients only treated
with anti-inflammatory treatment to reduce pain on
both sides of the joint.
THE ANATOMICAL
AND
HISTOLOGICAL
STRUCTURE OF
TMJ
Temporomandibular Joint (TMJ) is a complex
joint system in human body. TMJ is classed as
a ginglymoarthrodial joint
• ginglymus (hinging joint)
• arthrodial (sliding joint)
*Images courtesy of Robert L. Talley, DDS
TMJ INNERVATION AND VASCULARIZATION
(R. Schmelzle, 1989)
B : Bone
C : Fibrocartilageous area
I : Intermediate proliferation
area F : The outer area of the
fibrous
 MUSCLE
CONTRACTION
AND
RELAXATION
1. An action potential travels along a motor nerve to its endings on muscle fibers.
2. At each ending, the nerve secretes a small amount of the neurotransmitter substance
acetylcholine.
3. The acetylcholine open multiple “acetylcholinegated” and allows large quantities of
sodium ions to diffuse to the interior of the muscle fiber membrane. This initiates an action
potential at the membrane.
 TMJ
MOVEMENT

J. Okeson 2012: Normal TMJ

mechanics and intra-articular
disc movement
Kinesiology of Mastication and Ventilation
(Neumann et al., n.d.)
Movement of Muscle TMJ Movement
Mandible
Protrusion Lateral Pterygoid Translation
Medial Pterygoid
Retrusion Posterior fibres of
Temporalis
Lateral Excursion Lateral pterygoid Side translation
Medial pterygoid Slight multiplanar rotation
Depression Lateral pterygoid Rotation
Digrastric Translation
Geniohyoid
*Left lateral pterygoid with
Mylohyoid
right medial pterygoid turn the
Elevation Temporalis chin to left side & vice versa
Masseter
Medial pterygoid
https://radiopaedia.org/articles/temporomandibular-joint-dysfunction
RISK FACTORS
The etiology of temporomandibular disorders (TMDs) is
multidimensional.
Biomechanical, neuromuscular, biopsychosocial, and
neurobiological factors may contribute to the disorder
(Suvinen, 2002).
These factors are classified as:

predisposing initiating aggravating

• structural, • trauma or • parafunction,

• metabolic repetitive adverse • hormonal,
• psychologic loading of the • psychosocial
conditions masticatory factors
system
• Behavioral factors (grinding, clenching and abnormal
head posture)
• Social factors (could effect perception and influence of
learned response to pain)
• Emotional factors (depression and anxiety)
• Cognitive factors (negative thoughts and attitudes
which can make resolution of the illness more
difficult).
Many symptoms of TMJ syndrome can respond
well to home remedies or stress reduction and
relaxation techniques.

The following home remedies may provide some

relief:
1. Ice or cold packs
2. Nonsteroidal anti-inflammatory
drugs (NSAIDs) such as:
ibuprofen (Advil, Motrin)
or naproxen (Aleve), and other pain
relievers, including aspirin (Ecotrin)
3. Eating soft foods
4. Massage or gentle self-stretching of
the jaw and neck muscles
5. Relaxation techniques and stress
management and reduction
6. Some sedative essential oils (such
as lavender, chamomile) may
provide temporary relief from the
pain and discomfort of TMJ.
The following prescription-strength medicines may be
used to treat TMJ:

• Muscle relaxers: metaxalone (Skelaxin), cyclobenzaprine

(Flexeril)
• Anti-inflammatory medications: nabumetone (Relafen),
meloxicam (Mobic), celecoxib (Celebrex)
• Steroid injections: beclomethasone (Qvar)
• Tricyclic antidepressants: nortriptyline (Pamelor),
amitriptyline (Elavil, Endep), and desipramine (Norpramin),
imipramine (Norfranil, Tipramine, Tofranil)
• Benzodiazapines: diazepam (Valium), clonazepam
(Klonopin), alprazolam (Xanax)
• Sleep medications: doxepin (Silenor)
• Nerve pain medications: gabapentin (Neurontin),
topiramate (Topamax), levetiracetam (Keppra), pregabalin
(Lyrica)
• Opiate pain medications hydrocodone and acetaminophen
(Vicodin, Lortab), oxycodone and acetaminophen
(Percocet)