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Costen,syndrome TMJ syndrome TMJ pain dysfunction syndrome Myofacial pain dysfunction syndrome
Pathophysiology (aetiology) Psychogenic causes Parafunctional habits; Pipe smoking,teeth clenching,teeth grinding, lip licking, jaw thrusting, nail biting,constant chewing of tobacco and chewing gum
Occlusal Dishormony Inherent malocclusion---microtrauma Acquired malocclusion-fail to replace Iatrogenic; faulty restorations,
Internal derangements A. Disc displacement
a. With reduction b. Without reduction
Structural incompatibility of the arti. surfaces
a. Adhesions b. Alterations in the form c. Rheumatoid arthritis
D.D.D.: The normal TMJ
D.D.D. with Reduction
D.D.D. without Reduction
Pain Clicking Limited mouth opening
HISTORY CLINICAL EXAMINATION
Extra oral Intra oral
Panoramic radiography Tomograms Transcranial radiographs TMJ Arthrography Computed radiography CT SCAN Magnatic Resonance (MRI) Bone Scintigram—nuclear imaging—Technicium-99 –3hs—Single photon emission computerized tomography (SPECT)---Hot spots
Aspirin ; 2 tabs 0.3 to 0.6 gm/6hourly Piroxicam; 10 to20mg/3-4 times a day Ibuprofen ; 200 to 600mg/3 times a day Valium ; 5 to 10mg/2-3 times a day Amitriptyline; 10 to 25mg/ 3 times a day or at bed time
Occlusal rehabilitation (7 rs)
Remove---Extract Reshape---- Grind Reposition— Orthodontia/orthog.surgery Restore---Conservative dentistry Replace---prosthesis Reconstruct--- TMJ surgery Regulate Control habit and symptoms.
Heat ;heating lamps, moist or dry heating pads,hot moist application of towels 15 to 20 minutes 4 times a day. Altrasound; Alters blood flow and metabolic activity.0.7 to 1.0 watts/cm2 10 minutes. Cryotherapy; Massage; inactivates trigger points. Active stretch exercises
Intra articular injection
Hydrocartisone mixed with 0.5 cc of 2 percent Lignocain.not as a routine, once in a month.
1. To temporarily disengage the teeth 2. To create a balanced joint-tooth stabilization of the mandible. 3. To reduce spasm, contracture and hyperactivity of musculature. 4. To improve/restore vertical diamension. 5. To serve as safty or protective appliance.
TYPES OF SPLINTS Stabilization splint 12 to 18 hours for 4 to 6 months covers occlusal ant incisal surfaces Relaxation splints; short period(up to 4weeks), over max incisors.
TMJ Arthrocentesis (Lavage or irrigation of
the upper joint space) Indications; when conservative treatment fail to work. Objectives; To improve the disc mobility. To eliminate joint inflammation To remove the resistance to condyle translation. Early physiotherapy To eliminate pain
Simple technique Minimum armamentarium Less invasive Inexpensive Highly effective Therapeutic benefit
Diagnostic---single puncture Therapeutic as well as surgical--Double puncture technique
Disc dysfunction Osteoarthrosis Synovial disease Hypomobility due to disc problems Hypermobility associated with severe pain
Contraindications Regional infection Presence of tumour Usual medical contraindications t surgery
lavage-arthrocentesis Lysis of adhesions Disc mobility improvement Disc suturing Retrodiscal cauterization Shaving of the articular surfaces Biopsy Photography-----record
Inadequate findings Costly equipment Complete or sensory loss hearing loss and severe vertigo Facial paralysis Instrument breakage Iatrogenic damage to the disc
Surgical Treatment Condylar shave Condylectomy Eminectomy Disc surgery