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Treatment of TMJ (joint dysfunction)

Dysfunction of the temporomandibular joint is a fairly common pathology today, since it is largely due to stress factors. It is sometimes hard to understand what is primary, what is secondary, because people with joint dysfunction come, as a rule, with bite pathology, pathology of the musculoskeletal system (curvature of the spine, neck). Therefore, joint treatment is a complex event. Primary pathology can be a joint pathology or a pathology of the musculoskeletal system.

Causes of TMJ Dysfunction

The orthodontist must find out what was primary - bite, incorrect position of the teeth or the absence of some teeth, perhaps not very successful orthodontic treatment in history, early treatment when they were children or adolescents, and subsequent treatment could be the cause. It is important to correctly diagnose.

Comprehensive treatment of TMJ

When the doctor determined the cause of the joint pathology, or causes, he finds out the patient's readiness for a comprehensive treatment plan. In addition to the orthodontist, an osteopath or a manual therapist, or even an orthopedist, can be involved if a more complex correction of the musculoskeletal system is needed.

The patient must be aware that it is possible to level the position of the jaw with an articular splint, but it does not solve the problem with the wrong bite. Orthodontic treatment is required to correct the bite. If orthodontic treatment has already been done before, then it is more difficult to decide on repeated treatment.

Therefore, the joint problem is solved first with a splint, then bite correction is carried out, and, if necessary, prosthetics. In parallel, work is underway with an osteopath to restore the muscular system of the back and neck.

Sometimes the patient refuses treatment on braces after solving the issue with the joint. In this case, we warn him about the need to wear the joint bus constantly to avoid the appearance of old problems with TMJ. After all, relapse can happen on the background of stress quickly enough.

What are the symptoms of TMJ dysfunction?

  • Soreness or pain in one or both TMJs at rest or when opening the mouth.
  • Crunch, clicks, crepitus and other noises in the area of one or both temporomandibular joints when opening the mouth.
  • Injuries of the TMJ in history (previously), including dislocation, subluxation, chronic subluxation.
  • Limitations in mobility of the temporomandibular joint, limitation in mouth opening.
  • Excessive tone of the chewing muscles, bruxism («grinding» teeth in a dream, at rest).
  • Asymmetry of the chin, lips, lip bridles, asymmetry of mouth opening, S-shaped opening.
  • Suspected presence of the forced position of the lower jaw.

The presence of one or more of the above symptoms may indicate dysfunction of the TMJ.

Traditional orthodontic treatment is not aimed at the treatment of TMJ dysfunction. In the process of orthodontic treatment, the severity of dysfunction may not change, decrease or increase. At the moment, there is no convincing evidence in the world scientific orthodontic literature about the relationship between orthodontic treatment and the condition of TMJ. The deterioration of the joint after treatment may not be associated with this treatment.

Note! Even in the absence of visible clinical manifestations of joint dysfunction, there may be hidden disorders that require special diagnostics for their detection.

If there is a forced abnormal position of the mandible, its position may change in the course of treatment with a change and complication of the treatment plan (the need to remove some teeth, an increase in the duration of treatment). The forced position cannot be reliably diagnosed by traditional orthodontic methods, to check its presence, as a rule, a special analysis is required (manual functional analysis, determination of the central jaw ratio), the use of a special joint splint for a period of several months, which, however, does not give 100 % guarantees.

For detailed articular diagnostics, clarification of the specifics of your case, further manufacturing of the articular splint, you can make an appointment with an orthodontist dealing with the issue of TMJ dysfunction.

TMJ dysfunction is a chronic condition that can be compensated, but not cured (ie, it is possible to eliminate the symptoms, however, pathological changes in the joints, if they have already occurred, are likely to persist).

What will happen if you do not treat dysfunction of the TMJ?

If the dysfunction is not treated, the body's compensatory abilities may sooner or later be exhausted, the symptoms worsen, the pathology will begin to progress, leading to greater discomfort (sometimes over several years), thereby affecting the deterioration of the dental-maxillary function.

In order to try to prevent this and to carry out treatment, taking into account the individual characteristics of the structure and functioning of the temporomandibular joints, patients are usually offered the following approach.

Method of the treatment of dysfunction of the TMJ

1.   Diagnosing of dysfunction of the TMJ.

  • During the diagnosis of a joint, a number of measurements and tests are taken at the clinic, all sensations in the area of the joints (discomfort, clicks, pain, jaw deviation when opening and closing), the difference in sensations in the right and left joints are recorded.
  • The orthodontist also performs a casting of the jaws and takes photographs of the face and intraoral photographs, as well as a 3D computed tomography of the face (3D CT) is performed, and if necessary, the doctor can give direction to an additional study of the TMJ (MRI).
  • Often, in addition to manual functional analysis, an orthodontist performs a visual assessment: posture, symmetry of the shoulder girdle, shoulder blades, hip bone structures, etc., performs the necessary tests, photographs. Based on the results, an appointment for a consultation with an osteopath or a manual therapist for joint patient management is possible. Allied specialists (orthopedist, surgeon, periodontist) can also be connected to a treatment plan.

What exercises are prescribed to patients for the normalization of work and relaxation of the masticatory muscles?

Exercise # 1

Draw a vertical line on the mirror with a marker, stand opposite, so that the line separates the face into the right and left halves, put your fingers on the region of the articular heads, lift the tongue up and back, open and close the mouth on the line (maybe it will not happen immediately), 2-3 times / day for 30 repetitions. No need to open your mouth wide (comfortable width), the main thing is symmetrical (so that the jaw does not “slide” in any direction). If there is a click, open until click.

Exercise # 2 (cycle)

Do it when you can, for example, in front of the TV, at the computer, in traffic. Open - close your mouth, without closing your teeth for 30 seconds, then move tongue alternately to the right, then to the left cheek for 30 seconds. Open again - close your mouth, then for 30 seconds, move your tongue in a circle inside the vestibule (behind the lips) first to one, then to the other side (clockwise - counterclockwise), open again - close your mouth, etc. For this half an hour cycle, the teeth should not touch, the lips are closed. If you want to close your mouth or take a sip - lay your tongue between your teeth. Repeat the cycle for 20-30 minutes 2-3 times / day

2. Occlusive therapy of TMJ dysfunction

After diagnosis, the patient is making an appointment with the orthodontist to determine the central ratio of the jaws (the "true" position of the lower jaw, the position in which your joint and masticatory muscles will be most comfortable).

In order to more precisely set and fix this position, an occlusive splint of special plastic will be individually made for the patient, which is erased as it is worn. The tire must be worn constantly (sleep, talk, whenever possible there is in it) - this is the meaning of occlusive therapy, which will help the joint and chewing muscles to reorganize into the most comfortable functional state.

Cleaning and care of the splint is very simple - after eating (as well as during brushing your teeth), clean with a soft brush with paste or soap.

3. Installing a bracket system to a patient with TMJ dysfunction

The brackets are placed on the upper jaw on average after 3 months of occlusive therapy. The splint is corrected once every 1-2 weeks, or at the discretion of the doctor, until the main complaints from the temporomandibular joint are eliminated (in parallel with the teeth leveling in the upper jaw), then the braces are installed on the lower jaw with partial reduction (grinding) of the interfering parts of the splint or complete removal. The patient needs patience - the process can take several months.

At the same time, the new position of the lower jaw is monitored: repeated manual functional analysis, photometry, registration of the bite is possible, computed tomography of the face during the treatment, continuation of orthodontic treatment on the bracket system.

At the end of orthodontic treatment, the final control of the position of the lower jaw follows (manual functional analysis, photometry, bite registration, 3D CT scan of the face upon completion (after) treatment).

4. Result of treating TMJ dysfunction

The result of the treatment is a satisfactory aesthetic result, the achievement of a full-fledged occlusion with multiple fissure-bump contacts and the elimination or reduction of the severity of TMJ dysfunction. If there are indications, a complete rational prosthetic or functional-aesthetic restoration of teeth is mandatory, as the final stage of treatment - at this stage an extensive consultation of the orthopedic dentist is necessary.

Author: Badmaeva Anna, the orthodontist

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Clinical case report #1. Class III malocclusion, crowding treatment and prosthetic preparation.
Clinical case report #1. Class III malocclusion, crowding treatment and prosthetic preparation.

Problem: smile aesthetics and defect in bite function.
Diagnosis: the treatment of upper and lower jaw teeth misalignment and class III malocclusion, caused by increased mandible growth, and prosthetic preparation.
Therapy method chosen: orthodontic treatment using stainless steel self-ligating brackets Damon Q without teeth extraction..
Treatment time: 3 years.

 

Clinical case 2. Correction of the aesthetics of a smile and severe crowding of the dentition.
Clinical case 2. Correction of the aesthetics of a smile and severe crowding of the dentition.

Problem:  Smile Aesthetics
Diagnosis: treatment of severe crowding of the dentition.
Selected treatment method: orthodontic treatment with brackets without tooth extraction using the Damon Q metal self-ligating bracket system.
Treatment term:  2,5 years.

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