TMJ TREATMENT - ADVANCED PROSTHODONTICS

TMJ or TMD TREATMENT is most frequently performed by a prosthodontist as sophisiticated laboratory work is often necessary 

ADVANCED PROSTHODONTICS TMD or TMJ TREATMENT

CENTRIC RELATION NEWPORT SPLINT

PROTRUSION NEWPORT SPLINT

LEFT LATERAL EXCURSION NEWPORT SPLINT

RIGHT LATERAL EXCURSION NEWPORT SPLINT

The vast majority of occlusal splints that are prescribed for patients have no therapeutic benefit and many simply exacerbate the problem. Most patients cease wearing these splints after a few months. Dr. Wright's patients find their Newport Splints to be very comfortable and beneficial.

Temporo-Mandibular Joint Dysfunction Syndrome   

 

COMPUTERISED PANTOGRAPHIC RECORDS

 

THE TEMPORO-MANDIBULAR JOINT  

 

The temporomandibular joint connects the lower jaw (mandible) to the temporal bone of the skull. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of your head. As these joints are flexible, the mandible can move smoothly up and down and from side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the mandible control its position and movement.  

When we open our mouths, the rounded ends of the mandible, at the opposite end from the chin, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft fibrocartilaginous disc lies between the condyle and the temporal bone. The disc absorbs shocks to the TMJ from mastication and minor trauma.  

Temporomandibular Disorders -  There are three main categories:

Myofascial Pain: the most common form of TMD being discomfort or pain in the muscles that control joint function and the muscles of the head and neck;

Internal Derangement of the Joint: being either a dislocated mandible, displaced disc, injured condyle or some combination;

Degenerative Joint Disease: osteoarthritis or rheumatoid arthritis of the TMJ.  

A person may have one or more of these conditions at the same time.  

Temporo-mandibular Joint Dysfunction Syndrome  

TMD is a progressive and painful condition stemming from the joint, involving the muscles of mastication and the facial musculature. The pain may be localised to the joint capsule or radiate to the head and neck. It can be unilateral or bilateral.    The aetiology may be developmental, a history of traumatic injury, relapsed orthodontics, poor or inadequate dentistry or self-induced. Acute or chronic stress can lead to parafunctional activity of the muscles of mastication causing clenching or grinding of the teeth known as bruxing. This continuous grinding causes damage to the teeth and restorations in the mouth. It also causes inflammation of the delicate tissues of the temporo-mandibular joint. The disc or the ligaments attached to the disc can become perforated, stretched or torn. Muscles of the joint fatigue. Pain ensues and with it an altered chewing patern. This causes other muscles to fatigue. Pain radiates to various parts of the head and neck, the chewing pattern become further altered and there is the potential for more teeth or restorations to break. TMD affects young adult females more than any other category.  

Signs and Symptoms  

A variety of symptoms may be linked to TMD. Pain, in the chewing muscles or in and around the jaw joint, is the most common symptom. Other likely symptoms include:

• limited movement or locking of the jaw,
• radiating pain in the face, neck or shoulders,
• painful clicking, popping or grating sounds in the joint when opening or closing the mouth,
• a sudden, major change in the way the upper and lower teeth fit together.
• Symptoms such as headaches, earaches, dizziness and hearing problems may be related to TMD. It is important to keep in mind, however, that occasional discomfort in the jaw joint or chewing muscles is not uncommon and is generally not a cause for concern. Researchers are working to clarify TMD symptoms, with the goal of developing better methods of diagnosis with improved treatment. Chronic TMD sufferers can become addicted to prescription medications, depressed, and in extreme cases, suicidal. It is  not uncommon for such patients to move from one doctor or clinic to another in search of an elusive cure. It is essential to make a clear diagnosis of the type of condition before embarking on treatment even splint therapy. All historical medical and dental records can be useful in coming up with a diagnosis.    

Diagnosis Since the exact causes and symptoms of TMD are not clear, diagnosing these disorders can be confusing. At present, there is no widely accepted, standard test to correctly identify TMD. In about 90% of these cases, however, the patient's description of symptoms, combined with a simple physical examinaiton of the face and jaws, provides information useful for diagnosing these disorders.  The examination includes feeling the jaw joints and chewing muscles for pain or tenderness; listening for clicking, popping or grating sounds during jaw movement; and examining for limited motion or locking of the jaw while opening or closing the mouth. Checking the patient's dental and medical history is very important. In most cases this evauation provides enough information to locate the pain or jaw problem, to make a diagnosis, and to start treatment to relieve pain or jaw locking.  Regular dental x-ray and TMJ x-ray views (transcranial radiographs) are generally not useful in diagnosing TMD. In the past cineradiographic techniques were used to record the movements of the TMJ structures. The drawback was the large amount of radiation required. a series of digital tomograms taken at different openings can be helpful. Other imaging techniques, such as arthrography (joint x-rays using dye); magnetic resonance imaging (MRI), which pictures the soft tissues; and tomography (a special type of sectional radiograph)  provide more information about the capsule and disc. These are indicated when the clinician suspects arthritis or when significant persistant pain  does not improve with treatment. VideoMRI recordings are also becoming more popular.