What are the common causes of temporomandibular joint pain. How can you recognize the symptoms of TMJ disorders. What treatment options are available for managing TMJ pain. How does stress contribute to temporomandibular joint issues. Can TMJ pain be mistaken for other conditions.

The Anatomy and Function of the Temporomandibular Joint

The temporomandibular joint (TMJ) is a complex structure that plays a crucial role in our daily lives. It’s the joint that connects the mandible (lower jaw) to the temporal bone of the skull, allowing for the movements necessary for speaking, chewing, and facial expressions. Understanding its anatomy and function is key to grasping the complexities of TMJ disorders.

Key Components of the TMJ

• Mandibular condyle: The rounded projection at the top of the lower jaw
• Glenoid fossa: The depression in the temporal bone where the condyle sits
• Articular disc: A fibrocartilaginous structure that acts as a cushion between the bones
• Ligaments and muscles: Provide stability and enable movement

The TMJ is unique in that it allows for both hinge and sliding movements, making it one of the most complex joints in the body. This complexity, while enabling a wide range of motion, also makes it susceptible to various disorders.

Common Causes of Temporomandibular Joint Pain

TMJ pain can arise from various sources, both within and outside the joint itself. Identifying the cause is crucial for effective treatment. Here are some of the most common culprits:

Intra-articular Causes

• Osteoarthritis
• Rheumatoid arthritis
• Disc displacement
• Joint inflammation

Extra-articular Causes

• Myofascial pain dysfunction syndrome (MPDS)
• Bruxism (teeth grinding)
• Muscle tension from stress
• Trauma to the jaw area

Is TMJ pain always caused by a single factor? Rarely. In many cases, TMJ disorders result from a combination of factors, making diagnosis and treatment more challenging.

Recognizing the Symptoms of TMJ Disorders

Temporomandibular joint disorders can manifest in various ways, and symptoms may vary from person to person. Being aware of these signs can help in early detection and treatment.

Common Symptoms of TMJ Disorders

1. Pain or tenderness in the jaw area
2. Difficulty or discomfort while chewing
3. Clicking, popping, or grinding sounds when moving the jaw
4. Limited range of motion in the jaw
5. Headaches, particularly in the temple area
6. Earaches or tinnitus
7. Facial pain or numbness

Do all these symptoms always indicate a TMJ disorder? Not necessarily. Some of these symptoms can be associated with other conditions, which is why a proper diagnosis by a healthcare professional is crucial.

The Role of Stress in TMJ Disorders

Stress plays a significant role in the development and exacerbation of TMJ disorders. It’s a factor that’s often overlooked but can have a profound impact on jaw health.

How Stress Affects the TMJ

• Increased muscle tension in the jaw and face
• Higher likelihood of teeth clenching or grinding
• Altered pain perception, making existing discomfort feel worse
• Potential for stress-related habits that can strain the TMJ

Can managing stress help alleviate TMJ symptoms? Often, yes. Stress reduction techniques, such as meditation, yoga, or counseling, can be beneficial components of a comprehensive TMJ treatment plan.

Diagnostic Approaches for TMJ Disorders

Accurate diagnosis is crucial for effective treatment of TMJ disorders. Healthcare providers use a combination of methods to identify the underlying cause of TMJ pain and dysfunction.

Common Diagnostic Tools

1. Physical examination of the jaw and surrounding muscles
2. Review of medical history and symptoms
3. Imaging studies (X-rays, CT scans, or MRI)
4. TMJ arthroscopy in some cases

Why is a comprehensive diagnostic approach important? TMJ disorders can have multiple contributing factors, and a thorough evaluation helps ensure that all aspects of the condition are addressed in the treatment plan.

Treatment Options for TMJ Pain

Treatment for TMJ disorders varies depending on the underlying cause and severity of symptoms. A multidisciplinary approach is often most effective.

Conservative Treatment Options

• Pain relievers and anti-inflammatory medications
• Physical therapy and jaw exercises
• Oral appliances or splints
• Stress management techniques
• Dietary modifications (soft foods, avoiding extreme jaw movements)

Advanced Treatment Options

• Corticosteroid injections
• Botox injections for muscle relaxation
• Arthrocentesis or arthroscopy
• Open joint surgery (in severe cases)

Is surgery always necessary for TMJ disorders? No, in fact, most cases of TMJ pain can be managed with conservative treatments. Surgery is typically reserved for severe cases that don’t respond to other therapies.

Lifestyle Modifications for Managing TMJ Pain

In addition to medical treatments, certain lifestyle changes can significantly impact TMJ health and help manage symptoms.

Beneficial Lifestyle Changes

1. Practicing good posture
2. Avoiding excessive gum chewing
3. Using relaxation techniques to reduce jaw tension
4. Applying heat or cold packs to the affected area
5. Maintaining a balanced diet rich in anti-inflammatory foods

How effective are lifestyle modifications in managing TMJ pain? For many individuals, these changes can lead to significant improvement in symptoms, especially when combined with other treatments recommended by healthcare providers.

The Connection Between TMJ Disorders and Other Health Conditions

TMJ disorders don’t exist in isolation. They can be associated with or influenced by various other health conditions, making a holistic approach to diagnosis and treatment essential.

Related Health Conditions

• Fibromyalgia
• Chronic fatigue syndrome
• Sleep disorders
• Headaches and migraines
• Postural issues

Why is understanding these connections important? Recognizing the interplay between TMJ disorders and other health conditions can lead to more comprehensive and effective treatment strategies.

TMJ disorders are complex conditions that can significantly impact quality of life. They require a nuanced approach to diagnosis and treatment, often involving multiple healthcare disciplines. By understanding the various aspects of TMJ disorders – from their causes and symptoms to treatment options and lifestyle modifications – individuals can better navigate their path to relief and improved jaw health.

As research in this field continues to evolve, new insights and treatment modalities are likely to emerge, offering hope for those struggling with persistent TMJ pain. The key lies in early recognition, comprehensive evaluation, and a tailored treatment approach that addresses the unique needs of each individual.

For anyone experiencing symptoms of TMJ disorders, consulting with a healthcare professional is crucial. They can provide a proper diagnosis and develop a treatment plan that addresses the specific underlying causes of the condition. With the right approach, many individuals find significant relief from TMJ pain and a return to normal jaw function.

Remember, while TMJ disorders can be challenging, they are often manageable with the right combination of medical care, lifestyle adjustments, and self-care practices. Staying informed and proactive in your approach to jaw health can make a significant difference in managing TMJ disorders and improving overall quality of life.

Temporomandibular Joint Pain – Clinical Methods

Definition

Pain or other discomfort may arise in or around the articulation of the mandibular condyle with the glenoid fossa of the temporal bone. The pain may be mild or severe, acute or long-standing, and sharp or dull in character. Facial pain originating from the area of the temporomandibular joint (TMJ) may be due to intraarticular disease, disorders of adjacent structures outside the joint, or a combination of both.

Technique

Question the patient about the character of the pain and whether it remains localized or spreads to adjacent areas such as the ear, angle of the mandible, or neck. TMJ pain is often a dull, constant ache that is aggravated by opening the mandible or chewing. There may be a complaint of limited jaw opening and frequent “clicking,” “popping,” or “grinding” noise within the joint associated with mandibular movement or mastication. Associated symptoms may include tinnitus, changes in hearing, facial numbness, and headache. Symptoms may be worse in the morning, particularly if the patient clenches or grinds the teeth during sleep. Questioning of the patient’s bed partner is helpful in this regard.

A history of systemic disease (e.g., rheumatoid arthritis) that can manifest itself in the TMJ, ear infection, or trauma to the mandible (e.g., motor vehicle accident, altercation, difficult tooth removal, prolonged jaw opening during dental treatment) should be sought. The patient may be taking medications (e.g., phenothiazine tranquilizers) that can cause dystonic movements of the masticatory muscles or have a neuromuscular disorder (e.g., parkinsonism) in which involuntary dislocation of the TMJ occurs. The patient should be questioned about possible job, marital, or other interpersonal conflicts that might enhance stress-related habits (e.g., clenching, bruxism, habitual subluxation).

Basic Science

The normal function of the temporomandibular joint depends on coordination, both at rest and during mandibular movement, of joint position, masticatory muscle activity, and occlusion of the teeth. Highly sensitive proprioceptive nerve endings in all these structures provide input that maintains equilibrium of function in the normal state. In such a delicately balanced anatomic area of the body, improper function is easily initiated in the susceptible patient.

Aside from injuries and systemic illnesses that occasionally involve the TMJ, the vast majority of disorders are stress related. Parafunctional habits (e.g., bruxism, clenching) are responsible for sustained contraction of masticatory muscles, which can become self-perpetuating and chronic (the so-called myofascial pain–dysfunction syndrome, or MPDS). The vast majority of MPDS patients are young, otherwise healthy females.

Sensory nerve supply to the TMJ is principally from branches of the auriculotemporal nerve, a component of the mandibular division of the trigeminal nerve. Pain from disease in the mandible or mandibular teeth can, therefore, easily be referred to the preauricular area and misinterpreted as originating from within the TMJ. Conversely, intra- or periarticular TMJ pain may be perceived by the patient as an “earache,” and treatment may be sought on that basis.

Clinical Significance

The differentiation of pain originating within the joint from that coming from extraarticular structures is essential to successful treatment. The distinction cannot always be made from the history, however, and both intra- and extraarticular structures may be involved simultaneously.

The patient with stress-related MPDS usually complains of constant, dull pain that may or may not be exacerbated by mastication or mandibular movement and relieved by jaw rest. Quite often, this pain is worse in the morning, if related to nighttime parafunctional clenching or bruxism. The patient with intraarticular TMJ pain due to arthritis has the pain relieved by jaw rest and may be pain free except when moving the mandible or masticating solid food. Unfortunately, intraarticular TMJ disease often involves the masticatory muscles secondarily so that both types of pain (intra- and extraarticular) are experienced simultaneously by the patient.

Joint noise during function is highly suggestive of intraarticular disease. Grinding or crepitus often indicates an arthritic or other degenerative process and is caused by contact of roughened bony surfaces during function. Clicking or popping in the joint is usually associated with displacement of the fibrocartilaginous disk (meniscus) that separates the joint into upper and lower compartments.

Limitation of mandibular opening may be due to reflex spasm of masticatory muscles secondary to MPDS, to fibrous or bony ankylosis of the joint, to fracture of the mandibular condyle, or to total anterior displacement of the joint meniscus that blocks normal forward movement of the mandibular condyle.

References

1. Kaye LR, Moran JH, Fritz ME. Statistical analysis of an urban population of 236 patients with head and neck pain II. Patient symptomatology. J Periodontol. 1979;50:59. [PubMed: 284114]

2. Laskin DM. Etiology of the pain-dysfunction syndrome. J Am Dent Assoc. 1969;79:147. [PubMed: 5254545]

3. Meyer RA. Successive extrapyramidal reactions to two phenothiazines in one patient: report of case. Oral Surg. 1970;30:48. [PubMed: 5269803]

4. Meyer RA. Temporomandibular joint sequelae of mandibular condylar fractures in adults. In: Jacobs JR, ed. Maxillofacial trauma: an international perspective. New York: Praeger, 1983.

5. Travell J. Temporomandibular joint pain referred from muscles of the head and neck. J Pros Dent. 1960;10:745.

Temporomandibular Joint Pain – Clinical Methods

Definition

Pain or other discomfort may arise in or around the articulation of the mandibular condyle with the glenoid fossa of the temporal bone. The pain may be mild or severe, acute or long-standing, and sharp or dull in character. Facial pain originating from the area of the temporomandibular joint (TMJ) may be due to intraarticular disease, disorders of adjacent structures outside the joint, or a combination of both.

Technique

Question the patient about the character of the pain and whether it remains localized or spreads to adjacent areas such as the ear, angle of the mandible, or neck. TMJ pain is often a dull, constant ache that is aggravated by opening the mandible or chewing. There may be a complaint of limited jaw opening and frequent “clicking,” “popping,” or “grinding” noise within the joint associated with mandibular movement or mastication. Associated symptoms may include tinnitus, changes in hearing, facial numbness, and headache. Symptoms may be worse in the morning, particularly if the patient clenches or grinds the teeth during sleep. Questioning of the patient’s bed partner is helpful in this regard.

A history of systemic disease (e.g., rheumatoid arthritis) that can manifest itself in the TMJ, ear infection, or trauma to the mandible (e.g., motor vehicle accident, altercation, difficult tooth removal, prolonged jaw opening during dental treatment) should be sought. The patient may be taking medications (e.g., phenothiazine tranquilizers) that can cause dystonic movements of the masticatory muscles or have a neuromuscular disorder (e.g., parkinsonism) in which involuntary dislocation of the TMJ occurs. The patient should be questioned about possible job, marital, or other interpersonal conflicts that might enhance stress-related habits (e.g., clenching, bruxism, habitual subluxation).

Basic Science

The normal function of the temporomandibular joint depends on coordination, both at rest and during mandibular movement, of joint position, masticatory muscle activity, and occlusion of the teeth. Highly sensitive proprioceptive nerve endings in all these structures provide input that maintains equilibrium of function in the normal state. In such a delicately balanced anatomic area of the body, improper function is easily initiated in the susceptible patient.

Aside from injuries and systemic illnesses that occasionally involve the TMJ, the vast majority of disorders are stress related. Parafunctional habits (e.g., bruxism, clenching) are responsible for sustained contraction of masticatory muscles, which can become self-perpetuating and chronic (the so-called myofascial pain–dysfunction syndrome, or MPDS). The vast majority of MPDS patients are young, otherwise healthy females.

Sensory nerve supply to the TMJ is principally from branches of the auriculotemporal nerve, a component of the mandibular division of the trigeminal nerve. Pain from disease in the mandible or mandibular teeth can, therefore, easily be referred to the preauricular area and misinterpreted as originating from within the TMJ. Conversely, intra- or periarticular TMJ pain may be perceived by the patient as an “earache,” and treatment may be sought on that basis.

Clinical Significance

The differentiation of pain originating within the joint from that coming from extraarticular structures is essential to successful treatment. The distinction cannot always be made from the history, however, and both intra- and extraarticular structures may be involved simultaneously.

The patient with stress-related MPDS usually complains of constant, dull pain that may or may not be exacerbated by mastication or mandibular movement and relieved by jaw rest. Quite often, this pain is worse in the morning, if related to nighttime parafunctional clenching or bruxism. The patient with intraarticular TMJ pain due to arthritis has the pain relieved by jaw rest and may be pain free except when moving the mandible or masticating solid food. Unfortunately, intraarticular TMJ disease often involves the masticatory muscles secondarily so that both types of pain (intra- and extraarticular) are experienced simultaneously by the patient.

Joint noise during function is highly suggestive of intraarticular disease. Grinding or crepitus often indicates an arthritic or other degenerative process and is caused by contact of roughened bony surfaces during function. Clicking or popping in the joint is usually associated with displacement of the fibrocartilaginous disk (meniscus) that separates the joint into upper and lower compartments.

Limitation of mandibular opening may be due to reflex spasm of masticatory muscles secondary to MPDS, to fibrous or bony ankylosis of the joint, to fracture of the mandibular condyle, or to total anterior displacement of the joint meniscus that blocks normal forward movement of the mandibular condyle.

References

1. Kaye LR, Moran JH, Fritz ME. Statistical analysis of an urban population of 236 patients with head and neck pain II. Patient symptomatology. J Periodontol. 1979;50:59. [PubMed: 284114]

2. Laskin DM. Etiology of the pain-dysfunction syndrome. J Am Dent Assoc. 1969;79:147. [PubMed: 5254545]

3. Meyer RA. Successive extrapyramidal reactions to two phenothiazines in one patient: report of case. Oral Surg. 1970;30:48. [PubMed: 5269803]

4. Meyer RA. Temporomandibular joint sequelae of mandibular condylar fractures in adults. In: Jacobs JR, ed. Maxillofacial trauma: an international perspective. New York: Praeger, 1983.

5. Travell J. Temporomandibular joint pain referred from muscles of the head and neck. J Pros Dent. 1960;10:745.

Treatment of TMJ diseases in Tver

Few people know how complex the temporomandibular joint (TMJ) is, how it works, what functions it performs, how many muscles provide movement of the lower jaw. Pain in the neck, in the area of ​​the nose and eyes, headaches, spasms of chewing muscles are rarely associated with dentistry. As a rule, all problems associated with TMJ are solved surgically. Or they endure.

In fact, difficulty opening the mouth, crunching, clicking in the TMJ and many other problems can be solved by the dentist. Accordingly, improper dental treatment, performed without regard to the TMJ, can add problems to the patient where he does not expect them.

Let’s look at everything in order.

Biomechanics of lower jaw movements

You must have bitten your lip or cheek. Did you notice that your teeth instantly opened long before you had time to figure out what happened? The dentoalveolar system behaves similarly if a bone is found in food or if a tooth is broken.

This is due to the special property of the periodontium – the tissue that lines the space between the root of the tooth and the bone. The periodontium contains pressure sensors that automatically transmit signals to the central nervous system. Having detected a failure, the brain instantly gives a command to the chewing muscles.

More than two dozen muscles are involved in the movements of the lower jaw, including the tongue. Most chewing muscles are paired: left and right. For comparison: flexion of the knee joint is provided by six muscles, extension – by two.

It should be noted that chewing muscles are the strongest muscles in the body. A modern person can afford to keep all other muscles in a relaxed state, but these inevitably “train” at least several times a day. Some go to the refrigerator even at night. Pulling nails out of boards or holding a bus cable with your teeth is not a trick, but a conscious use by tricksters of the physiological characteristics of the masticatory muscles: their enormous strength.

The temporomandibular joint is the only paired joint in the body: the lower jaw is connected to the upper jaw in two places. Both joints are not rigid. The gap between the articular heads of the lower jaw and the articular cavities located on the skull fills the cartilaginous disc – the meniscus. It provides smooth rotation, and also performs the function of a shock absorber – a bearing and a silent block in one bottle. At the same time, it not only serves as a gasket, but accompanies the movements of the head of the lower jaw, ensuring its smooth movement, increasing the safe wide opening of the mouth. The movement of the disc, the synchronism of its course, together with the lower jaw, is controlled by a special muscle – musculus pterygoideus lateralis (lateral pterygoid muscle).

Two-phase closing of the mouth

Opening and closing of the mouth on the principle of a simple hinge (similar to a door hinge) occurs in only 14% of people. In the vast majority of cases, when closing the mouth, the rotational movement in the joint ends with the contact of only a few teeth (sometimes with the contact of several tubercles on several teeth). But the process of closing the mouth does not end there. Further, the lower jaw is displaced along the plane of closure of the teeth (it is called

occlusal plane) to the tightest possible contact of all teeth. In this case, the heads of the lower jaw are displaced inside the articular cavities. Depending on how the antagonist teeth relate to each other, the lower jaw can move forward, backward, sideways, the muscles can rotate it and warp it in three-dimensional space.

The two phases of closing the mouth can be compared to parking a car. The rotational movement of the lower jaw is the entrance to the parking lot. Then follows the search for a free space and taxiing into it. If the cars are standing at random, a huge SUV is blocking the passage somewhere, there is a hole somewhere in the asphalt, then the path through the parking lot can be long, and taxiing into the parking pocket may require several complex forward-backward-right-left movements. 90% of all accidents happen in the parking lot. Even experienced drivers “level” the path for their cars at the expense of bumpers, and sometimes more significant parts of cars.

In the final phase of closing the mouth, the teeth of the lower jaw move through the tubercles and fissures of the teeth of the upper jaw. Only this is not one car, but a whole motorcade.

Normally, the upper and lower dentitions fit perfectly to each other, so the “parking” of the lower jaw is trouble-free. Unfortunately, anomalies (an abnormal initial state) and pathologies (a change in the normal state) are common. If there are defects in the dentition, movement of neighboring or antagonistic teeth towards the defect, incorrect prostheses or fillings, when moving “in the parking lot”, the lower teeth will stumble upon obstacles in the form of upper teeth, crushing both themselves and their antagonists.

Having imagined this small aspect of biomechanics, we can already understand that any pathology in the dentition will inevitably lead to a noticeable abrasion of the teeth, their displacement, displacement of the lower jaw from its normal position laid down by nature, to deformation of the TMJ meniscus, to overload some chewing muscles and other problems. Increased muscle tone can cause pain, limit the movement of the lower jaw, dislocate the TMJ in one or both joints. Further more. Jaw movements can become spasmodic, accompanied by a crunch and clicks. Dislocations of the mandible may occur. Deformation of the bones of the lower and upper jaws may occur. Organic changes may occur in the elements of the TMJ – the surfaces of the articular heads of the lower jaw and the articular cavities of the upper jaw will eventually resemble the state of Russian roads. Such defects are difficult to correct even by surgeons.

Influence of dental treatment on the TMJ

Any dental treatment changes the nature of the occlusion of teeth (occlusion scheme) – puts antennas, spoilers, towbars, trailers on cars, turns them around in the parking lot, evacuates cars, puts others in their place, digs holes, patches asphalt parking. It may be that a dental restoration interferes with the movement of the mandible.

Loss of a tooth or an over-ground filling (“to keep it out of the way”) deprives the opposing tooth of contact or, as dentists say, of support. Feeling no contact, the muscles continue to pull the lower jaw further, distorting it and causing overload on other teeth.

If the filling or crown of an artificial tooth is slightly above the natural level, it will cause premature contact. This is even worse, since in this case the pull of the muscles will be much stronger. Due to functional overload, both the restoration and the antagonist tooth will collapse. In addition, premature contact becomes an additional axis of rotation. Trying to tightly close the teeth, chewing muscles will pull the heads of the lower jaw out of the articular cavities, injuring the joint.

1. The total vector of muscle thrust.
2. Rotation of the lower jaw along an axis passing through the heads of the lower jaw.
A.3. Tight multiple contact – rotational movement of the mandible is completed.
B.3. Premature contact – the muscles continue to pull the lower jaw, the head of the lower jaw dislocates from the articular cavity.

It should be noted: the size of the interference felt by the patient is 8 microns.

All patients want to get rid of their dental problems as quickly as possible, preferably with the snap of a finger or the wave of a magic wand. Of course, the cost of dental treatment should tend to zero. Unfortunately, very often dentists follow the lead of their “customers”, offering simple, universalized methods of treatment. Especially acutely now, for example, this is manifested in orthodontics. Manufacturers of orthodontic equipment offer braces programmed to align teeth in their ideal position – in the so-called “Hollywood smile”. And orthodontists are happy: you don’t have to think much, the system itself will “put your teeth in the right places.”

With good luck, the result of such treatment may look beautiful, but it rarely corresponds to the biomechanical laws and anatomical features of a particular patient. As a result, after some time, the teeth “spread” again, and the jaw goes into a forced position.

The deterioration of the patient’s condition caused by the actions of a doctor is called iatrogenic.

Among such long-term complications arising from orthodontic treatment are cracking, mobility, unpredictable tooth movements, exposure of their roots, the appearance of wedge-shaped defects and much more. One of the most formidable and painful complications is just dysfunction of the temporomandibular joint.

Stress and the dental system

We all react differently to stress, pain, and discomfort. To put it more rigorously, we have different adaptive capacities. Some part of patients will be able to adapt (get used) to dental restorations performed without taking biomechanics into account. But most people will get the problems described above, which dentists call “TMJ dysfunction syndrome.”

Bruxism has a huge impact on the condition of the teeth and, accordingly, the TMJ – involuntary clenching or grinding of the teeth during sleep, in stressful situations or during hard work. In the literature, another term is often used – the parafunction of masticatory muscles..

Through the work of masticatory muscles, the body uses up chemical compounds that accumulate in the blood due to stress (stress mediators). It should be noted that with bruxism, the nature of the sliding of the teeth over each other is very different from the movements during chewing, and the force and time of muscle contraction are much greater. Bruxism results in catastrophic tooth wear. In the WHO classification, bruxism is classified as a group of mental disorders (F45.8). But the most authoritative ideologists of modern dentistry attribute bruxism to the functions of the dentition and, accordingly, consider it a mandatory requirement for dental treatment to provide this function.

Director of Denta-Lux Training Center Candidate of Medical Sciences, Associate Professor, Master of Science N.B. Lopukhova delivers a lecture on “Realization of psychological stress: bruxism and occlusion” at the Vladimir Novikov Training Center (Moscow), 2013.

Other factors affecting the health of the TMJ

It is no secret that all people have genetic differences. Dentists divide the facial skeleton into three classes. The bite can be deep, closed, open… excuse me, orthognathic, progenic, biprognathic, etc. Over time, the facial skeleton and dentoalveolar system undergo several phases of growth and development. The muscles of the dentoalveolar system are involved in maintaining the head and shaping the posture of a person.

Within the framework of this article, it is impossible to consider all the factors affecting the state of the temporomandibular joint. We need to finally move on to the question: how can dentists help patients with TMJ dysfunction?

Gnathology and the harsh Russian reality

Relationships between organs and tissues of the dentoalveolar system are studied by a relatively young branch of medical science — gnatology (from the Greek words γνάθου — jaw and λόγος — meaning, reason, basis). Like any science, gnatology has its own subject (object), tasks, theories, ways to test them, research methods. And, of course, the goal is to develop methods for diagnosing and treating patients, testing their effectiveness, creating devices, tools and materials.

Alas, most Russian dentists have heard only ringing about gnatology. In 2011,

The Ministry of Education and Science of the Russian Federation, by its order, approved the educational standard for the specialty “Dentistry”. The basic (mandatory) part of the educational program, in the section “As a result of studying the disciplines of the basic part of the cycle, the student must know” included the item “occlusion, biomechanics of the dentoalveolar system, gnathology”. Not a single university fulfilled this requirement for a banal reason: there were no gnathologists in the country. There was no literature, no methodological plans, no manuals, no teachers. As a result, in February 2016, a new educational standard was approved, in which the training program for dentists was at the mercy of the universities themselves. For the same reasons, Russian universities with relief refused to teach gnathology.

Implementation of the gnathological approach into the practice of Denta-Lux

An urgent need forced the Denta-Lux holding to master the methods of gnathology. The desire to provide quality medical care, to get good long-term results, moved us to the European protocol, forced us to follow the achievements of world dentistry and introduce advanced methods that have proven their safety and effectiveness into everyday practice. It was possible to obtain the necessary knowledge only from foreign colleagues, Denta-Lux specialists attended training courses of world luminaries both in Russia and abroad.

In 1996 we purchased the first articulator. They themselves translated the instructions, trained a dental technician. At first, we used the articulator only for making prostheses, thus improving the results of prosthetics. Since 2005, we have been using the articulator in functional diagnostics. Since 2006, Natalya Bertovna Lopukhova, Director of the Denta-Lux Training Center, Candidate of Medical Sciences, Associate Professor of the Department of Orthopedic Dentistry of the TSMA, began to lecture her students on clinical gnathology. In 2007, she spoke at the XVIII All-Russian Scientific and Practical Conference

“Stomatology of the XXI century”, organized according to the order of the Ministry of Health and Social Development No. 533. The report was highly appreciated by colleagues, including Professor Valentina Alexandrovna Khvatova, the author of the only book in Russian at that time on clinical gnathology. In 2008, Natalya Bertovna entered the Danube University on the course of Professor Rudolf Slavichek, the author of the concept of “New Gnathology”, a year later she received the title of Academic Expert in the field of function and dysfunction of the dentition, and a year later she successfully defended the Master Thesis and received the title of Master of Science. All the knowledge received from world authorities, Natalya Bertovna immediately transferred to the doctors of Denta-Lux. Our specialists have learned to see signs of bruxism, functional overload of teeth and other symptoms in the clinical picture that require consultation with a gnathologist. Gnathological consultation and various methods of functional diagnostics were introduced into the list of holding services. The holding acquired the necessary equipment and tools, and most importantly, invaluable experience in treating patients with dysfunction of the temporomandibular joint.

Methods for the diagnosis and treatment of TMJ dysfunctions

Our experience shows that the treatment of patients with TMJ disorders is very painstaking, delicate and usually lengthy. Symptomatic treatment (elimination of pain and restriction of mouth opening without eliminating their causes) brings only a temporary and weak effect or is useless at all. Identifying and eliminating the causes of problems is fundamental to success in treatment.

To correct problems in the TMJ, the most important thing is to position the lower jaw in a position in which movements in the joint will be unhindered, smooth and free. Dentists call this position of the lower jaw therapeutic.

• Psychotherapeutic training

As a rule, patients who are pretty worn out by life, with nervous work, with stressful living conditions, who have managed to beat the thresholds of dental clinics, tired of discomfort and pain, with a shaken psyche, seek treatment for TMJ dysfunctions. Whether the mental characteristics of the patient really lead to excessive abrasion of teeth and subsequent problems in the joint, or, conversely, problems in the TMJ make a person nervous, it is impossible to say. It’s a snowball, one thing clings to the other. Therefore, the first and most important task in the treatment of TMJ is to calm down, trust the doctor and be patient. It is very likely that joint treatment by a dentist and a neuropsychiatrist or psychiatrist will be required. You may need psychological help before dental treatment.

After the patient and his attending physicians make sure that he is mentally prepared, you can proceed to solve the following tasks.

• Computed tomography

The condition of the bones of the temporomandibular joint can be assessed using computed tomography. “Denta-Lux” uses a “Rayscan Symphony Alpha Sm3D” cone beam computed tomograph with a cephalostat from the South Korean company “Samsung”.0003

• Magnetic resonance imaging

Relatively recently, the Denta-Lux holding established cooperation with the MRT-Expert medical center. Now, in the arsenal of tools that our doctors can use if necessary, there is also a functional MRI.

This diagnostic method allows you to determine the condition of the soft tissues that ensure the functioning of the joint: muscles, ligaments, joint capsule, TMJ meniscus, etc.

• Palpation of masticatory muscles

A dentist can obtain preliminary information about the displacement of the lower jaw by examining the condition of the muscles of the facial skeleton. Palpation will reveal asymmetry, show the tone of the masticatory muscles, soreness, pain points, the nature of the spread (irradiation) of pain.

• Splint therapy

Splint therapy can eliminate the increased tone of the masticatory muscles and stop muscle pain.

As we said earlier, in the final phase of closing the mouth, the muscles pull the lower jaw to the maximum tight contact between the teeth. Defects in the dentition lead to a lack of uniform contact and reflexively force the muscles to move the jaw into an adapted or forced position. Over time, a vicious spastic stereotype is fixed in the muscles. Increased muscle tone causes pain. To eliminate them, it is necessary to relax (relax) the muscles.

To fool the muscles, dentists came up with a little trick. If a hard flat plate is laid between the teeth, which cannot be bitten through, the muscles will not be able to press the lower jaw into a forced position. The developed stereotype will fade away over time, the muscles will begin to work symmetrically, positioning the jaw in a central position.

This is just an idea, a principle underlying splint therapy. Due to defects in the dentition, the plate is unlikely to be installed evenly. In fact, the doctor, based on the real clinical picture, makes a special splint with a complex surface. In the literature, a splint can be called an occlusive splint. This is true, a splint is a kind of occlusal splint, done in order to separate the teeth of the upper and lower jaws and relax the masticatory muscles.

The rules for modeling the surface of the splint is a whole art, and the doctor who mastered it is a maestro. Keep this in mind when choosing a doctor and medical organization.

As a rule, the splint is put on at night. If there are indications, the doctor may prescribe the wearing of a splint during the day. Using a properly made splint relieves symptoms in just a few days. As a rule, gnathologists allocate three to four weeks for the stage of splint therapy.

The elimination of pain, clicking, crunching, the patient gaining freedom of movement in the TMJ signals to the doctor that the optimal therapeutic position of the lower jaw has been found. Ideally, it corresponds to the initial position, but more often, due to the deformation of the tissues of the TMJ, it still differs from it.

The doctor must determine the main parameters of the found position: the angle of the occlusal plane, the height of the dentition, free space, and others. Having received the necessary data, the doctor can begin to choose the methods of dental rehabilitation and treatment planning.

• Variator

Relatively recently, articulators began to be equipped with additional devices that allow simulating the displacement of the heads of the lower jaw. Dentists operate with small values: millimeters, their tenths and hundredths. Obviously, the smooth operation of these devices determined their name. Like automobile devices for continuously variable transmission of torque from the engine to the wheels, these dental devices are called variators.

Using the variator, the dentist can experiment in his office, saving the patient time and nerves. The search for the therapeutic position of the lower jaw is greatly facilitated, the accuracy of manufacturing occlusal splints is increased, and the time of wearing the splint is reduced. Thanks to the variator, the patient parted with his problems much faster.

• Brax check

Dental restoration should provide not only free and comfortable opening and closing of the mouth, but also other functions of the dentition. Including bruxism.

To determine the nature of bruxism, the places most affected by it, scientists have developed many different methods – from the study of wear facets on dental models, to somnological studies of brain activity. The most convenient and informative method is to use a marriage checker.

Based on the individual patient’s teeth, the dental technician makes a thin tray that fits snugly to the teeth. The patient puts it on at night, in rare cases – during the day during intensive work. Due to the parafunction (perverted function) of the masticatory muscles, the kappa is rubbed in some places. Having studied the flaws on the marriage checker, the doctor understands how his patient’s teeth suffer, which teeth are in overload, and which are in disocclusion (separated).

• Gnathology modeling

Later, at the stage of modeling the surfaces of dental restorations (fillings, inlays, prostheses), the dental technician and dentist will recreate such an occlusal scheme in which all teeth will contact their antagonists evenly – harmonious occlusion. Sounds nice, right?

In addition, the occlusal scheme must be symmetrical, correspond to the type of the patient’s facial skeleton, his age, stage of development, provide free functional space – in a word, keep the “parking lot” in perfect condition. This approach to modeling the surfaces of dental restorations is called gnathological.

• Axiography

One hundred years ago, dentists began to look for ways to record the movements of the lower jaw. Today, dental science offers doctors various devices that allow them to visually see how the lower jaw moves when chewing and during conversations. The American school calls them axiographs (from the Latin word “axis” – “axis” and the Greek “γράφω” – “I write”), the European school calls them condylographs (from “κόνδυλο” – “condyle” and “γράφω” – “I write”).

“Denta-Lux” to study the biomechanics of the lower jaw of patients with TMJ dysfunction uses the Cadiax hardware-diagnostic complex manufactured by Gamma (Austria).

The data obtained during axiography provide both qualitative and quantitative characteristics of all movements of the lower jaw. They can be visualized on the monitor screen in the form of graphs or tables, or even an animated 3D model. These data become parameters for setting articulators and variators.

Stop enduring pain, clicking and crunching while chewing and talking! Today, patients with TMJ dysfunction have real chances to correct the “fictitious effects”. Denta-Lux holding specialists have a wide range of tools and have accumulated rich experience in diagnosing and treating problems of the temporomandibular joint in a non-surgical way. Our capabilities + your positive attitude = this is the formula for inevitable success.

MRI TMJ in dentistry | MRI Expert

An integral component of dental and, as a result, general health, is the normal function of the temporomandibular joints (TMJ). To date, the prevalence of TMJ diseases in the population is quite high.

The most common cause of TMJ dysfunction is internal damage and disruption of the normal anatomical relationship between the articular disc and condyle of the mandible.

Clinically, dysfunction manifests itself as impaired mouth opening, crunching when moving the lower jaw, tension in the muscles of the head and neck, the appearance of “trigger points”, headache (and the pain can be so severe that they are often confused with migraine).

Precise localization of the articular disc is very important in assessing TMJ injury and can be easily determined using MRI.

In this case, the anterior displacement of the articular disc is determined in 34% of healthy volunteers, and the normal position of the articular disc is only in 16-23%.

At an early stage, the disc retains its shape. Over time, a damaged disc deforms.

More often, the deformation occurs in the form of thickening of the posterior zone and thinning of the anterior and intermediate.

Each examination performed must be done in 2 positions – with a closed and an open mouth.

Oblique-sagittal view with closed mouth. Normal TMJ.

The articular disc is not deployed, its back part is located at 12 o’clock of the condyle.

Normal disc mobility

Open mouth position. The condyle has shifted ventrally, to the level of the glenoid fossa. At the same time, the articular disc retained the normal position of the interposition, preventing the bone structures from directly contacting each other.

Disk offsets.

Distinguish between anterior, anterior-lateral, anterior-medial, lateral, medial and posterior displacements; the most commonly diagnosed is anterior disc displacement.

Disc dislocations – fixed and intermittent (subluxation).

In fixed dislocation, the disc is displaced anterior to the condyle in both open and closed mouth positions; with intermittent dislocation (subluxation), the disc is displaced anteriorly only when the mouth is closed. When the mouth is opened, the disc returns to its normal position of interposition between the condyle and the articular tubercle. At the same time, a characteristic click is heard.

Intermittent (reduced) dislocation / subluxation.

A. Closed mouth. Forward displacement of the disk.
B. The mouth is open. The disc returned to its normal position between the condyle and the temporal bone.

Fixed (unreduced) dislocation.

A. Mouth closed. Forward displacement of the disk.
B. The mouth is open. The disk continues to be displaced.

Stuck disc.

Jammed disc. PD sag images with open (A) and closed (B) mouth – the posterior edge of the disc (arrow) remains in the mandibular fossa of the temporal bone. For this reason, the opening of the mouth is severely limited. The likely cause is the formation of adhesions.

Rear disc offset.

Posterior disc displacement (less than 0.01% of all TMJ pathologies).