Temporomandibular Mandibular Dysfunction
Introduction
Temporomandibular dysfunction (DTM) account after the origins of dental pain the most common cause of orofacial pain.
This disease has been named in many ways: Costen syndrome, syndrome myofascial, Temporomandibular Disorder Mandibular, Désordre Skull-Mandibulaire (DCM), Dysfunctional Algo syndrome masticatory system (SADAM), Neuralgia and dysfunction of masticatory system (ADAM), Troubles musculo-squelettiques of the appareil manducateur, Dysfunctions of the masticatory system (DAM).
In an international harmonization worries, it is now called temporomandibular dysfunction.
DTM definition
A temporomandibular dysfunction (DTM) is defined as a disorder mandibular
dysfunctional, expression of myopathy and or joint or the masticatory system.
DTMs have joint forms, muscle forms and are often
combined musculo-articular. The diagnosis of DTM is defined by the presence of at least one of these three signs:
– Loud noises in the temporomandibular joint in the jaw movements (slam, crackling or crackling).
– facial pain modulated mandibular function may include joint pain, or muscle pain.
– abnormal mandibular kinematic: limitation, deviation or deflection of the normal movements of the mandible.
Review, based on 6 cohort studies from 5 pays, showed that pain in the temporomandibular region affected 11.3% of women and 6.5% men. Swedish epidemiological data confirmed the prevalence: 12.7% among women and 6.7% at men's.
anatomy
To understand this disease, it is necessary to have some anatomy notions of the area in question. It is generally of the upper and lower jaws, joints that allow the movements of the lower jaw relative to the upper one and muscles that actuate these same movements.
the bone
The maxillary bones support the teeth of the dental arch top. the mandible, single moving bones of the face supports the dental arch bottom.
The temporomandibular joints
They unite the mandible to the temporal bones, they are even and symmetrical. They allow the movement of the mandible relative to the maxillary bones.
They contain within them a cartilaginous articular disc which facilitates movement and left the constraints of the articular surfaces. The function of the articular disc is similar to that of the menisci of the knee.
Muscles
Their contraction causes movement of the mandible. There are the levator muscles of the mandible, that close the jaws.
– temporal muscles at the temples
– masseter muscles at the corners of the mandible
– pterygoid medial equivalent masseter muscles to internally
Depressants depressor muscles of the mandible, which open the jaws.
– muscle digastrique
– muscle mylo hyoidien
– muscle genio hyoidien
And there's the lateral pterygoid who have a complex and essential role in the. they own 2 beams and fit especially on the articular disc.
The dental articulation
this is the way the lower dental arch is articulated with the upper dental arch when the jaws are closed. It is dependent on how the mandible jaw faces but also the way the teeth of the arch top faces the teeth of the lower arch.
Causes
Bruxism is the most common cause of DTM. These repetitive involuntary contractions of masticatory muscles without food goal. These contractions may cause different movements of the jaws relative to each other such as tightness, squeaks, tonic movements, advanced movements / Reversing the lower jaw. These contractions can occur day or night.
Over time these contractions "useless" from a functional point of view of sound adversely on the joints, muscles and teeth.
the dental articulation disorders can in some cases lead to stresses in the temporomandibular joints and implement positioning reflex patterns mandibular joint and muscle stress in becoming pathological term. An example might be closer to this phenomenon is that of a wobbly chair whose structure is weakened if subjected to repeated stresses.
Evolution
The long-term evolution of the DTM is random. The symptoms can be stabilized and regress with appropriate treatment; Ideally also is to control the causes which is not always possible.
treatments
Drug therapy
drug treatments are largely symptomatic, they do not treat the cause. These painkillers, anti-inflammatory and muscle relaxants.
Physical therapy / rehabilitation
Physical therapy reduces muscle pain through massage. Rehabilitation helps recondition the patient.
– Relaxing the muscles of mastication
– Observe and reduce parafunctions
– Avoid excessive jaw movements
– Maintain a soft diet and chew with caution when painful episodes
– alternately mastication
– Improve posture and sleep
Botulinum toxin
This treatment is very effective when bruxism is causing DTM. Treatment is chewing on the partial paralysis of the muscles with botulinum toxin. This toxin is injected transcutaneously at masticatory muscles.
In most cases the injected muscles are: the temporal and masseter. These injections depending on the dose used to significantly reduce the strength of these muscles. This does not remove the muscle contractions but significantly decreases the intensity which reduces the effects of bruxism
Gutters and re-equilibration occlusal
There are several types of gutter can be useful in the DTM, however it is not recommended for use in the long term. Using a dentist to correct the dental articulation disorder may be appropriate in some cases.
Surgery
The need for surgery in the DTM is exceptional. It is conceivable only in very special cases, particularly if there are disturbing and significant abnormalities of bone relationship between the jaws.
