Research behind TMD?

1. 30 yrs ago, dentistry studied how teeth caused TMD-hammer sees nails-plumber sees pipes
2. 20 yr ago, studies revealed damage was joint-muscle-ligament-disc-bone support & teeth
3. 10 yrs ago, we treated began treating TMD as an orthopedic science

Tearing Lateral Ligament-TMD Disc

1. Clench & grind
2. Tension in muscles
3. Trauma
4. TMJ bracing due neck pain

Confusion Terms:

1. TMD=name of joint not disease,
2. TMD=broad collection structural damage all tissues chewing system
3. Internal Derangement= structural damage to TMD
4. Articular Disc Displacement = pathologies specific to disc
5. Relationship disc to condyle: mild----moderate----severe

Relationship disc to condyle

1. Mild =Partial Displaced Disc
2. Moderate = Completed Disc Displacement
3. Severe = Osteoarthritis

Mild disc displacement

1. Includes: Muscle discomfort & partial disc displacement
2. General dentist should treat or try prevent further damage
3. Dentist needs to study this area of health for their patients
4. Repeated recommendations prevent joint muscle damage
5. Tooth damage we can treat but joint muscle damage is difficult treat
6. Early mentioning of grind-clench makes appliances easier prescribe
7. Early recognition of accumulative damage to all 4 chewing structure
8. Early referral to OFPS in saga of atypical toothache reduces damage chewing structures
9. Early recognition of anxiety issues coupled w/ TMD issues makes refer easier
10. Recognition of accumulative trauma creates need for better history base

Moderate damage = need for referral to Orofacial Pain Specialist:

1. Moderate chewing pain
2. Restricted opening
3. Referred ear pain
4. Deviation opening
5. Facial asymmetry
6. Comorbid: Hypermobility, IBS, Sleep, Allergies, Sinus,
7. High anxiety, need dental sedation, fear dentistry, PTSD, OCD, Bipolar
8. Clenching & grinding
9. Neighboring pains: neck and headache
10. Atypical Toothache
11. Burning mouth
12. Trigeminal nerve injury
13. Atypical earache
14. Sleep apnea & TMD

Four primary factors

• Destructive Clench-Grind ( higher level grinding)
• Significant Tension muscles (back, neck, jaw, head)
• Trauma (MVA, Blows, Falls)
• Head & Neck pain (jaw muscle bracing due pain in neck or head)

Four secondary factors

• Open lock (subluxation TMD)
• Pain System Escalation
• Dual Bite (jaw jt bite vs tooth bite)
• Major Occlusal interferences-bite discrepancies

Tearing Lateral Ligament: assume 10, 000 fibers

1. Age 12-26: habit clench/ grind tears 2 fibers per week = 1248 fiber
2. Age 12-26: high muscle tension tears 1 fiber per week = 624 fibers
3. Total Para tears (1248) + Tension tears (624) = total 1872
4. MVA: moderate speed 25 mph: age 26 = tearing 828 fibers
5. Age 26 to 36, habit clench/grind tears 4 fibers per week = 2496 fibers.
6. Ager 26 to 36, tension in muscles tears 2 fibers per week =1248 fibers.
7. Total Para tear (2496) + Ten tear (1248) = total 3744
8. Total tearing by parafunction & tension muscles & MVA: 6444
9. By age 36, She has torn over half of fibers of lateral ligament of TMD & has complete displace disc