Temporomandibular disorders (TMD)

Temporomandibular disorders (TMD) are one of the most widespread illnesses in general population. According to many researches, about 50% or even 80% of general population have signs of TMD. Depending on the biological capacity of organism adaptation, the symptoms of TMD either appear or do not appear. There are many causes of TMD, from skeletal anomalies, systemic and idiopathic causes to misalignment of teeth, wrong fillings, prosthetic jobs, etc. They all lead to neuromuscular imbalance which causes TMD.

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Symptoms of TMD:

  • Clicking and creaking in the temporomandibular joint
  • Pain in the area of temporomandibular joint and masseter muscles
  • Loss of strength in masseter muscles
  • Inability of mouth opening
  • Tooth wearing and increased tooth mobility

Bruxism

Apart from TMD which affect the temporomandibular joint, masseter muscles and teeth, bruxism is the illness quite widespread today in general population. Bruxism describes excessive grinding and clenching of teeth. It is most present during sleep when much stronger chewing forces can develop than in awake state. The cause of bruxism is of psychosomatic nature (most commonly it is connected with stress).

bruxism

Symptoms of bruxism are:

  • Wear of hard teeth tissues (enamel)
  • Pain and increased tooth sensitivity
  • Lowering of vertical occlusion dimension (lowering of the lower face third)
  • Thickening of masseter muscle points of attachment
  • Pain in the masseter muscles

The diagnosis of TMD and bruxism is established by history and clinical examination, as well as by specific examinations, analysis of chewing system function, which result in tissue-specific diagnosis.
For a presentation on the analysis of the functioning of masticatory system click here

Diagnostics of TMD and bruxism:

  • Clinical function analysis (RDC clinical protocol)
  • Manual function analysis
  • Instrumental function analysis (articulator)
  • X-ray diagnostics (CT, MRI)

TMD and bruxism therapy can be temporary and permanent. Temporary or reversible therapy consists of making occlusal splints. Occlusal splints are appliances made of hard plastics worn on upper or lower jaw. Depending on the type of a splint and its purpose, the therapy lasts from 2 weeks to 1 year. Sometimes, several of them have to be made. The most frequent types of splints are worn for 6 months.
For a presentation on making occlusal guards click here

Types of splints:

  • Relaxation
  • Stabilisation
  • Protrusion

Upon completed therapy by occlusal splints, the permanent or irreversible therapy starts – most frequently parodonthological, orthodontic and prosthetic therapy.

TMD or bruxism diagnostic procedures and therapies:

a. history and status
b. clinical functional analysis (manual functional analysis)
c. establishing definitive or working diagnosis
d. Possible referral of a patient to X-ray (OPG, CT, MRI)

a. teeth impressions of the upper and lower jaw
b. determining interjaw relationships (buccal arch, centric registrate)

a. re-montage of the occlusal splint made in the dental laboratory
b. giving the occlusal splint to a patient

a.check-up of wearing an occlusal splint

a.check-up of wearing an occlusal splint

a. check-up of wearing an occlusal splint

a. check-up of wearing an occlusal splint
b. re-evaluation of occlusal splint therapy
c. possible decision on permanent or irreversible therapy

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