Temporo Mandibular

Symptoms arising from disordered function of the Temporo Mandibular (jaw) Joint (TMJ) are many and varied. Medical causation is similarly complex and etiological factors can usefully be grouped[1] as a) anatomical, b) pathophysiological and c) psychological.

PRACTICE POINT

Temporo Mandibular Dysfunction compromises many different syndromes with a wide range of physical and psychological causal factors

Finnish researchers[2] have documented the magnifying effect of clinical depression on symptoms of Temporo Mandibular Dysfunction (TMD), particularly in women patients, who greatly outnumber men. A US team[3] studied a number of psychological differences in addition to Depression between TMD sufferers and controls.

PRACTICE POINT

In clinical populations of Temporo Mandibular Dysfunction patients, trauma is not a major factor

A recent paper[4] attempted to quantify the contributions of various dental, traumatic and age factors in 2 large populations of women. Non-MVA trauma was a major factor in both displacement of the joint disc and excessive wearing (osteoarthrosis) of the joint surfaces. However, meta-analysis has found no excess of TemporoMandibular Dysfunction following conventional orthodontic treatment [4a,4b]. There was no support for propositions that orthodontic treatment in adolescence provokes or prevents TMD, nor for the claim that it is useful for treating TMJ disorders.

An Australian study[5] similarly concluded that road traffic accidents were an uncommon cause of TMD for which treatment was sought, and TMD was infrequently associated with cervical whiplash and jaw fracture. By contrast, a US team[6] which specifically looked for TMJ symptoms in cervical whiplash victims found them to be common, confirming an earlier Irish study (Medical Litigation News Volume 1, Issue 1).

PRACTICE POINT

In Post Traumatic TMD, it is prudent to corroborate the client’s account that symptoms first appeared after the injury by examination of pre-injury clinical records

Irish anatomists and bioengineers have provided[7] a useful analysis of the tensile, compressive and shear forces which act on the jaw joint during rearending MVA.

Since management of TMD has hitherto been the subject of much anecdote and authoritarian opinion but little science, other authors have attempted[9] to establish a more rational basis for therapy. As many different treatment approaches produce comparable results, they recommend a multidisciplinary, nonsurgical programme.

PRACTICE POINT

Traumatic cause and the litigation process predict resistance to treatment

Canadian researchers, finding significant differences in Post Traumatic TMD, endorsed[10] the multidisciplinary approach for this hard-to-treat group of patients. Another Canadian team also found[11] litigating patients more resistant to treatment than nonlitigating.