Checking for temporomandibular joint dysfunction

Cure For Tmj, Bruxing And Tooth Grinding

Bruxism Homeopathic Cure

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It is important to document any evidence of temporomandibular joint (I'M)) dysfunction prior to treatment, and inform the patient that the condition exists. Asymptomatic clicking is generally not treated prior to orthodontics, but monitored as treatment proceeds. If muscular imbalances and/or pain exist, and centric relation cannot be accurately recorded, then a phase of splint therapy and physical therapy is indicated prior to orthodontics. After the patient has been stabilized, orthodontic treatment can be commenced.

Patients should also be monitored during orthodontic treatment, in case I'M) symptoms develop. If these symptoms are managed when they first occur, prior to the formation of true internal derangement, then frequently normal 'I'MJ function can be re-established without permanent damage. If symptoms do develop, it is first beneficial to eliminate the use of all forces, such as headgear and elastics, while resolving the TM) problem. The patient is asked to remain on a soft diet, and use conservative measures to manage the symptoms.

If symptoms persist, then splint therapy and physical therapy can be initiated and orthodontic treatment delayed for a short period. Orthodontic treatment can then resume and proceed in a normal fashion with most patients. It is generally accepted that a seated and reasonably centered condyle position is the most beneficial position to establish during orthodontic treatment. Condyle position can be evaluated clinically with mandibular-positioning techniques, and radiographically with corrected tomography. While some clinicians feel that such radiographs are important in all cases, ihe authors do not routinely take tomographs unless symptoms are detected.

In most cases, minor changes can be made during the finishing stage of treatment to allow for correction of condyle and mandibular positions. For example, if the patient shows an anterior skid with a corresponding anterior condyle position, it is beneficial to continue with headgear or Class II mechanics for an additional period of time to eliminate the anterior skid and allow the condyles to seat in the fossae (Fig. 10.17).

Conversely, if the patient shows a significantly posterior condylar position with no evidence of an anterior skid, it is beneficial to provide a slight amount of anterior skid so that the condyle can be in a more centered position. This may be achieved by ceasing Class 11 elastics or headgear, or by the use of Class III elastics, and is particularly important in cases that show a Class III growth tendency (Fig. 10.18).

Finally, if the condyles are in a seated and reasonably centered position, with the dentition in a settled Class I position, appliances can be removed. This should allow normal TMJ development and function after orthodontic treatment. Patients should be monitored during the retention phase of treatment to determine if TMJ symptoms occur. Orthodontists cannot predict the physical and emotional stress levels that will occur with their patients, but they can provide the most satisfactory structural environment to best withstand these stressful forces.

Fig. 10.18 If the patient shows a significantly posterior condylar position, further treatment should be provided, to achieve a more centered position.

Fig. 10.17 If the patient shows an anterior skid, with a corresponding anterior condyle position, it is beneficial to continue with headgear or Class II mechanics to allow the condyles to seat in the fossae.

Fig. 10.18 If the patient shows a significantly posterior condylar position, further treatment should be provided, to achieve a more centered position.

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