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Treatment of TMJ (joint dysfunction)

Comprehensive treatment of stress-related joint, bite and musculoskeletal pathologies.
Restore joint function and improve quality of life
Treatment time from 1 month
from 15 000 rub

TMJ dysfunction – a fairly common pathology these days, as it is largely caused by stress factors. Here it can be difficult to understand what is primary, what is secondary, because people with dysfunction of the joint come, as a rule, with pathology of the bite, pathology of the musculoskeletal system (curvature of the spine, neck). Therefore, the treatment of the joint – a complex story. It happens that the primary pathology – is the pathology of the joint, it happens that the musculoskeletal system.

Causes of TMJ dysfunction

The orthodontist should find out what was the primary – overbite, malposition of teeth or missing some teeth, possibly a history of poor orthodontic treatment, early treatment when they were children or adolescents and subsequent treatment may have been the cause. It is important to get the diagnosis right.

Comprehensive treatment of TMJ

When the doctor has determined the cause of the joint pathology, or causes, he or she ascertains the patient's readiness for a comprehensive treatment plan. In addition to the orthodontist, an osteopath or chiropractor may be involved, or even an orthopedist if more complex musculoskeletal correction is needed.
The patient should be aware that it is possible to align the jaw with a joint splint or «splint» but it will not solve the problem of malocclusion. Orthodontic treatment will be required to correct the bite. If you have had orthodontic treatment before, it may be more difficult to decide to repeat treatment.

Therefore, the joint problem is first addressed with a splint or joint splint, followed by bite correction and, if necessary, prosthetics. At the same time, work with an osteopath is carried out to restore the muscular corset of the back and neck.

Sometimes a patient refuses brace treatment after the joint issue has been resolved. In this case, we warn them to wear a joint splint at all times to prevent old TMJ problems from recurring. After all, a relapse can happen quite quickly on the background of stress.

What are the symptoms of TMJ dysfunction?

  • Soreness or pain in the area of one or both TMJ at rest or when opening the mouth.
  • Crunching, clicks, crepitation and other noises in the area of one or both TMJ when opening the mouth.

  • TMJ injuries in the anamnesis (were earlier), including dislocation, subluxation, chronic subluxation.

  • Limitations in TMJ mobility, restriction in mouth opening.

  • Excessive tone of masticatory muscles, bruxism («grinding» teeth in sleep, at rest).

  • Asymmetry of the chin, lips, bridles of the lips, asymmetry of the mouth opening, S-shaped opening.

  • Suspicion of a forced position of the lower jaw.>

The presence of one or more of the above signs may indicate TMJ dysfunction.

Traditional orthodontic treatment is not intended to treat TMJ dysfunction. During orthodontic treatment, the severity of dysfunction may not change, decrease or increase. At the moment, there is no conclusive data on the relationship between orthodontic treatment and TMJ condition in the world scientific orthodontic literature. Deterioration of the joint after treatment may be unrelated to this treatment.

Please note! Even in the absence of visible clinical manifestations of joint dysfunction, hidden disorders may occur that require special diagnostics to identify them.

If there is a forced incorrect position of the lower jaw, its position may change during treatment with a change and complication of the treatment plan (the need to remove individual teeth, increase the duration of treatment). A reliably forced position cannot be diagnosed by traditional orthodontic methods, to check its presence, as a rule, a special analysis is required (manual functional analysis, determination of the central ratio of the jaws), the use of a special joint splint for a period of several months, which, however, does not give a 100% guarantee.

To conduct a detailed joint diagnosis, clarify the specifics of your case, and further manufacture of an articular splint, you can make an appointment with an orthodontist dentist dealing with TMJ dysfunction.

TMJ dysfunction is a chronic condition that can be compensated, but not cured (i.e. it is possible to eliminate the symptoms, however, pathological changes in the joints, if they have already occurred, are likely to persist).

What happens if TMJ dysfunction is not treated?

If the dysfunction is left untreated, the body's compensatory capacity may sooner or later be exhausted, the symptoms will worsen, the pathology will progress, causing more discomfort (sometimes for several years), thus affecting the deterioration of the function of the dento-mandibular system.

To try to prevent this from happening and to treat it taking into account the individual characteristics of the structure and functioning of the temporomandibular system.

To try to prevent this and provide treatment tailored to the individual structure and function of the temporomandibular joints, patients are usually offered the following approach.

The structure of the TMJ

Treatment methods for TMJ dysfunction

1. Diagnosis of TMJ dysfunction.

  • During the diagnosis of the joint in the clinic, a number of measurements and tests are carried out, all sensations in the joint area are recorded (discomfort, clicks, pain, deviation of the jaw when opening and closing), the difference in sensations in the right and left joints.

  • The orthodontist also takes jaw casts and takes photographs of the face and intraoral photographs, as well as performs three-dimensional computed tomography of the face (3D CT), if necessary, the doctor can give a referral for additional research - magnetic resonance imaging of the TMJ (MRI).

  • Often, an orthodontist, in addition to manual functional analysis, conducts a visual assessment of: posture, symmetry of the shoulder girdle, shoulder blades, hip bone structures, etc., performs the necessary tests, photographs. According to the results, it is possible to appoint a consultation with an osteopath or chiropractor for joint management of the patient. Related specialists (orthopedist, surgeon, periodontist) can also be involved in the preparation of a treatment plan.

What exercises are prescribed to patients to normalize the work and relax the chewing muscles?

Exercise №1

Draw a vertical line on the mirror with a marker, stand opposite so that the line divides the face into right and left halves, put your fingers on the area of the articular heads, raise your tongue up and back, open and close your mouth according to the line (you may not get it right away), 2-3 times/day for 30 repetitions. It is not necessary to open your mouth wide (comfortable width), the main thing – symmetrically (so that the jaw does not “move out” in any direction). If there is a click, open until there is a click.

Exercise№2 (cycle)

Do it whenever you can, for example, in front of the TV, at the computer, in traffic while driving. Open-close your mouth without closing your teeth for 30 seconds, then reach your tongue alternately to the right and left cheeks for 30 seconds. Again open - close the mouth, then 30 seconds make a movement of the tongue in a circle inside the vestibule (behind the lips) first in one, then in the other direction (clockwise - counterclockwise), again open - close the mouth, etc. During this half-hour cycle, the teeth should not touch, lips closed. If you want to close your mouth or swallow--put your tongue between your teeth. Repeat the cycle for 20-30 minutes 2-3 times/day 

2. Occlusal therapy for TMJ dysfunction

After diagnosis, the patient will make an appointment with an orthodontist to determine the central jaw relationship («true» position of the lower jaw, the position in which your joint and masticatory muscles are most comfortable).

To establish and fix this position more precisely, an occlusal splint (splint) made of special plastic, which is washed as it is worn, will be individually made for the patient. The splint must be worn at all times (sleeping, talking, eating with it on if possible) – this is the point of occlusal therapy, which will help the joint and masticatory muscles to adjust to the most comfortable functional state.

Cleaning and care of the splint is very simple - after eating (as well as when brushing your teeth) brush with a soft brush and paste or soap.

3. Placement of a brace system in a patient with TMJ dysfunction

Upper jaw braces are placed after an average of 3 months of occlusal therapy. The splint is adjusted once every 1-2 weeks, or at the discretion of the doctor, until the main complaints of TMJ are eliminated (in parallel with the alignment of teeth on the upper jaw), then the bracket system is installed on the lower jaw with partial reduction (grinding off) of the interfering parts of the occlusal splint, or complete removal. The patient needs to be patient here - the process can take several months.

Simultaneously, the new position of the mandible is monitored: repeated manual functional analysis, photometry, possible bite registration, computerized tomography of the face in the process of treatment, continuation of orthodontic treatment on the bracket system.

At the same time, the new position of the mandible is monitored.

After completion of orthodontic treatment, final control of mandibular position (manual functional analysis, photometry, bite registration, 3D CT scan of the face at the end of (after) treatment)..

Joint splint
Joint splint with braces

The result of treatment of TMJ dysfunction

The result of the treatment is a satisfactory aesthetic result, the achievement of a full-fledged occlusion with multiple uniform fissure-tubercle contacts and the elimination or reduction of the severity of TMJ dysfunction. Mandatory, if indicated, is a full-fledged rational prosthetics or functional and aesthetic restorations of teeth, as the final stage of treatment - at this stage, a detailed consultation of an orthopedic dentist is necessary.

Treatment and diagnosis of TMJ dysfunction in Konfidencia clinic

The Konfidencia clinic employs orthodontists with education in the field of maxillofacial surgery. They know modern diagnostic techniques, and the clinic is equipped with modern diagnostic equipment. A comprehensive approach is used in the treatment, including the recommendation of exercises, wearing a joint splint, and installing braces. Depending on the case, implantologists, orthopedists, periodontists are involved in order to fully restore the health of the joint and oral cavity.

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Updated 16.02.2024

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