TEMPOROMANDIBULAR

DISORDER
Poerwati Soetji Rahajoe

OUTLINE

GAMBARAN UMUM
ETIOLOGI
PATHOFISIOLOGI
KLASIFIKASI (DETAILED DISCRIPTION)
TRAUMA TMJ

TEMPOROMANDIBULAR
DISORDER
A collection of medical and dental
conditions affecting the TMJ and/or the
muscles of mastication as well as
contiguous tissue components

ETIOLOGI
Multifactorial
Predisposing factors
Musculoskeletal

Precipitating factors
Trauma, clenching, grinding

Perpetuating factors
psychogenic

Aetiology
Skeletal jaw relationships
Occlusal disharmonies
Lack of posterior teeth
Unilateral teeth loss
Parafunctional habits
Anxiety and depression
Trauma

Epidemiology
60-70% of general population have
one sign
Prevalence by self report: 5-15% (one
source estimates 10% of women, 6%
of men)
5% or less seek treatment
Women>men 4:1 seek treatment

Epidemiology
Early adulthood (ages 20-40)
Many TMD are self-limiting or
fluctuate over time without
progression
5% require surgery

TEMPOROMANDIBULAR JOINT
DISORDER
3 Main Categories;
Myofascial pain dysfunction sydrom(JAW
MUSCLES, neck muscles, shoulder
muscles)
Internal derangement of the joint
(dislocated joint, DISPLACED DISC,
condylar trauma)
Degenerative joint disease
(OSTEOARTHROSIS, RA)

SYMPTOM (UMUM) TEMPOROMANDIBULAR

DISORDER (Tanda Kardinal)

Sakit sendi TMJ

Pembatasan dan deviasi gerak mandibula
Suara sendi
Rasa sakit otot mastikasi

PATHOFISIOLOGI TMD

Acute

Cronic
Trauma
TMJ
(Responses)

Membran sinovial
Musculus
Condyle
Recove
ry

Ligament & capsul

Deformity of
TMJ

Dislocation
Hypomobility
Muscle,
Facia, Skin
contracture

Hypermobility

Causes

Muscle
imbalance
Idiopathic

Aquired
dislocation
Joint
Adhesio
n

Congenital
TMJ
Developmen

Mecanichal
block (ID,
osteoarthritis)

RESPONSE TMJ TERHADAP

TRAUMA
CAPSUL DAN
LIGAMENT
LAXITY
KONTRAKTUR
SINOVIAL
MEMBRAN
EFFUSI
HIPERTROPI
ADHESI (dgn
CARTILAGO)

CARTILAGO
DESTRUKSI
DEGENERASI
PROLIFERASI
MUSCLE
ATROPI
HIPERTROPI
KONTRAKTUR

KLASIFIKASI

Myofacial Pain and Dysfunction

(MPD)
Internal Derangement,DISC
DISPLACEMENT (ID)
Degeneration Joint Desease (DJD/
ARTHROSIS)

1. MYOFACIAL PAIN
DISFUNCTION

Myofascial Pain Dysfunction Syndrome

Commonest cause of
complaint involving
TMJ.

3 cardinal symptoms:
1. Pain associated with
TMJ or its
musculature.
2. Clicking of the joint.
3. Limitation of joint
movement.

Myofascial Pain Dysfunction Syndrome

Symptoms vary in
intensity during the
day.

Most common in the

morning.

Tenderness to
palpation of origins
and insertions of
masticatory muscles
is usual.

More frequent in
women with a mean
age at presentation of
30 years.

Change in dental
occlusion
Modification of muscle
activity
Localized
hyperactivity

Stress
Daytime clenching
Bruxism
Muscle hyperactivity

Damage to regions of
weak
And susceptible jaw
muscles
Pain/dysfunction
Healing if rest achieved by
treatment

Stress

Muscular
Hyperactiv
ity

Dental
Irritation

Muscular
Fatique
Muscular
Over
EXtention

MYOSPASM

Muscular
Over
Contractio
n

MYOFACIAN PAIN-DYSFUNCTION
SYNDROME
Contractur

Oclusal
disharmon
y

Internal
derangeme
nt

DEGENERA
TIVE
Arthritis

Altered chewing pattern

(JAMA 79: 147-153, 1969 cit. Sarnat & Laskin, 1992)

2.INTERNAL DERANGEMENT

INTERNAL DERANGEMENT
AKIBAT POSISI DISC YANG TIDAK
NORMAL/DISC DISPLACEMENT

Disc Displacement
Abnormal positional
relationship between
the articular disc, the
head of the condyle,
and the articular fossa
of the temporal bone.
It has been reported in
25-65% of elderly
patients.

Disc Displacement
It is also prevalent in
patients with
myofascial paindysfunction syndrome
and/or osteoarthritic
changes in the joint.
Whether the
displacement
precedes or follows
such changes in
unclear.
Not all patients with
displacements have or
develop signs or

INTERNAL DERANGEMENT (ID)

KLASIFIKASI
1. TYPE IA,CLICKING TANPA RASA SAKIT
(50%NORMAL SUBYEK)
2.TYPE IB,CLICKING ,ADA RASA SAKIT ,AKIBAT
KRONIK STECTHING CAPSULAR LIGAMAENT,
BILAMINAR ZONE.
3.TYPE II, = TYPE IB TETAPI ADA RIWAYAT
LOCKING
4.TYPE III.,PERSISTEN LOCKING,SAKIT KRONIK.

Internal derangement
Disc
displacement
with reduction

Reproducible clicking
Disc displacement shown
by imaging and absence
of degenerative bone
disease
There may be pain,
deviation of jaw
movements
No limitation of opening
Stabilization splint or

INERNAL DERANGEMENT
Disc
displacement
without
reduction

Disc is displaced during

opening & closing

Persistent limitation of
mouth opening

Disc displacement shown

by imaging and absence of
degenerative bone disease

Pain

No clicking

INTERNAL DERANGEMENT
Jaw lock

LAT.
PTERYOID
SPASM

COMPRESSION/MI
SUSE
ALTERED
SURFACE OF TMJ
IN
COORDINATION

TRAU
MA

INCREASED
FRICTION

ADR(ANTERIOR DISPLACED
WITH REDUCTION)

ADWR (ANTERIOR
DISPLACED WITHOUT
REDUCTION)
(Etiologi Internal
Derangement, Sarnat & Laskin, 1992)

Internal derangement
anterior displacement of the disk

Internal derangement
(incoordination)

ANTERIOR DERANGEMANT

ANTERIOR DERANGEMENT WITH

REDUCTION

ANTERIOR DISPLAMENT WITHOUT

REDUCTION

3.OSTEOARTHROSIS

AGE CHANGES OF TMJ

1- Flattened condyle
2- osteoporosis of the condyle bone.
3- Thickning of the fibrous covering of the
condyle.
4- Thinning of the cartilagenous zone of
condyle.
5- Thinning of the disc
6- Fibrotic synovial folds
7- Thickening of the b.v. walls
8- Decrease the number of nerves

AGE CHANGES OF TMJ

These age changes lead to:
-Decrease in the synovial fluid
formation
-Impairment of motion due to decrease
in the disc and capsule extensibility
-Decrease the resilience during
mastication due to chondroid
changes into collagenous elements
-Dysfunction in older people

Arthritis of TMJ

Infectious arthritis
Rheumatoid arthritis
Degenerative arthritis
Traumatic arthritis

Osteoarthrosis
(Osteoarthritis)
A degenerative disease which mainly affects
weight-bearing joints.
In the TMJ it differs from other joints probably
because:
1. It is not a weight-bearing joint.
2. The articular surface is covered with fibrous
tissue rather than hyaline cartilage.
. It is rare in TMJ before 5th decade of life, but after
that it increases proportionately with age.

Osteoarthrosis
Clinical features:
Pain.
Crepitus.
Limitation of jaw movement.
Deviation on opening.
Many cases are clinically silent.

Osteoarthrosis

Clinical features:

Clinical studies suggest a relationship in

some cases between later development
of osteoarthrosis and:
a. untreated myofascial pain-dysfunction
syndrome,
b. loss of molar support,
c. disc displacement.
. Spontaneous resolution is common.

Increased
remodelin
g

overloadi
ng

Disc
displacement

Negative
adaptatio
n

Deviation in
form
overloadi
ng

ARTHROSIS
Link of arthrosis and Dis
displacement,Sanat

Disc
displacem
ent

KESIMPULAN

Differential diagnosis of intraarticular

and extraarticular conditions that
effect the TMJ
Signs and symptoms

Intraarticular

Extraarticular

Preauricular pain

Localized

Diffuse

Limitation of movement

Constant

Inconsistent

Joint sounds

Crepitus

Clicking

Masticatory muscle tenderness Yes

Yes

Radiographic signs

No

Yes