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Diagnostic Classification Confusion
The NIH Technology Assessment Conference Statement concluded that, “there are significant problems with present diagnostic classifications of TMD, because these classifications appear to be based on signs and symptoms rather than on etiology.” They further state that, “…scientifically based guidelines for diagnosis … are still unavailable.”
The medical and dental community usually diagnoses TMJ based on range of motion tests, listening for sounds in the joints, examining the teeth, and manual palpation of the jaw joints as well as the muscles of the face, and head. Typically the dentist may ask for information about your pain and other symptoms, injuries, oral habits, and previous medical and dental treatments. A subjective assessment and examination may be completed, but often without confirmation of objective measured instrumentation and analysis, which is now becoming a standard with the community scientific methodology and standards and those clinicians who are seeking a higher standard of objective care for their patients.
Muscular Theory
- Perspective on muscle balance
- Examines pain patterns from trigger points
- Muscle changes do not necessarily involve increased EMG activity – hypomobility,
- Tight muscles lead to altered TMJ mechanics, altered degenerative changes in joints
- Malocclusion can result in tight muscles
Psychological Theory
- Most of the symptoms are due to stress, tension or emotional upset
- Leads to increased muscular activity
- Nocturnal bruxism
- Psychological testing – stress related behavior, anxiety and poor coping skills
- Eventually bruxism and clenching lead to changes in the dentition and muscles
- Leading to TMJ disorders, muscular imbalance and eventual malocclusion.
Malocclusion Theory
- Use of splints to prevent premature contact
- Relief can be obtained by revising occlusion – Two schools of focus:
- 1) Occlusal disharmony causes the muscular dysfunction
- 2) TMJ mechanics
- Cause of premature contact is due to trigger points in the muscles – Relieve muscles before splinting
- Prolonged dental work, stress or trauma – malocclusion can perpetuate trigger point activity
- Proprioception/muscle disturbance can cause malocclusion and altered TMJ mechanics
Read More:
- Educating Yourself About TMJ
- Psycho-social Intervention for Chronic Orofacial Pain: Weak Supportive Evidence
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