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Temporomandibular
joint problems
Piero
Silvestrini, M.D., Ph. D., D.S.
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Temporomandibular
joint (TMJ)
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TMJ:
dynamic, physiological movement of the joint as a whole, i.e. mandibular
condyle, disk, articular capsule and ligaments
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Temporomandibular
joint (TMJ) TMJ: dynamic, physiological movement of the joint
as a whole, i.e. mandibular condyle, disk, articular capsule and
ligaments. The articulation of the lower jaw to the skull is achieved
by two symmetric joints provided with a free functional movement.
They feature an articular disk, "meniscus", having a dampening,
lubricating and sliding function. Besides having a rotational
movement, the mandibular condyles can also undertake a protrusive
movement to allow maximum mouth opening. Clicking sounds, rubs,
locking on mouth opening or closing, deviation of the mandible
on mouth opening, are all symptoms of discomfort of the joint
system and, more specifically, of a lack of coordination between
the disk and the joint, causing "obstacles".
The causes may be multifarious and range from degenerative diseases
to arthritis but also, more simply, to malpositions of the mandible
resulting from maloclusion.
The most frequent pathology is the anterior derangement of the
articular disk, which may commonly cause two types of alterations.
If the disk does not fit back in the articular cavity of the joint,
it limits the anteriorly sliding movement of the condyle (articular
bone of the mandible). If the problem is bilateral, it will lead
to restricted mouth opening and ofter cause pain to the limit
of movement. Instead, if the pathology is monolateral, for example
only affecting the left side, as in animation, the mouth, on opening,
will only deviate to the left .
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Left
articular disorder with anterior disk derangement and its non- -repositioning
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If,
at a given moment, the disk can fit back in its articular space, as
in animation, two events can be observed. First, the mouth will deviate
to the left due to the braking action of the anteriorly deranged disk,
then, as soon as it fits back, it causes a sound (click), the mandible
springs forward and tends to realign, as if it had overcome an obstacle.. |
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Left
articular disorder with anterior disk derangement and its repositioning
on wide mouth opening
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Naturally,
these are only a few simplifications of the problems which may
be much more diversified and complex. A careful clinical and instrumental
analysis may be a guidance to establish first the therapeutical
needs and then the treatment mode.
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