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Temporomandibular joint problems
Piero Silvestrini, M.D., Ph. D., D.S.
Temporomandibular joint (TMJ)
TMJ: dynamic, physiological movement of the joint as a whole, i.e. mandibular condyle, disk, articular capsule and ligaments

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 .

Left articular disorder with anterior disk derangement and its non- -repositioning
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..
Left articular disorder with anterior disk derangement and its repositioning on wide mouth opening

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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