Diagnosis and Treatment of T.M.D.
Excerpt from Dr. Truitt´s Presentation to the Colegio Nacional De CiRujanos Dentistas, A.C.
The diagnosis and treatment:
Temporal Mandibular Dysfunction is a relatively new area in modern dentistry. It has been complicated by the fact that many teaching institutions fail to recognize the importance of normal T.M.J. function. Many clinicians still feel that T.M.D. is essentially a psychosomatic condition primarily found in the menopausal female and should be treated with drug therapy and possibly a flat plane splint.
In reality, T.M.D. has been reported to occur in 35% of all children in America under twelve years of age. There is also abundant evidence in both the dental and medical literature that incorrect restoration and orthodontic procedures can complicate and even initiate severe T.M.D.
The objective of the presentation is to teach the clinician to first recognize and properly diagnose the various stages of T.M.D. Second, to stabilize the T.M.J.´s and eliminate the systemic side effects such as pain and vertigo. And third, to permanently stabilize the case with either T.M.J. orthodontics, reconstruction, equilibration or a combination of these procedures.
Let us first address the question of diagnosis. All T.M.D. patients should be divided into two basis classifications. These are internal derangement cases and external derangement cases. The internal derangement case simply means that there is a mechanical problem within the T.M.J. capsule. The external derangement indicates that there is a problem within the muscle-skeletal system outside of the T.M.J. capsule. Another type of classification is intra-capsular and extra-capsular dysfunction. All external derangements are the result of internal derangements with the exception of problems such as an abscess within the muscle, direct trauma to musculo-skeletal complex, or neuro-muscular problems such as Meniere´s syndrome – these are unique situations that should be treated as independent problems. Therefore the side effects of most T.M.D. external derangement cases should subside when the internal derangement is correctly addressed.
At this point, it is appropriate to discuss normal T.M.J. function before we address any pathology. First, there should be no opening or closing deviations of the mandible. There should be no noise or pain when the mandible is extended through a full range of motion. Normal vertical opening should be at least 50 mm from centric relation. Normal lateral excursion should be 12 mm to 15 mm per side when the skeletal midlines are correctly aligned at an edge to edge relationship of the incisors.
- Internal Derangements
- External Derangements
- Anterior Mandibular Repositioning Splint
- Pivotal Splint
- Flat Plane Splint
- Phase Two – Stabalization