Жақ буынының аурулары және синдромы

the syndrome with joint pain

Temporomandibular joint dysfunction (TMD, TMJD) is an umbrella term covering pain and dysfunction of the muscles of mastication (the muscles that move the jaw) and the temporomandibular joints (the joints which connect the mandible to the skull). The most important feature is pain, followed by restricted mandibular movement, this is because the symptoms can become chronic and difficult to manage. In this article, the term temporomandibular disorder is taken to mean any disorder that affects the temporomandibular joint, and temporomandibular joint dysfunction (here also abbreviated to TMD) is taken to mean symptomatic (e. g. pain, limitation of movement, clicking) dysfunction of the temporomandibular joint. However, there is no single, globally accepted term or definition However, these factors are poorly understood, Usually people affected by TMD are between 20 and 40 years of age, TMD has been considered as a type of musculoskeletal, or rheumatological disorder. It is hypothesized that there is a great deal of similarity between TMD and other pain syndromes like fibromyalgia, irritable bowel syndrome, interstitial cystitis, headache, chronic lower back pain and chronic neck pain.

Frequently, TMD has been treated as a single syndrome, but the prevailing modern view is that TMD is a cluster of related disorders with many common features. whereas many other sources use the term 'temporomandibular disorder' synonymously, or instead of the term 'temporomandibular joint dysfunction'. In turn, the term 'temporomandibular disorder' is defined as "musculoskeletal disorders affecting the temporomandibular joints and their associated musculature. It is a collective term which represents a diverse group of pathologies involving the temporomandibular joint, the muscles of mastication, or both". Another definition of temporomandibular disorders is "a group of conditions with similar signs and symptoms that affect the temporomandibular joints, the muscles of mastication, or both." 'Temporomandibular disorder' is a term that creates confusion since it refers to a group of similarly symptomatic conditions, whilst many sources use the term temporomandibular disorders as a vague description, rather than a specific syndrome, and refer to any condition which may affect the temporomandibular joints (see table). The temporomandibular joint is susceptible to a huge range of diseases, some rarer than others, and there is no implication that all of these will cause any symptoms or limitation in function at all. The preferred terms in medical publications is to an extent influenced by geographic location. For example, in the United Kingdom, the term 'pain dysfunction syndrome' is in common use. "Headache or facial pain attributed to temporomandibular joint disorder." (International Classification of Headache Disorders 2nd edition (ICHD 2), International Headache Society). "Temporomandibular joint pain dysfunction syndrome" listed in turn under "Temporomandibular joint disorders" (International Classification of Diseases 10th revision, World Health Organization).

Occlusal factors as an etiologic factor in TMD is a controversial topic. there are no statistically significant differences in the number of occlusal abnormalities in people with TMD and in people without TMD. A small minority of dentists continue to prescribe occlusal adjustments in the belief that this will prevent or treat TMD despite the existence of systematic reviews of the subject which state that there is no evidence for such practices, and the vast majority of opinion being that no irreversible treatment should be carried out in TMD (see Occlusal adjustment).

TMD does not obviously run in families like a genetic disease.<! The results of one study suggested that the periods of highest pain in TMD can be correlated with rapid periods of change in the circulating estrogen level.<! Headache.

The temporomandibular joints are the dual articulation of the mandible with the skull. Each TMJ is classed as a "ginglymoarthrodial" joint since it is both a ginglymus (hinging joint) and an arthrodial (sliding) joint, and involves the condylar process of the mandible below, and the articular fossa (or glenoid fossa) of the temporal bone above. Between these articular surfaces is the articular disc (or meniscus), which is a biconcave, transversely oval disc composed of dense fibrous connective tissue. Each TMJ is covered by a fibrous capsule. There are tight fibers connecting the mandible to the disc, and loose fibers which connect the disc to the temporal bone, meaning there are in effect 2 joint capsules, creating an upper joint space and a lower joint space, with the articular disc in between.<! Due to its concave shape, sometimes the articular disc is described as having an anterior band, intermediate zone and a posterior band. When the mouth is opened, the initial movement of the mandibular condyle is rotational, and this involves mainly the lower joint space, and when the mouth is opened further, the movement of the condyle is translational, involving mainly the upper joint space. This translation movement is achieved by the condylar head sliding down the articular eminence, which constitutes the front border of the articular fossa.

The muscles of mastication are paired on each side and work together to produce the movements of the mandible. The main muscles involved are the masseter, temporalis and medial and lateral pterygoid muscles. They can be thought of in terms of the directions they move the mandible, with most being involved in more than one type of movement due to the variation in the orientation of muscle fibers within some of these muscles. Protrusion – Lateral and medial pterygoid.<! Each lateral pterygoid muscle is composed of 2 heads, the upper or superior head and the lower or inferior head.<! Clicking often accompanies either jaw opening or closing, and usually occurs towards the end of the movement. The noise indicates that the articular disc has suddenly moved to and from a temporarily displaced position (disk displacement with reduction) to allow completion of a phase of movement of the mandible.

MRI is the optimal choice for the imaging of soft tissues surrounding the TMJ. It is also useful for assessing the integrity of neural tissues, which may produce orofacial pain when compressed. While having significant diagnostic sensitivity, US has inadequate specificity when identifying osteoarthrosis. Moreover, it is not accurate enough for the diagnosis of cortical and articular disc morphology based on the findings done related to morphological alterations. However, with US, identification of effusion in individuals with inflammatory conditions associated with pain is possible and confirmed by MRI

TMD can be difficult to manage, and since the disorder transcends the boundaries between several health care disciplines – in particular, dentistry and neurology, the treatment may often involve multiple approaches and be multidisciplinary.

Given the important role that psychosocial factors appear to play in TMD, psychosocial interventions could be viewed to be central to management of the condition. Hypnosis is suggested by some to be appropriate for TMD. Studies have suggested that it may even be more beneficial than occlusal splint therapy, and has comparable effects to relaxation techniques. Relaxation techniques include progressive muscle relaxation, yoga, and meditation. Ear canal inserts are also available, but no published peer reviewed clinical trials have shown them to be useful.

Medication is the main method of managing pain in TMD, mostly because there is little if any evidence of the effectiveness of surgical or dental interventions.<! or nortriptyline have also been described. Despite many randomized control trials being conducted on these commonly used medications for TMD a systematic review carried out in 2010 concluded that there was insufficient evidence to support or not to support the use of these drugs in TMD. Examples include morphine, fentanyl, oxycodone, tramadol, hydrocodone, and methadone. Botulinum toxin solution ("Botox") is sometimes used to treat TMD. Injection of botox into the lateral pterygoid muscle has been investigated in multiple randomized control trials, and there is evidence that it is of benefit in TMD. It is theorized that spasm of lateral pterygoid causes anterior disc displacement. Botulinum toxin causes temporary muscular paralysis by inhibiting acetylcholine release at the neuromuscular junction. There are many different approaches described, but exercises aiming to increase the range of mandibular movements are commonly involved. Jaw exercises aim to directly oppose the negative effects of disuse that may occur in TMD, due to pain discouraging people from moving their jaw. After initial instruction, people are able to perform a physical therapy regimen at home. The most simple method is by regular stretching within pain tolerance, using the thumb and a finger in a "scissor" maneuver. Gentle force is applied until pain of resistance is felt, and then the position is held for several seconds.<! "Friction massage" uses surface pressure to cause temporary ischemia and subsequent hyperemia in the muscles, and this is hypothesized to inactivate trigger points and disrupt small fibrous adhesions within the muscle that have formed following surgery or muscular shortening due to restricted movement. The goals of a PT in reference to treatment of TMD should be to decrease pain, enable muscle relaxation, reduce muscular hyperactivity, and reestablish muscle function and joint mobility. PT treatment is non invasive and includes self care management in an environment to create patient responsibility for their own health. Therapeutic exercise and Manual Therapy (MT) are used to improve strength, coordination and mobility and to reduce pain. Treatment may focus on poor posture, cervical muscle spasms and treatment for referred cervical origin (pain referred from upper levels of the cervical spine) or orofacial pain MT has been used to restore normal range of motion, promoting circulation, stimulate proprioception, break fibrous adhesions, stimulate synovial fluid production and reduce pain. Exercises and MT are safe and simple interventions that could potentially be beneficial for patients with TMD. No adverse events regarding exercise therapy and manual therapy have been reported.

This is the adjustment or reorganizing of the existing occlusion, carried out in the belief that this will redistribute forces evenly across the dental arches or achieve a more favorable position of the condyles in the fossae, which is purported to lessen tooth wear, bruxism and TMD, but this is controversial. These techniques are sometimes termed "occlusal rehabilitation" or "occlusal equilibration". arthroscopy, meniscectomy, disc repositioning, condylotomy or joint replacement. Invasive surgical procedures in TMD may cause symptoms to worsen.

Acupuncture is sometimes used for TMD. However, some suggest that acupuncture may be no more effective than sham acupuncture, that many of the studies investigating acupuncture and TMD have significant risk of bias,

Chiropractic adjustments (also termed manipulations or mobilizations) are sometimes used in the belief that this will treat TMD. Related conditions that are also claimed to be treatable by chiropractic include tension headaches and neck pain. Some sources suggest that there is some evidence of efficacy of chiropractic treatment in TMD, Overall, although there is general agreement that chiropractic may be of comparable benefit to other manual therapies for lower back pain, there is no credible evidence of efficacy in other conditions, including TMD. However, there is some evidence of possible adverse effects from cervical (neck) vertebral manipulation, which sometimes may be serious. It has been suggested that TMD does not cause permanent damage and does not progress to arthritis in later life, An older name for the condition is "Costen's syndrome", eponymously referring to James B. Costen. Costen was an otolaryngologist, Costen hypothesized that malocclusion caused TMD, and placed emphasis on ear symptoms, such as tinnitus, otalgia, impaired hearing, and even dizziness. recommending a treatment revolving around building up the bite. and also because ear problems are now thought to be less associated with TMD. Other historically important terms that were used for TMD include "TMJ disease" or "TMJ syndrome", which are now rarely used.