Tempero-Mandibular Joint Disorders (TMD) are most commonly the result and cause of mal-occlusion of teeth. The masticatory muscles, which position and connect the mandible to the skull, should be the focal point of correct occlusion. Occlusion is maintained by the activities of these masticatory muscles which are controlled by neural integration of the feedback from peripheral proprioceptors and the reflex mechanism from the CNS. This is science.
If you have any of the above symptoms, it may be a sign of TMD. Clarify your doubts on TMD, through our expert chat
In simple words, bite registration decides the fate of the patient. If taken correctly, he’s going to be the happiest patient. The smallest occlusal discrepancy would transform the perfectly normal TMJ complex into a TMD, hence leading the patient to headaches, neck-aches, migraine, etc. These patients then visit the ENT specialist, the neurosurgeon, the orthopedician, etc., for treatment of these aches but to no avail. Almost 80% of patients end up with TMD as a result of that discrepancy and suffer the agony and would need to depend on medicines all their life.
Centric occlusion (CO) and centric relation (CR) are terms that have always ended up pushing the mandible upward and backward. But for a TMD patient, isn’t it that very same CO that has led to the problem? What all we do, to try and coerce that patient into CO….the Dawson’s technique, the forced swallow technique, the hand in mouth technique! Have you ever given it a thought that while forcing the patient to bite into that CO, you may be actually pushing the mandible, and hence the condyles, backward and upward into the retrodiscal pad of the glenoid fossa? That CO, may only be his habitual occlusion, which his body may have self-repaired to compensate for that small occlusal discrepancy, which we always tend to overlook. The muscles of mastication that act upon the mandible have been trained by our CNS to keep the condyles there and hence the mandible in that erroneous position to avoid that high point! Any interference in the mandibular path of closure will send a noxious signal to the brain resulting in a Avoidance conditioning Response, that will basically tell the mandibular muscles to avoid that path and take another. Continuous noxious signals create a sensory engram leading to the muscles controlling the mandible to become hypertrophic in the new path. Hypertrophic muscles are shorter in length. Since, the articular disc in the TMJ complex is, virtually the continuation of the superior head of the lateral pterygoid muscle, any shortening of the muscle will result in the anterior displacement of the disc. The recapture is heard as the click which we can diagnose as Internal Disc Derangement (IDD) with Reduction. Further shortening, like in chronic patients, end up as IDD without reduction.
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