etiology clinical a/p chua ee kiam (bds, mds, fams, diploma in guidance & counselling
TRANSCRIPT
![Page 1: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/1.jpg)
ETIOLOGY
Clinical A/P Chua Ee Kiam(BDS, MDS, FAMS, Diploma in Guidance & Counselling
ETIOLOGY
Clinical A/P Chua Ee Kiam(BDS, MDS, FAMS, Diploma in Guidance & Counselling
![Page 2: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/2.jpg)
INTRODUCTION
Disorders of the TMJ similar to other joints in the body (/)
Confusing terminology add to confusion of the etiological factors (X)
TMD became a multi-factorial etiology disorder (X)
![Page 3: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/3.jpg)
1. Costen’s Syndrome (1934)He reinforced & established the occlusal & biomechanical approaches
2. Psychophysiological (1960-70) -the impact of physiological states and systems on psychological states and processes
3. Disc displacement (1970- 80’s)
Intra-capsular problems were clearly defined by anatomical & radiological studies
4. Current Concepts
Emotive states and their impact on persons health
CONCEPTS OF TMD
![Page 4: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/4.jpg)
SIGNS & SYMPTOMS
1. Functional Jaw Pain2. TMJ sounds (crepitations & clicks)3. Limitation of mouth opening4. Recurrent Headache
![Page 5: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/5.jpg)
ETIOLOGY
Macrotrauma Repetitive loading Occlusal factors Stress & bruxism Systemic conditions Abnormal growth Psychological factors Genetic / Gender factors
![Page 6: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/6.jpg)
ETIOLOGY
Macrotrauma
- iatrogenic
[extraction of 3rd molar, intubation, long
dental procedures, yawning]
- accidental or intentional sudden force
[fights, RTA, falls]
![Page 7: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/7.jpg)
ETIOLOGY
Macrotrauma
- 25 % had jaw trauma and 32% had iatrogenic trauma [Katzberg et al, 1980]
- 30 % had major traumatic event [Pullinger et al, 1985]
![Page 8: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/8.jpg)
TRAUMA – DISPUTED
FRACTURED, DISLOCATED CONDYLE
Surgical fracture of condyles of Rhesus monkeys - reduced vs non-surgical closed reduction - regeneration in the latter (Walker,1960); little deformity
noted (Boyne, 1967)
Studies on trauma of the TMJ suggest remarkable adaptive properties of the entire masticatory system
Application : Some patients would like you to attribute their current jaw problems to their previous history of non-recent trauma to the oro-facial tissues
![Page 9: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/9.jpg)
h/o Right retro-discitis and temporal tendonitis, arthroscopy
Use of Cervical traction on painful displaced TMJ disc (x)
![Page 10: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/10.jpg)
ETIOLOGY
Macrotrauma Repetitive loading
![Page 11: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/11.jpg)
ETIOLOGY
Repetitive loading
Destructive oral habits
[excessive chewing, hard foods, unilateralchewing, certain occupation or activities,unnatural posturing]
![Page 12: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/12.jpg)
ETIOLOGYBiting force
- Average = 22 kg [Gibbs et al, 1986]
- Maximum = 3-5x in nocturnal bruxism
- Controlling factors
[emotional status, pain threshold, number of teeth, periodontal status]
ApplicationCan surgical disc reduction work?Can replacement of disc with plasticized materials work?
![Page 13: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/13.jpg)
ETIOLOGY
Repetitive or Chronic loading
Muscle and joint problems had been reported
by violinists and scuba divers
[Pinto,1966; Reider, 1976]
Common to clench during weights training
![Page 14: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/14.jpg)
ETIOLOGY
Macrotrauma Repetitive loading Occlusal factors
![Page 15: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/15.jpg)
ETIOLOGYOCCLUSAL FACTORS/ ROLE OF OCCLUSION
1. Malocclusion
2. Bruxism
3. State of occlusion
(NWSC, Canine or Group function, Dentate vs Edentulous)
4. Occlusal Dysharmony (Muscle symmetry)
5. Unilateral Chew
6. ICP VS RCP
7. Repositioning
8. Condylar positioning
![Page 16: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/16.jpg)
ETIOLOGY
Malocclusion
Unstable occlusion lead to muscle hyperactivity
[Olson, 1970; Moller et al, 1984; Stohler et al, 1988]
Application : Use of Jaw pulsing machines to reduce “hyperactivity”?
![Page 17: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/17.jpg)
ETIOLOGY
Malocclusion
Occlusal contacts & chewing patterns [Gibbs et al, 1971]
Subjects with malocclusion- on mastication had shorter occlusal contacts; - and chewing patterns are irregular & less coordinated
![Page 18: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/18.jpg)
ETIOLOGY
Malocclusion
No difference in TMD S&S between subjects with or without Ortho Tx n=402 adolescents followed up for 5 & 10 years
Egermark et al 2003
Using meta analysis–data does not indicate that Ortho tx increased prevalence of TMD
Kim et al, 2002
![Page 19: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/19.jpg)
ETIOLOGY
MALOCCLUSIONEarly treatment of malocclusion to prevent grinding / clenching is not supported by longitudinal studies
Vanderas & Manetas Pediatr Dent, 1995
![Page 20: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/20.jpg)
ETIOLOGY
DENTAL OCCLUSIONBody of knowledge and practice of occlusion should be taught systematically in the dental curriculum
However, occlusal adjustment (OA) is irreversible and is not usually recommended in the Tx of TMD
Non-working (balancing side) in mediotrusive position dentate patients is not an occlusal interference
![Page 21: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/21.jpg)
ETIOLOGY
OCCLUSAL ADJUSTMENTS
Meta-analysis on Occlusal Adjustments Koh H & Robinson PG, Cochrane Database Systemic Review, 2003:
Occlusal adjustments are ineffective for treating or preventing TMDs
![Page 22: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/22.jpg)
ETIOLOGY
STATE OF OCCLUSION
1. Non-working side contacts
- Ramfjord, 1961 claimed NWS interference were destructive in nature (X)
- Ingervall, 1972 found 85% of his sample had NWS contact on lateral excursion;
18% canine rise (/)
- Barghi & co, 1979 found no symptoms in those with NWS contacts (/)
![Page 23: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/23.jpg)
ETIOLOGY
STATE OF OCCLUSION
2. Canine function vs Group function
Which type of occlusion reduces occlusal forces better in splints?
![Page 24: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/24.jpg)
ETIOLOGY
STATE OF OCCLUSION
3. Dentate vs Edentulous (loss of teeth)
![Page 25: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/25.jpg)
ETIOLOGY
4. Others
cross-bites, overjetdual bitesdifferential wearlarge RCP to ICP slides
![Page 26: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/26.jpg)
ETIOLOGYOCCLUSAL FACTORS/ ROLE OF OCCLUSION
1. Malocclusion
2. Bruxism
3. State of occlusion
(NWSC, Canine or Group function, Dentate vs Edentulous)
4. Occlusal Dysharmony (Muscle symmetry)
5. ICP VS RCP
6. Condylar positioning
![Page 27: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/27.jpg)
OCCLUSAL DISHARMONY
No evidence that premature contact between opposing teeth can initiate or maintain prolonged hyperactivity of jaw closing muscles (Yemm, 1976)
MPD syndrome patients were relieved of symptoms by grinding the teeth (Dawson, 1974; Ramfjord, 1983; Shore, 1976) (X)
64% of patients had improvements with mock equilibration (Goodman, 1976) (X)
Interference not the cause (La Bell et al, 2002)
![Page 28: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/28.jpg)
ETIOLOGYOCCLUSAL FACTORS/ ROLE OF OCCLUSION
5. ICP VS RCP
More pain elicited in patients with TMD in RCP
Therapeutic position in splints
![Page 29: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/29.jpg)
ETIOLOGY
Condylar positioning- non-concentric or concentric position
![Page 30: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/30.jpg)
ETIOLOGY
Occlusal Factors
1. Condylar positioning
- non-concentric or concentric position
- position of centric relation [Posselt, 1951]
![Page 31: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/31.jpg)
ETIOLOGY
Macrotrauma Repetitive loading Occlusal factors Stress & bruxism
![Page 32: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/32.jpg)
ETIOLOGYStressIt is the disruption and disorganisation of the individual's physical and mental condition resulting from the effects of uncontrollable external events.Lundeen et al,1987 JOR 14:447
Stress is a non-specific response of the body to any demand made upon itDr Hans Seyle
![Page 33: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/33.jpg)
ETIOLOGY
Bruxism
Static or dynamic contact or occlusion in the teeth at times other than for normal function such as mastication or swallowing.
[or clenching or nocturnal grinding]
![Page 34: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/34.jpg)
STRESS & BRUXISM
Bruxism is thought to be a physical manifestation of an emotional problem
Stimulation of brain area associated withresponses to stress causes an increase in excitability of motor neurons of jaw-closingmuscles (Landgren, 1977)
![Page 35: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/35.jpg)
STRESS & BRUXISM
Grinding resolves when life crises resolve
[Carlsson, 1976; Funch, 1980; Rugh, 1975, 1988]
Increased urinary levels of cathecholamines were correlated with nocturnal masseter activity
[Clark, 1980]
![Page 36: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/36.jpg)
ETIOLOGY
Stress- High correlation between muscular pain and stressful life events
[Brooke, 1977; Lundeen, 1987; Lupton, 1969; Rugh, 1983]
- TMD patients experienced 2x more stressful events controls
[Speculand, 1984]
![Page 37: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/37.jpg)
ETIOLOGY
Bruxism1. Psychological Input
2. Muscular Input
3. Dental Input
![Page 38: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/38.jpg)
EMG RECORDINGS
Development of portable EMG instruments (Burgar & Rugh, 1983)
Aid in identification of oral habits due to increase in masticatory muscle activity
EMG evaluations of resting muscle activity
Patients with MPD tended to respond to stresswith greater masticatory and facial muscleactivity (Johnson, 1972, Mercuri, 1979)
![Page 39: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/39.jpg)
IDENTIFICATION OF MUSCLE HYPERACTIVITY & ORAL HABITS
Interviews – awareness, reports by others Questionaires – oral symptoms, life-styles Pain & activity charting - insights regarding
cyclic trends Clinical examination EMG recordings
![Page 40: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/40.jpg)
BRUXISMEffect on :-
1. Masticatory Muscles- contraction of muscles bring teeth together- which increases muscle tension- lactic acid accumulation- hypertrophy of muscle- cause splinting, trismus, contracture
![Page 41: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/41.jpg)
ETIOLOGY
BRUXISMEffect on :- TMJ
- cause pain
- disc displacement
- bone changes
![Page 42: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/42.jpg)
ETIOLOGY
BRUXISM
Effect on :- Teeth
- teeth are subjected to wear
- mobility of teeth
- fractured teeth and restorations
![Page 43: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/43.jpg)
ETIOLOGY
BruxismEffect on :-Teeth
![Page 44: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/44.jpg)
ETIOLOGY
BruxismEffect on :-
Teeth
![Page 45: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/45.jpg)
![Page 46: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/46.jpg)
EFFECTS OF BRUXISM ON TEETH & ORAL TISSUES
![Page 47: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/47.jpg)
![Page 48: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/48.jpg)
ETIOLOGY
BruxismEffect on :-
Mucosa
![Page 49: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/49.jpg)
Association between Nocturnal Bruxism & Sleep
Bruxing is a 8 sec per event [Clarke et al, 1979]
In bruxists those with pain had more bruxing events during REM sleep [ Ware & Rugh, 1988]
Level of sustained contraction is higher in REM than non-REM sleep [Rugh & Ware, 1987]
![Page 50: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/50.jpg)
Sleep Cycle
- In adult 80% non-REM & 20% REM sleep- REM sleep last about 5-15 mins.- complete cycle of sleep = 60-90 mins.- non-REM sleep restore body functions- REM sleep restore function of cortex & brain
![Page 51: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/51.jpg)
ETIOLOGY
Systemic Conditions
1. Joint Laxity
2. Rheumatoid Arthritis3. Reiter’s Syndrome ("the patient can't see, can't pee and can't bend
the knee“)
4. Systemic Lupus Erythematosus
![Page 52: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/52.jpg)
ETIOLOGYSystemic conditions
1. Joint Laxity
No association was found between intra-articular disorders and systemic hypermobility (p > 0.05).
Relationship between systemic joint laxity, TMJ hypertranslation, and intra-articular disorders.Conti PC, Miranda JE, Arauio CR; Cranio. 2000 Jul;18(3):192-7.
![Page 53: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/53.jpg)
ETIOLOGY
Systemic conditions
1. Joint Laxity
2. Rheumatoid Arthritis
![Page 54: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/54.jpg)
ETIOLOGY
Systemic ConditionsIn patients with systemic conditions such aspsoriasis, poly rheumatoid arthritis & Sjogren’s syndrome
- 33% had radiographic erosions of TMJ and - 54% had anterior open bite[Nordahl S et al, Acta Odont Scan 1997]
![Page 55: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/55.jpg)
RA
Rheumatoid Arthritis - degenerative & inflammatory forms- auto immune disease - destruction of synovial tissues- rapid arthritic breakdown produces painful articularsymptoms & masticatory muscle symptoms
![Page 56: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/56.jpg)
Psoriatic Arthritis
![Page 57: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/57.jpg)
Pain R TMJ x 3 years; ROM 25/32mm; AOB
1 year later – flattened L>R condyles; RA
![Page 58: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/58.jpg)
ETIOLOGY
Macrotrauma Repetitive loading Occlusal factors Stress & bruxism Systemic conditions Abnormal growth
![Page 59: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/59.jpg)
ETIOLOGYAbnormal growth
- Enlarged condyle
- Enlarged coronoid
- Hypertrophy of masticatory muscles
- Abnormal active growth of jaw
- Tumour
![Page 60: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/60.jpg)
![Page 61: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/61.jpg)
![Page 62: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/62.jpg)
ABNORMAL GROWTH
ENLARGED CORONOIDS
![Page 63: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/63.jpg)
Past history of jaw stuck x 3 years; Jaw shifts to left on opening;Class III
Dx: Hypoplasia R condyle
![Page 64: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/64.jpg)
ETIOLOGY
Macrotrauma Repetitive loading Occlusal factors Stress & bruxism Systemic conditions Abnormal growth Psychological factors
![Page 65: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/65.jpg)
n=191 TMD patients Mean Age: 38.4yrs (16-65, majority 25-44) Female: Male : 3.1 : 1 Muscle Disorders : 31.4% Disc displacements : 15% Arthralgia, arthritis, arthrosis : 13% Depression : 39.8% Somatization : 47.6%
Prevalence of TMD subtypes, psychologic distress & psychosocial dysfunction in Asian patients
Yap AUJ, Chua EK et al J Orofac Pain 2003 (17) 21-8
![Page 66: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/66.jpg)
Significant and strong correlation (r = 0.74) was observed between depression and reporting of multiple non-specific physical symptoms
Depressive symptoms in Asian TMD patients and their association with non-specific physical symptoms reporting
Yap AUJ, Chua EK & Tan KBC J Oral Pathol Med 2004; 33: 305-310
![Page 67: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/67.jpg)
ETIOLOGY
Psychological factors
1. Chronic pain
2. Anxiety levels
3. Depression
4. Personality Profile
5. Emotional Distress
![Page 68: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/68.jpg)
ETIOLOGY
Psychological factors1. Chronic pain
2. Anxiety levels
- 26% more anxious [Fricton, 1985]
- less tolerant of pain when anxious [Melzack, 1984]
![Page 69: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/69.jpg)
ANXIETY (AN EMOTIONAL STATE)
Pain thresholds are lowered and pain conditions feel worse during anxiety. Anxiety may elicit a variety of oral habits.
• 26% of MPD patients were clinically anxious
[n=16; Fricton, 1985]
• 17% suffer from anxiety [Gerschman, 1987]
• 62% had major life event preceding treatment
[Marbach, 1978]
![Page 70: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/70.jpg)
FEAR
SLEEP DEPRIVATION ANXIETY
PAIN
![Page 71: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/71.jpg)
ETIOLOGY
Psychological factors1. Chronic pain
2. Anxiety levels
3. Depression
![Page 72: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/72.jpg)
Lowers pain threshold and decrease patient’s
willingness to tolerate pain
Objective outcome maybe good but subjective outcome
poor
52% moderately depressed (n=368 of chronic facial
pain patients) & 18% severely depressed
[Gerschman, 1987] Hamilton Depression Scale
23% depression (n=164) [Fricton, 1985]
DEPRESSION
![Page 73: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/73.jpg)
ETIOLOGY
Psychological factors
1. Chronic pain
2. Anxiety levels
3. Depression
4. Personality Profile
![Page 74: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/74.jpg)
History of HA, Insomnia, difficulty breathing, tongue discomfort, pain left masseter & temporal, discomfort on palatal of upper teeth, upper teeth had descended, lower teeth shifted
![Page 75: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/75.jpg)
![Page 76: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/76.jpg)
RED FLAGS
1. Clinically significant anxiety or depression
2. Evidence of drug abuse3. Repeated failures with
conventional therapies4. Evidence of secondary gain5. Over dramatization of symptoms6. Inconsistent, vague or
inappropriate report of pain7. Major life events
![Page 77: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/77.jpg)
ETIOLOGY
Psychological factors1. Chronic pain
2. Anxiety levels
3. Depression
4. Personality Profile
5. Emotional Distress
![Page 78: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/78.jpg)
ETIOLOGY
Genetic factors
NATURE: The human genome - The sequence of the human genome(Feb 15, 1981)Looking at diseases in a new way
![Page 79: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/79.jpg)
ETIOLOGY
Genetic factors
NATURE: The human genome - The sequence of the human genome(Feb 15, 1981)Looking at diseases in a new way
Zhifeng Zhu et al, Nature Vol. 452 24 April 2008 p 997-1002Genetic variation in human Nucleopeptide Y (NPY) – gene
that affects mood
![Page 80: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/80.jpg)
ETIOLOGY
Gender factorsWhy women?
Bingekors K & Isaacson D European J of Pain 2004 :8, 435-450
Females are more prone to HA 3.6:1; Shoulder ache 2.6:1; Back ache >1:1 ; Arms & legs .1:1)
Females different pain system – different receptor system
Gender specific pains – Labour pains & menstrual pains are natural and second nature
Injected saline in 22 year olds males and females
During follicular phase in females -estrogens levels high
During this period, Males show up with less pain 3.5/10; females 5.5/10)
And to maintain same pain levels more infusion is needed in males.
![Page 81: ETIOLOGY Clinical A/P Chua Ee Kiam (BDS, MDS, FAMS, Diploma in Guidance & Counselling](https://reader036.vdocument.in/reader036/viewer/2022062518/5697bf7c1a28abf838c84484/html5/thumbnails/81.jpg)
ETIOLOGY
Macrotrauma Repetitive loading Occlusal factors Stress & bruxism Systemic conditions Abnormal growth Psychological factors Genetic / Gender factors