Disfuncion de la articulacion temporomandibular / Temporomandibular Joint Dysfunction: Una guia practica para el Annika Isberg. Editorial. Title, Disfunción de la articulación temporomandibular: una guía práctica. Author, Annika Isberg-Holm. Publisher, Artes Médicas, ISBN, Disfunción de la articulación temporomandibular: una guía práctica. Front Cover. Annika Isberg. Artes Médicas, – pages.

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Temporomandibular joint dysfunction TMDTMJD 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, isbberg by restricted mandibular movement, [2] and noises from the temporomandibular joints TMJ during jaw movement. Although TMD is not life-threatening, it can be detrimental to quality of life[3] because the symptoms can become chronic and difficult to manage.

TMD is a symptom complex rather than a single condition, and it is thought to be caused by multiple factors. There are many treatments available, [7] although there is a general lack of evidence for any treatment in TMD, and no widely accepted treatment protocol.

Common treatments include disfincion of occlusal splints, psychosocial interventions like cognitive behavioral therapyand pain medication or others. Most sources agree that no irreversible treatment should be carried out for TMD. TMD is considered by some to be one of the 4 major symptom complexes in chronic orofacial pain, along with burning mouth syndromeatypical facial pain and atypical odontalgia.


These disorders have also been theorized to be caused by centrally mediated sensitivity to pain, and furthermore they often occur together. Frequently, TMD has been treated as a single syndromebut the prevailing modern view is that TMD is a cluster of related disorders with many common features. In turn, the term temporomandibular disorder is described as “a clinical term [referring to] 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 temporomandibklar mastication, or both”.

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, e. The American Academy of Orofacial Pain uses temporomandibular disorder, whilst the National Institute of Dental and Craniofacial Research uses temporomandibular joint disorder. In addition to those already mentioned, examples include “temporomandibular joint pain dysfunction syndrome”, “temporomandibular pain dysfunction syndrome”, “temporomandibular joint syndrome”, “temporomandibular dysfunction syndrome”, “temporomandibular dysfunction”, “temporomandibular disorder”, “temporomandibular syndrome”, “facial arthromyalgia”, “myofacial pain dysfunction syndrome”, “craniomandibular dysfunction” CMD”myofacial pain dysfunction”, “masticatory myalgia”, “mandibular dysfunction”, and “Costen’s syndrome”.

The lack of standardization in terms is not restricted to medical papers. Notable internationally recognized sources vary in both their preferred term, and their offered definition, e. 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. It has been suggested that TMD may develop following physical trauma, particularly whiplash injury, although the evidence for this is not conclusive.

Group I are muscle disorders, group II are disc displacements and group III are joint disorders, [10] although it is common for people with TMD to fit into more than one of these groups.

Sometimes distinction is made between acute TMD, where symptoms last for less than 3 months, and chronic TMD, where symptoms last for more than 3 months. Signs and symptoms of temporomandibular joint disorder vary in their presentation. The symptoms will usually involve more than one of the various components of the masticatory system, musclesnervestendonsligamentsbonesconnective tissueor the teeth.

The three classically described, cardinal signs and symptoms of TMD are: Other signs and symptoms have also been described, although these are less common and less significant than the cardinal signs and symptoms listed above. TMD is a symptom complex i.

In people with TMD, it has been shown that the lower head of lateral pterygoid contracts during mouth closing when it should relaxand is often tender to palpation. To theorize upon this observation, some have suggested that due to a tear in the back of the joint capsule, the articular disc may be displaced forwards anterior disc displacementstopping the upper head of lateral pterygoid from acting to stabilize the disc as it would do normally.

As a biologic compensatory mechanism, the lower head tries to fill this role, hence the abnormal muscle activity during mouth closure. There is some evidence that anterior disc displacement is present in proportion of TMD cases. Anterior disc displacement with reduction refers to abnormal forward movement of the disc during opening which reduces upon closing.


Anterior disc displacement without reduction refers to an abnormal forward, bunched-up position of the articular disc which does not reduce. In this latter scenario, the disc is not intermediary between the condyle and the articular fossa as it should be, and hence the articular surfaces of the bones themselves are exposed to a greater degree of wear which may predispose to osteoarthritis in later life.

The general term “degenerative joint disease” refers to arthritis both osteoarthritis and rheumatoid arthritis and arthrosis. The term arthrosis may cause confusion since in the specialized TMD literature it means something slightly different from in the wider medical literature. In medicine generally, arthrosis can be a nonspecific term for a joint, any disease of a joint or specifically degenerative joint diseaseand is also used as a synonym for osteoarthritis.

Over time, either with normal use or with parafunctional use of the joint, wear and degeneration can occur, termed osteoarthritis. Rheumatoid arthritis, an autoimmune joint disease, can also affect the TMJs. Degenerative joint diseases may lead to defects in the shape of the tissues of the joint, limitation of function e. Emotional stress anxiety, depression, anger may increase pain by causing autonomicvisceral and skeletal activity and by reduced inhibition via the descending pathways of the limbic system.

The interactions lx these biological systems have been described as a vicious “anxiety-pain-tension” cycle which is thought to be frequently involved in TMD. Put simply, stress and anxiety cause grinding of teeth and sustained muscular contraction in the face.

This produces pain which causes further anxiety which in turn causes prolonged muscular spasm at trigger points, vasoconstrictionischemia and release of pain mediators. The pain discourages use of the masticatory system a similar phenomenon in other chronic pain conditions is termed “fear avoidance” behaviorwhich leads arficulacion reduced muscle flexibility, tone, strength and endurance.

This manifests as limited mouth opening and a sensation that the teeth are not fitting properly. It has been postulated that such events induce anxiety and cause increased jaw muscle activity. Muscular hyperactivity has also been shown in people with TMD whilst taking examinations or watching horror films. Others argue that a link between muscular hyperactivity and TMD has not been convincingly demonstrated, and that emotional distress may be more of a consequence of pain rather than a cause.

Bruxism is an oral parafunctional activity where there is excessive clenching and grinding of the teeth. It can occur during sleep or whilst awake. The cause of bruxism itself is not completely understood, but psychosocial factors appear to be implicated in awake bruxism and dopaminergic dysfunction and other central nervous system mechanisms may be involved in sleep bruxism.

If TMD pain and limitation of mandibular movement are greatest upon waking, and then slowly resolve throughout the day, this may indicate sleep bruxism. Conversely, awake bruxism tends to cause symptoms that slowly get worse throughout the day, and there may be articulcion pain at all upon waking. The relationship of bruxism with TMD is debated.

Many suggest that sleep bruxism can izberg a causative or contributory factor to pain symptoms in TMD. Other parafunctional habits such as pen chewing, lip and cheek biting which may manifest as morsicatio buccarum or linea albaare also suggested to contribute to the development temporomandibulzr TMD. Trauma, both micro and macrotrauma, is sometimes identified as a possible cause of TMD; however, the evidence for this is not strong.

It is thought that this leads to microtrauma and subsequent muscular hyperactivity. This may occur during dental treatment, with oral intubation whilst under a general anestheticduring singing or wind instrument practice really these can be thought of as parafunctional activities. It has been proposed that a link exists between whiplash injuries sudden neck hyper-extension artkculacion occurring in road traffic accidentsand the development of TMD.

Occlusal factors as an etiologic factor in TMD is a controversial topic. A causal relationship between occlusal factors and TMD was championed by Ramfjord in the s. TMD does not obviously run in families like a genetic disease. It has been suggested that a genetic predisposition for developing TMD and chronic pain syndromes generally could exist.

This has been postulated to be explained by variations of the gene which codes for the enzyme catechol-O-methyl transferase COMT which may produce 3 different phenotypes with regards pain sensitivity. COMT together with monoamine oxidase is involved in breaking down catecholamines e. The variation of the COMT gene which produces less of this enzyme is associated with a high sensitivity to pain. Females with this variation, are at times greater risk of developing TMD than females without this variant.


However this theory is controversial since there is conflicting evidence. Since ibserg are more often affected by TMD than males, the female sex hormone estrogen has been suggested to be involved.

Low estrogen was se correlated to higher pain. Post-menopausal females who are treated with hormone replacement therapy are more likely to develop TMD, or may experience an exacerbation if they already had TMD. Several possible mechanisms by which estrogen might be involved in TMD symptoms have been proposed.

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Estrogen may play a role in modulating joint inflammation, nociceptive neurons in the trigeminal nerve, muscle reflexes to pain and? TMD has been suggested to be associated with other conditions or factors, with varying degrees evidence and some more commonly than others. Severe TMD restricts oral airway opening, and can result in a retrognathic posture that results in glossal blockage of the oropharynx as the tongue relaxes in sleep.

This mechanism is exacerbated by alcohol consumption, as well as other chemicals that result in reduced myotonic status of the oropharynx.

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, [39] 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 meniscuswhich 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.

The synovial membrane of the TMJ lines the inside of the fibrous capsule apart from the articular surfaces and the disc. This membrane secretes synovial fluidwhich is both a lubricant to fill the joint spaces, and a means to convey nutrients to the tissues inside the joint. Behind the disc is loose vascular tissue termed the “bilaminar region” which serves as a posterior attachment for the disc and also fills with blood to fill the space created when the head of the condyle translates down the articular eminence.

Together, these ligaments act to restrict the extreme movements of the joint. 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.

Each lateral pterygoid muscle is composed of 2 heads, the upper or superior head and the lower or inferior head.

Disfunción de la articulación temporomandibular: una guía práctica – Annika Isberg – Google Books

The lower head originates from the lateral surface of the lateral pterygoid plate and inserts at a depression on the neck of mandibular condyle, just below the articular surface, termed the pterygoid fovea. The upper head originates from the infratemporal surface and the infratemporal crest of the greater wing of the sphenoid bone. The upper head also inserts at the fovea, but a part may be attached directly to the joint capsule and to the anterior and medial borders of the articular disc.

The lower head contracts during mouth opening, and the upper head contracts during mouth closing. The function of the lower head is to steady the articular disc as it moves back with the condyle into the articular fossa.

It is relaxed during mouth closure. Noises from the TMJs are a symptom of dysfunction of these joints. The sounds commonly produced by TMD are usually described as a “click” or a “pop” when a single sound is heard and as “crepitation” or “crepitus” when there are multiple, grating, rough sounds.