Understanding “The TMJ Triad”
Why is it that some people with horrendous malocclusions suffer no TMJ symptoms, while others with a moderate or even a mild malocclusion suffer from severe TMJ symptoms?
The answer to this question revolves around 3 etiological factors called "The TMJ Triad." That is to say 3 factors that have to be present, all at the same time, to initiate a TMJ response. They are:
1) Predisposition. Predisposition is "a condition of special susceptibility."
a) Intrinsic. This would involve inherited abnormality or weakness of muscles, tendons, ligaments etc
b) Extrinsic. Traumatic, or pathological changes in the tissues relevant to correct function
2) Tissue Alteration. The kinds of tissue alteration includes: Arthritic changes Occlusal relationships Loss of posterior support Iatrogenic changes TMJ / skeletal relationships etc 3) Psychological Dependence. This is probably the most difficult to understand. TMJ personalities are said to exist - often described as tense, depressed, obsessive etc. It is during such periods of stress that TMJ sufferers indulge in oral parafunction such as bruxing and clenching. *TYPES OF TREATMENT FOR TMD (TMJ DISORDER)*
These are designed to gently work the facial and neck muscles to reduce spasm and encourage normal muscle
movement. TMJ problems are caused by the occlusion, over-stressing the TMJs, finally leading to muscle spasm and pain. The
muscle spasm is caused by overworked facial muscles or by abnormal movements of the muscles, because the jaw joint is not
functioning in the correct manner. The advantages of facial exercises in TMJ treatment are:-No cost to you, once you know what to
do and how to do it. Non-invasive – no dental appointments. Requires no time off work or college or for other commitments, as the
2.Your teeth come together by the actions of certain groups of muscles and this action involves these muscles
carrying out some pretty hard work. Like all muscles in the body they need to rest now and again which is fine most of the time but if
you clench your teeth, or grind your teeth (bruxism), the muscles cannot rest, because they are always hard at work. This can
produce TMJ symptoms. So if you wake up in the morning with TMJ symptoms, there is a very good chance you are either
clenching or bruxing during sleep. This is where the night guard comes in handy. They are made of a soft plastic that covers the
upper or lower teeth. So when you are asleep and are clenching or bruxing, the muscles do not have to work so hard because of the
3. Occlusal Equilibration. Human teeth are designed to meet (occlude) in a very precise way. When this happens, very little stress
is transmitted to the TMJs. But if the occlusion is misaligned, meaning the teeth meet in an abnormal fashion (mal-occlusion)
abnormal stresses are placed on the TMJs and can, in some cases lead to TMJ pain. This mal-occlusion can be caused by dental
neglect, gum disease, poor dental treatment, trauma, or just the way the teeth naturally end up in some people. Treatment involves
the careful grinding of certain parts of the teeth with a dental drill to ensure a correct occlusal relationship, thereby reducing TMJ
4. Occlusal Restoration. This really is the next step up from occlusal equilibration. If the occlusion is so bad, occlusal equilibration
is not as option – especially if there has been loss of teeth. Therefore occlusal restoration aims to achieve the same end results as
occlusal equilibration, but on a grander scale. Treatment could involve fillings, inlays, onlays, crowns, bridges, partial and full
dentures. But the end result, as always is to get the TMJs in a neutral position, where minimum stress is placed upon them.
5.The job of a mouth splint is to reduce stress on the TMJs – as indeed are all forms of TMJ treatment. There are many
different types of splint and they are often chosen according to the TMJ Specialist’s personal preferences. My own preference is
something called an Anterior Repositioning Splint which places the upper and lower front teeth in line, but a few millimetres apart. It
would not be practical, or for that matter very interesting to list the different mouth splints as they all aim to achieve the same end
result – freedom from pain and other related TMJ symptoms.
6. Other TMJ Specialist Treatments. This is not meant to be a complete list, but rather to give some idea of what options are out
there: TMJ surgery, Injections into the TMJ, Application of heat, Drugs, Cold packs, Psychiatric treatment
*RX Medications may be used in coordination with the above mentioned TMD treatments;
Medications can be prescribed to aid in control of TMD symptoms. Because there are so many factors that contribute to TMD & variable symptoms, a variety of medications may or may not be used in conjunction with other treatments. Here is a list of medications that are most commonly used in the treatment of TMD;
Acetaminophen (Tylenol) Non-Steroidal Anti Inflammatory Drugs (NSAIDs); Ibuprofen - Advil, Motrin, Nabumetone Meloxicam Naproxen – Aleve. Muscle Relaxants; Carisprodol , Cyclobenzaprine , Diazepam , Lioresal – Baclofen, Metaxalone , Tizanidine Alprazolam Anti-Depressants; Amitriptyline – Elavil, Nortriptyline – Pamelor, Imipramine – Tofranil, Escitalopram Oxalate - Setraline Bupropion hydrochloride . Topical Analgesics ; EMLA cream, Lidocaine patches – Lidoderm,Capsascin . Nerve Pain Medications ; Gabpentin , Topiramate - Topamax , Levetriacetam Pregabalin Duloxetine Pain Medications ; Hydrocodone & APAP (APAP=acetaminophen) , Oxycodone & APAP - Propoxyphene & APAP - Darvon, Morphine Sulfate Kadian, Avinza, Fentanyl - Duragesic, Fentora, Actiq.
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