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Orthodontics and TMD

anatomy of TMJ

• glenoid fossa and articualr tebercle
• condylar process of mandible
• articular disc
• joint campsule
• lateral TMJ ligamnet
• sphenomandibular ligament
• stylomandibular ligament

Brimm versus malloy

• 1987
• dr malloy accused of causing TMD in a 16 year old with Class II div 1
• treatment involved premolar maxillary exo and headgear
• Dr JW Witzig sided with the pt, stated dental negligence

TMD symptoms

• pain in face, TMJ, MOM, head and ear
  • tinnitus,
  • ear fullness
  • vertigo

TMD etiology

• trauma
  • direct trauma/ macrotrauma
  • indirect trauma (whiplash)
  • microtrauma - parafunctional habits
• psychosocial
  • anxiety, depression etc.
• physiopathological factors
  • systemic: degenerative, endocrine, infectious, metabolic, neoplastic, neurological, vascular
  • local: synovial fluid viscosity, inctra articular pressure, oxidative stress
  • genetic

Diagnosis

• no current reliable method for diagnosing TMDs

Imaging

• opg
• lat tomo
• lat ceph
• pa ceph
• cbct
• findings:
  • asymmetyrical joint spaces
  • asymmetric condyles
  • abnormal wearing of articular surfaces
  • anatomy of glenoid fossa and eminence

Management

• conservative
  • counselling
  • self care
  • medicaiton
  • splint
  • Botox injection
• surgical
  • arthrocentesis - saline and drainage of joint
  • arthroplasty
  • condylectomy
  • total TMJ replacement

Indications for tmj surgery

• failed appropriate nonsurgical treatment

Ortho and TMD

Does Orthodontics Cause TMD?

• Accusations that orthodontics causes TMD are countered by evidence suggesting otherwise.

Can Orthodontics 'cure' or 'fix' TMD?

• The promise that orthodontics can cure TMD is scrutinized, with modern evidence-based views advocating for objective analysis over anecdotal claims.

• TMD is a complex disease with a multi-factorial aetiology.

• With the advent of the modern-day evidence-based view, more attention should be spent objectively analyzing the evidence, rather than toward anecdotes, opinions and empiricism.

Negligence

• lack of attention care or concern
• breach of professional duty
• to prove negligence a patient must prove
  • a legal duty of care
  • breach of that duty
  • resultant loss or damage
• issues of informed consent
  • how much did the patient understand and remember
  • were the risks fully explained
• dentist should discuss
  • benefit of treatment
  • necessary cooperation
  • limitations and expectations
  • risks of treatment options
  • risks of no treatment
  • necessity to treat

Bolam test

• common law countries
• standard of care is measured in concordance with the body of opinion in the profession
• evidence based decision making

Primum non nocere

• first, do no harm