Functional diagnostics and therapy

What are temporomandibular disorders?

The masticatory system is a complex functional unit responsible for chewing, speaking, and swallowing, composed of bones, joints, ligaments, teeth, and muscles. All of these components are coordinated by the neurological system that regulates movements. The mechanics and physiology of these movements are the foundation of studying masticatory function. In order for the masticatory system to function harmoniously, the position of the teeth, dental arches and their mutual relationship, as well as the forces of surrounding soft tissues, must be coordinated. During the eruption and after the teeth eruption, any change or disturbance in the size, direction, or frequency of muscular forces will affect tooth movement, thus creating certain malocclusions conditioned by tooth position. They can also affect function. When they exceed an individual's physiological tolerance limit, the system begins to show certain functional changes. Possible sites of damage are muscles, TMJs, supporting structures of teeth, and teeth themselves.

Temporomandibular disorders (TMDs) encompass a whole range of clinical problems related to masticatory musculature, temporomandibular joints (TMJs), and associated structures. These disorders are often accompanied by pain in the preauricular region, pain in the masticatory muscles, TMJs, and associated hard and soft tissues of the oral cavity. Other symptoms include limitation or deviation in the movement of the lower jaw, sounds in the TMJ, and/or headaches and facial pain.

According to data from various researchers, the prevalence of TMDs ranges from 27% to 76%. In the general population, the prevalence of TMDs is twice as high in women as in men. The frequency of TMDs, as claimed by certain authors, is most pronounced in women between the ages of 18 and 50, although disorders are also present in the postmenopausal period. The frequency of TMDs in adolescents aged 12 to 18 years who have painful symptoms and seek treatment is 3% to 7%.

It is still a little-known fact that an incorrect relationship between the upper and lower jaw can be the cause of a range of dental disorders and painful conditions of teeth, muscles, and the temporomandibular joint. Due to prolonged, non-physiological stress, abrasion (wear) of chewing surfaces appears on the teeth, and the teeth can become mobile and painful because the surrounding supporting bone disappears.

In the temporomandibular joint, painful skipping, dislocation of the disc, or the formation of arthritic changes can occur, also accompanied by pain. Ringing in the ear (tinnitus) may occur.

Possible pain in the muscles of the head, neck, and shoulders, due to their overexertion or shortening, can also occur. Chronic headaches, muscle pain in the head and neck, dizziness, reduced mouth opening, swallowing problems, increased sensitivity to light are frequent symptoms in these patients. Since the position of the jaw affects the statics of the whole body, if it is irregular, the body is no longer in balance and one side of the body (hip, knee, and foot) is more burdened. We call this set of conditions temporomandibular disorders, which often remain unrecognized due to their wide range of symptoms.

Diagnostics

We make a diagnosis based on a very detailed medical history, and a manual and instrumental analysis. If there are symptoms, it is important to identify them and determine whether the problem is in the muscles, the disc, or the joint itself. It is important to make a good differential diagnosis. We often need a CBCT scan of the joints to diagnose bone changes and/or an MRI to determine changes in the ligaments or muscles.

In our clinic, we use the protocol of the Group for Functional Diagnosis and Therapy (GFDT) (APW, Neustadt) of which we are long-standing, honorary members. To carry out this type of diagnosis and therapy, we need a strict medical indication and a lot of clinical experience. In addition to clinical examination and manual diagnosis, we also use instrumental diagnostic methods for visualizing the movement of the lower jaw in all three spatial planes using 3D devices, which record the best clinical results. Also, using 3D digital technology, we visualize contacts between inter-jaw relations and their strength on each individual tooth.

Therapy

Depending on the causes of the disorder, therapy can range from very simple procedures that relieve the chewing system and relax the muscles, to very complex procedures that bring the relationship between the jaws back to a physiological position. Such procedures usually require a complete reconstruction of the dental occlusal surfaces. We follow the established principles of occlusion and function. It is extremely important to emphasize that respecting occlusal principles is a prerequisite and foundation for the production of all reconstructive dental works (fillings, crowns, implants, bridges). As an initial therapy, it is often necessary to wear a splint as a therapeutic tool, after which definitive therapy must follow. After the symptoms disappear, the splint is removed and orthodontic therapy and/or prosthetic rehabilitation should follow immediately. Basic occlusal parameters must be set so that the symptoms do not reappear. If the symptoms are of a psychological nature, this type of therapy will not completely eliminate the problem, but it can certainly help. Sometimes, a maxillofacial surgeon's intervention may be necessary.

HOW TO START?

The first step to a more beautiful smile

Consultation with a specialist doctor is the first step towards a more beautiful and healthy smile – a smile that leaves a positive impression on other people, makes us safer and full of confidence. In the safe hands of our doctors, we provide our clients with impeccable results with an individual approach, knowledge and love of work. Based on quality diagnostics, we will suggest an individual therapy plan oriented towards achieving top results.