Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
7. Abnormal maxillo-mandibular relationships.Abnormal maxillo-mandibular relationships.
Rheumatic / musculo-skeletal disorders.Rheumatic / musculo-skeletal disorders.
Poor general health and unhealthy lifestyle.Poor general health and unhealthy lifestyle.
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12. III. Fractures of the condyleIII. Fractures of the condyle
IV.IV. InflammatoryInflammatory
ArthritisArthritis
Rheumotoid arthritisRheumotoid arthritis
OsteoarthritisOsteoarthritis
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13. V.V. NeoplasticNeoplastic
VI.VI. Extra-articular disturbancesExtra-articular disturbances
VII. Temporomandibular jointVII. Temporomandibular joint syndrome (TMD)syndrome (TMD)
TMD secondary to myofacial pain and dysfunctionTMD secondary to myofacial pain and dysfunction
(MPD)(MPD)
TMD secondary to true articular disease.TMD secondary to true articular disease.
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17. Hypoplasia of the mandibular condyleHypoplasia of the mandibular condyle::
Under development / defective formationUnder development / defective formation
Congenital hypoplasiaCongenital hypoplasia
IdiopathicIdiopathic
Characterized by uni / bilateral underCharacterized by uni / bilateral under
development of the condyledevelopment of the condyle
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19. C/f:C/f:
DependsDepends
Degree of malformation.Degree of malformation.
AgeAge
DDurationuration
UnilateralUnilateral
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20. Limited lateral movementsLimited lateral movements
Midline shiftMidline shift
Lack of downward and forward growth of theLack of downward and forward growth of the
mandiblemandible
Arrest of theArrest of the chief growth centerchief growth center of theof the
mandible i.e.,mandible i.e., condyle.condyle.
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21. Treatment & prognosis:Treatment & prognosis:
Cartilage / bone transplantsCartilage / bone transplants
Unilateral and bilateral osteotomyUnilateral and bilateral osteotomy
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22. Hyperplasia of the mandibular condyleHyperplasia of the mandibular condyle::
RareRare
unilateral enlargement of the condyleunilateral enlargement of the condyle
Causes:Causes:
-Obscure-Obscure
-Mild chronic inflammation.-Mild chronic inflammation.
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23. C/f:C/f:
Elongation of the faceElongation of the face
deviation of the chin away from the affected side.deviation of the chin away from the affected side.
Enlarged condyleEnlarged condyle
may or may not be painfulmay or may not be painful
severe malocclusionsevere malocclusion
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26. R/F:R/F:
Elongated neck and enlarged condylar headElongated neck and enlarged condylar head
Treatment and prognosis:Treatment and prognosis:
CondylectomyCondylectomy
Orthognathic surgeryOrthognathic surgery
Resection of condyleResection of condyle
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29. C/F:C/F:
UnilateralUnilateral
AsymptomaticAsymptomatic
Pop or click of TMJPop or click of TMJ
R/F:R/F:
Bilobed appearanceBilobed appearance
AsymptomaticAsymptomatic no treatmentno treatment
necessary.necessary.
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30. Histologic section of bifid condyleHistologic section of bifid condyle
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32. Luxation and subluxationLuxation and subluxation
Dislocation of the TMJDislocation of the TMJ
Luxation of the jointLuxation of the joint
SubluxationSubluxation
LuxationLuxation ‘acute’, due to a sudden traumatic injury‘acute’, due to a sudden traumatic injury
resulting in the fracture of the condyle.resulting in the fracture of the condyle.
Yawning / wide opening of mouthYawning / wide opening of mouth
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35. Luxation & SubluxationLuxation & Subluxation
C/f:C/f:
Sudden locking and immobilization of the jaws.Sudden locking and immobilization of the jaws.
Prolonged spasmodic contraction of the temporal,Prolonged spasmodic contraction of the temporal,
internal pterygoid and masseter muscles.internal pterygoid and masseter muscles.
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36. Luxation & SubluxationLuxation & Subluxation
Treatment:Treatment:
Relaxation of the muscles and then guiding the head of theRelaxation of the muscles and then guiding the head of the
condyle under the articular eminence into its normal positioncondyle under the articular eminence into its normal position
by an inferior and posterior pressure of the thumbs in theby an inferior and posterior pressure of the thumbs in the
mandibular molar area.mandibular molar area.
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37. AnkylosisAnkylosis
Fusion of head of the condyleFusion of head of the condyle temporal bone.temporal bone.
EtiologyEtiology::
IdiopathicIdiopathic
Traumatic injuriesTraumatic injuries
InfectionInfection
Rheumatoid arthritisRheumatoid arthritis
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38. AnkylosisAnkylosis
C/f:C/f:
11stst
decadedecade
Before 10 yearsBefore 10 years
M = FM = F
Unilateral /BilateralUnilateral /Bilateral
In ability to open the jawsIn ability to open the jaws
Pain, tenderness and malocclusionPain, tenderness and malocclusion
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40. AnkylosisAnkylosis
Intra-articular ankylosisIntra-articular ankylosis Extra-articular ankylosisExtra-articular ankylosis
-Destruction of the meniscus-Destruction of the meniscus
-Flattening of the mandibular-Flattening of the mandibular
fossa thickening of the headfossa thickening of the head
of the condyleof the condyle
-narrowing of the joint space-narrowing of the joint space
-Fibrous adhesion-Fibrous adhesion
External fibrous / osseousExternal fibrous / osseous
encapsulation.encapsulation.
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41. AnkylosisAnkylosis
R/F:R/F:
Abnormal / irregular shape of the head of theAbnormal / irregular shape of the head of the
condylecondyle
Treatment:Treatment:
Surgical osteotomy / removal of section of boneSurgical osteotomy / removal of section of bone
below the condyle.below the condyle.
Fibrous ankylosis can be treated by functionalFibrous ankylosis can be treated by functional
methods.methods.
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42. Injuries of the articular diskInjuries of the articular disk
MalocclusionMalocclusion
Loss of adaptation of the disk to the condyle.Loss of adaptation of the disk to the condyle.
Precipitating factorsPrecipitating factors
Blow / fallBlow / fall
Rheumatoid arthritisRheumatoid arthritis
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43. C/f:C/f:
FemalesFemales
Young adultsYoung adults frequently affected.frequently affected.
Pain, snapping or clicking and crepitation.Pain, snapping or clicking and crepitation.
Transient / prolonged locking of the jaw mayTransient / prolonged locking of the jaw may
occur.occur.
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44. Injuries of the articular diskInjuries of the articular disk
Normal disc positionNormal disc position Anterior discAnterior disc
displacementdisplacement
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45. Injuries of the articular diskInjuries of the articular disk
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46. Injuries of the articular diskInjuries of the articular disk
R/F:R/F:
No +ve findingsNo +ve findings
Treatment:Treatment:
ImmobilizationImmobilization
Menisectomy / surgical removal of theMenisectomy / surgical removal of the
disk.disk.
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48. Condylar fracture:Condylar fracture:
Traumatic injuryTraumatic injury
Limitation of motionLimitation of motion
Pain and swellingPain and swelling
Displaced anteriorly and medially into theDisplaced anteriorly and medially into the
infratemporal regioninfratemporal region
Surgical reduction
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51. Arthritis.Arthritis.
3 types :3 types :
1.1. Arthritis due to a specific infection.Arthritis due to a specific infection.
2.2. Rheumatoid arthritis.Rheumatoid arthritis.
3.3. Osteoarthritis / degenerative joint disease.Osteoarthritis / degenerative joint disease.
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52. UncommonUncommon
Neisseria gonorrhea, Str, Staph. Pneumococci,Neisseria gonorrhea, Str, Staph. Pneumococci,
tubercle bacilli, H. influenzaetubercle bacilli, H. influenzae
Direct spread of a local infection or blood stream /Direct spread of a local infection or blood stream /
lymphatic metastasis.lymphatic metastasis.
C/F:C/F:
-- Severe pain in the joint.Severe pain in the joint.
Extreme tendernessExtreme tenderness
HealingHealing results in ankylosis.results in ankylosis.
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53. H-PH-P
DestructionDestruction articular cartilage and articular disc.articular cartilage and articular disc.
Obliteration of joint spaceObliteration of joint space by the development ofby the development of
granulation tissuegranulation tissue
Transforms into scar tissue.Transforms into scar tissue.
Rx:Rx:
Antibiotics – in the acute phaseAntibiotics – in the acute phase
Meniscetomy / condylectomy is advocated in the advancedMeniscetomy / condylectomy is advocated in the advanced
cases.cases.
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54. Rheumatoid arthritisRheumatoid arthritis
Chronic autoimmune disorderChronic autoimmune disorder
non-suppurative inflammatory destruction of thenon-suppurative inflammatory destruction of the
joints.joints.
Etiology:Etiology:
UnknownUnknown
Cross reaction of antibody against microorganismsCross reaction of antibody against microorganisms
deposited in the synovial membrane.deposited in the synovial membrane.
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55. A reactive macrophage – laden fibroblasticA reactive macrophage – laden fibroblastic
proliferation from the synovium creeps onto theproliferation from the synovium creeps onto the
joint surface.joint surface.
↓↓
Releases collagenases & proteasesReleases collagenases & proteases
↓↓
Destroys the cartilage & boneDestroys the cartilage & bone
TMJ involvementTMJ involvement 20%20%
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57. Pain, swelling and stiffness jointPain, swelling and stiffness joint
Clenching the teeth on one side produces pain ofClenching the teeth on one side produces pain of
contra lateral joint.contra lateral joint.
Destruction of condylar headDestruction of condylar head receding chin &receding chin &
malocclusionmalocclusion
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58. R/F:R/F:
Flattened condylar headFlattened condylar head
An irregular surface of temporal fossaAn irregular surface of temporal fossa
Anterior displacement of the condyleAnterior displacement of the condyle
High resolution CTHigh resolution CT erosions of the condyle &erosions of the condyle &
glenoid fossae.glenoid fossae.
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59. H-P :H-P :
HyperplasiaHyperplasia of synovial lining cellsof synovial lining cells
Hyperemia, edemaHyperemia, edema and inflammation of the synovialand inflammation of the synovial
tissuestissues
diffuse infiltration of chronic inflammatory cells into thediffuse infiltration of chronic inflammatory cells into the
articular architecture.articular architecture.
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60. destructiondestruction of articular surface of the condyle.of articular surface of the condyle.
Invasion of the cartilage and its replacement byInvasion of the cartilage and its replacement by
granulation tissue.granulation tissue.
Perforation of meniscusPerforation of meniscus
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64. OsteoarthritisOsteoarthritis
Disorder of articular cartilage, subcondral boneDisorder of articular cartilage, subcondral bone
with secondary inflammation of the synovialwith secondary inflammation of the synovial
membranemembrane
Etiology:Etiology: unknown.unknown.
GeneticGenetic
Aging process.Aging process.
Chronic microtraumaChronic microtrauma
PrimaryPrimary above 50 yrs & asymptomaticabove 50 yrs & asymptomatic
SecondarySecondary due to trauma, metabolic diseasedue to trauma, metabolic disease
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65. C/F:C/F:
Unilateral pain over the condyle & over muscles ofUnilateral pain over the condyle & over muscles of
masticationmastication
Limitation of mandibular openingLimitation of mandibular opening
Crepitus and stiffnessCrepitus and stiffness
Deviation of mandible towards painful sideDeviation of mandible towards painful side
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66. R / F:R / F:
Obliteration of the joint spaceObliteration of the joint space
Surface irregularities and protruberancesSurface irregularities and protruberances
Flattening of the articular surface.Flattening of the articular surface.
Radiolucent subchondral cystsRadiolucent subchondral cysts
Ossification within the synovial membraneOssification within the synovial membrane
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67. H-P /F:H-P /F:
Degeneration of cartilage cellsDegeneration of cartilage cells
infiltration of chronic inflammatory cellsinfiltration of chronic inflammatory cells
Loss of osteocytesLoss of osteocytes
fatty degeneration & necrosis of the marrowfatty degeneration & necrosis of the marrow
Large degenerative space beneath the articularLarge degenerative space beneath the articular
cartilage (Subchondral cysts)cartilage (Subchondral cysts)
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71. Neoplasms and tumor-like growths, benign andNeoplasms and tumor-like growths, benign and
malignant, may involve the TMJ.malignant, may involve the TMJ.
Etiology:Etiology: UnknownUnknown
From embryonic mesenchymal remnants ofFrom embryonic mesenchymal remnants of
synovium.synovium.
That become metaplastic, calcify, break off into theThat become metaplastic, calcify, break off into the
joint spacejoint space
Chondromas, osteomas and osteochondromas areChondromas, osteomas and osteochondromas are
common benign tumors.common benign tumors.
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73. Osteochondroma – bone capped with cartilage and denseOsteochondroma – bone capped with cartilage and dense
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74. CT scan and arthroscopy is necessary forCT scan and arthroscopy is necessary for
accurate diagnosis.accurate diagnosis.
Rx:Rx:
Conservative and surgical removal of involvedConservative and surgical removal of involved
synovium and articular disk.synovium and articular disk.
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76. A variety of extraarticular disturbances mayA variety of extraarticular disturbances may
manifest themselves clinically as TMJ problems.manifest themselves clinically as TMJ problems.
Impacted molar teethImpacted molar teeth
Sinusitis & Middle ear diseaseSinusitis & Middle ear disease
Infratemporal cellulitisInfratemporal cellulitis
Neuritis of the 3Neuritis of the 3rdrd
division of the trigeminal nerve.division of the trigeminal nerve.
Odontolgia.Odontolgia.
Overclosure of the mandible due to severe dentalOverclosure of the mandible due to severe dental
attrition.attrition.
Costen’s syndrome.Costen’s syndrome.
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78. Most common cause of facial pain afterMost common cause of facial pain after
toothache.toothache.
TMD can be classified broadly as:TMD can be classified broadly as:
TMD secondary to myofacial pain andTMD secondary to myofacial pain and
dysfunction (MPD).dysfunction (MPD).
TMD secondary to true articular diseaseTMD secondary to true articular disease
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79. Etiology:Etiology:
Tissue injuryTissue injury
Physical stressPhysical stress Bruxism and day time jawBruxism and day time jaw
clenching in a stressed and anxious person.clenching in a stressed and anxious person.
Psychological & behavioural abnormalitiesPsychological & behavioural abnormalities
Poor nutritional statusPoor nutritional status
Genetic predispositionGenetic predisposition
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81. C /F:C /F:
Constant diffuse unilateral painConstant diffuse unilateral pain
Severe in the morning and worsens as daySevere in the morning and worsens as day
progressesprogresses
Radiates to cervical region, shoulders and backRadiates to cervical region, shoulders and back
Limitation of jaw movementLimitation of jaw movement
Deviation to the affected siteDeviation to the affected site
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82. VII. TEMPOROMANDIBULAR JOINTVII. TEMPOROMANDIBULAR JOINT
SYNDROME (TM disorder)SYNDROME (TM disorder)
Cl / Ft:Cl / Ft:
Tenderness in MMTenderness in MM
Angle of mandibleAngle of mandible
Anterior temporal region & coronoid aspectAnterior temporal region & coronoid aspect
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86. C/F:C/F:
Affects young woman aged 20-40 yrs.Affects young woman aged 20-40 yrs.
M:F – 1:4.M:F – 1:4.
In TMD pain is unilateral associated with clicking,In TMD pain is unilateral associated with clicking,
popping and snapping sounds.popping and snapping sounds.
Limited jaw opening due to pain / disk displacement.Limited jaw opening due to pain / disk displacement.
Associated with chewing and may radiate to head.Associated with chewing and may radiate to head.
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87. Treatment & Prognosis:Treatment & Prognosis:
1. Self limiting.1. Self limiting.
2. Conservative treatment involving self care2. Conservative treatment involving self care
practices.practices.
Rehabilitation aimed at eliminating muscleRehabilitation aimed at eliminating muscle
spasms.spasms.
3. NSAIDs3. NSAIDs
Prognosis is good.Prognosis is good.
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90. ReferencesReferences
Shafer’s Textbook of Oral Pathology. 5Shafer’s Textbook of Oral Pathology. 5thth
edition.edition.
Neville: Oral & Maxillofacial Pathology. 2Neville: Oral & Maxillofacial Pathology. 2ndnd
edition.edition.
Jaffery P. Okeson – Management ofJaffery P. Okeson – Management of
Temporomandibular disorders and occlusion.Temporomandibular disorders and occlusion.
Martin S. Greenberg, Michael Glick – Burkit’s oralMartin S. Greenberg, Michael Glick – Burkit’s oral
medicine and diagnosis.medicine and diagnosis.
Franklin C.D.: Pathology of the temporomandibularFranklin C.D.: Pathology of the temporomandibular
joint. Current Diagnostic Pathology (2006): 12, 31-39.joint. Current Diagnostic Pathology (2006): 12, 31-39.
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