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Temporomandibular Joint Analysis

Temporomandibular Joint Vibration Analysis - the temporomandibular Joint is the skeletal foundation of the stomatognathic system; comprising the mouth, teeth, tongue and muscles of mastication and facial expression.

The healthy function and stability of these structures is interdependent and capable of considerable adaptive and compensatory alteration; teeth may drift and move at any age, head position may adjust, muscles adapt and the temporomandibular joint itself has an inbuilt functional range and an ability to remodel and regenerate in response to the functional forces and demands placed upon it.

Temporomandibular dysfunction (TMD) describes the occurrence of a functional disturbance to the stomatognathic system which may present with a diverse range of acute or chronic symptoms

  • emanating directly from the teeth, muscles or joints
  •  in the distribution the nerves associated with these structures
  • referred pain, such as headaches
  • in wider supporting structures such as the neck or back

The sophistication of the temporomandibular joint, the range of individual variation of facial form and the position of the joint renders it highly elusive to clinical assessment and analysis of function tends to be highly subjective.

Joint Vibration Analysis is a system of objective palpation and recording of the joint offering an inexpensive and non-invasive assessment useful for diagnostic, screening and treatment monitoring purposes.

Triage:
A JVA would be indicated for a patient presenting with one or more of the following:

  • Pain
  • Difficulty chewing, swallowing or speaking
  • The need for significant dentistry, crowns, orthodontics or provision of implants or dentures

Initial observations:

The range of movement of the jaw, maximum opening and ease of movement of the mandible (lower jaw) from side to side is the first indication of a problem with the TMJ.

Clicks and noise from the TMJ is not normal but these "sounds" or more accurately vibrations may not be audible.

The JVA works on the principle that healthy joints function smoothly, the cartilage disc is held in stability by the joint ligaments and the surfaces are smooth and well lubricated providing a full range of unimpeded movement with minimal friction. Any disruption to this situation results in vibrations generated with movement of the joint. These vibrations have particular characteristics according to their specific cause and may fall within or outside the audible range.

Presence of any vibration indicates that the joint function is not normal.

The JVA detects vibrations by simple placement of sensors over the joints, a tracking device fitted like a hat  allows simultaneous recording of the movements of the lower jaw. 

In the first instance, detection of the presence of a vibration is required. If none is present in conjunction with a normal range of movement of the mandible, the purpose of the investigation is satisfied in eliminating the presence of any joint dysfunction.

If a vibration is found in the joint, analysis of the vibration will render more detailed information about the nature of the dysfunction present to guide the clinician. Comparison of the trace characteristics of the vibrations with the clinical observations in patients undergoing open temporomandibular joint surgery showed clear consistency with specific physical changes in the joint structures. Thus a correlative assessment of the vibration is possible.

Analysis of the waveform produced by the vibration includes

  • amplitude (wave height which equates to the energy of the vibration)
  • frequency of the waveform gives an indication of the nature of the tissue vibrating
  • duration and timing of the vibration in the opening and closing cycle
  • transference of energy to the contralateral side.

This information is sufficient to correlate the vibration to an intracapsular derangement.  Diagnosis and any subsequent treatment or management decision requires further clinical information. If joints are damaged they will be in one of three states:

  • Actively breaking down
  • Adapting
  • Adapted

The reproducibility of the JVA information lends itself to screening and repeat observations to indicate what stage of problem is present and assist with the clinical decisions about the need for interventive treatment, the risk of damage to dental restorations and for monitoring of the effectiveness and outcomes of treatments such as occlusal splints.

JVA screening is part of the routine examination and diagnosis for patients attending Granta Dental for extensive dental treatment or for investigation of dental and facial pain that cannot be attributed to cavites or dental infections.

Granta Dental will accept referrals for the basic JVA screening and analysis from dentists and any other health professionals who require information about the condition of the temporomandibular joint. Detailed demonstration of the system will also be part of the study group meeting to be held on Friday 19th April 2013.

Research references.

 


Posted on 14 April 2013
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