3/30/11 Guideline on Acquired Temporomandibular Disorders in Infants, Children, and Adolescents

Department of Pediatric Dentistry
Resident’s Name:Murphy Program: Lutheran Medical Center - Providence
Article title: Guideline on Acquired Temporomandibular Disorders in Infants, Children, and Adolescents
Author(s): Review Council
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2010 v32 No 6 pg 232-278
Major topic: TMD
Minor topic(s):
Main Purpose: To assist in the recognition and diagnosis of TMD and to identify possible treatment options. This guideline is not aimed at recommending specific tx modalities.
Overview of method of research: Electronic search using buzz words for TMD. 69 articles were reviewed.

Findings:
In the development and growth of the TMJ, function influences form. The TMJ is made up of three major components, The mandibular condyle, fossa, and associated connective tissue (articular disk). The TMJ starts to develop 8 weeks after conception.
1st decade-Condyle becomes less vascularized, most morphologic changes are complete
2nd decade-Continued slow growth
3rd decade-Condyle changes form wider than longer
Lifetime-TMJ changes throughout life

TMD has been defined as “functional disturbances of the masticatory system”. Masticatory muscle issues, degenerative/inflammatory changes in the TMJ, and TMJ displacement can also be included in the definition. Certain medical conditions may mimic TMJ symptoms, including psychological disorders such as anxiety, mood disorders, etc.

TMD disorders have multiple etiological factors. An alteration any combination of teeth, PDL, TMJ, or MOM can lead to TMD. Other factors include
-Trauma
-Occlusal Forces such as open bite, overjet >6mm, retrocuspal position, ClassIII, or missing >5 posterior teeth
-Parafunctional habits
-Posture
-Changes in freeway dimension
Current literature does not support that development of TMD is caused by orthodontics.

TMD can present in infants, children, adolescents, and adults. Approx. 25% of children have TMJ, with clicking being the most common symptom. Recent reviews show that girls are more effected than boys (early puberty).

All comprehensive dental exams should include a TMJ exam. Various questions should be asked about the TMJ, including

-Difficulty opening?
-Hear noise when you open?
-Pain in/around ears? Cheeks? When chewing? Opening? Yawning?
-Has bite changed?
-Ever get locked open?
-Any head/neck injuries?

Clinical assessment should include palpation, auscultation, examination of jaw movements, and radiographs.

Simple, conservative, reversible tx is best for children. Tx should be aimed at finding a balance between active and passive tx options. Tx may include
Reversible
-Patient education ie relaxation training, coping strategies
-Physical therapy ie jaw exercises, transcutaneous electrical nerve stimulation
-Behavioral therapy
-Prescription meds is NSAIDS
-Occlusal splints

Irreversible
-Occlusal adjustment
-Mandibular repositioning surgery
-Orthodontics

If you’re not comfortable treating or diagnosing TMD, refer.
Key points/Summary:
Main points are that kids, infants even can have TMD. We need to be aware of it, and make sure we ask our patients about it regularly. Always be sure to assess the TMJ if trauma has occurred. Tx for kids should be reversible, and should go from less invasive to most.

Assessment of Article: Another lovely guideline. Good stuff.