dear collegue, can you read my report on arthroscopy of TMJ in my profile, it is in Flemish, I am presenting an afternoon in Gent/Brussel in Belgium on TMJ disorders in adolescents for orthodontists. TMJ disorders are much more common in orthodontic population especially in patients with retrognathy of mandible or asymmetries.

regards,Bernard Bonte

Hello Bernard, class ii cases are prone to disc displacement:

Wright WJ Jr: (1986) Temporomandibular disorders: occurrence of specific diagnoses and response to conservative management. Clinical observations, Cranio 4:150-155.

Seligman DA, Pullinger AG (1989) Association of occlusal variables among refined TM patient diagnostic groups, J Craniomandib Disord 3:227-236

80. Solberg WK, Bibb CA, Nordstrom BB, Hansson TL (1986) Malocclusion associated with temporomandibular joint changes in young adults at autopsy, Am J Orthod 89:326-330.

Pullinger AG, Seligman DA. (1991) Overbite and overjet characteristics of refined diagnostic groups of temporomandibular disorder patients. Am J Orthod Dentofac Orthop. 100(5):401–15.

Tsolka P, Walter JD, Wilson RF, Preiskel HW (1995) Occlusal variables, bruxism and temporomandibular disorder: a clinical and kinesio graphic assessment, J Oral Rehabil 22:849-956

Celic R, Jerolimov V (2002) Association of horizontal and vertical overlap with prevalence of temporomandibular disorders, J Oral Rehabil 29:588-593

Miller JR, Burgess JA, Critchlow CW (2004) Association between mandibular retrognathia and TMJ disorders in adult females. J Public Health Dent 64:157-163

Miller JR, Manci L, Critchlow C (2005) Severe retrognathia as a risk factor for recent onset painful TMJ disorders among adult females. J Orthod 32:249-256,

Tallents RH, Stein S, Macher DJ, Katzberg RW, Murphy W. (2012) Predisposingand Precipitating Factors in Temporomandibular Disorders. Semin Orthod.Elsevier Inc.;18(1):10–29.

Orbach, S. (1998) "TMD issues in patient with skeletal deformity of jaws." TheNew York state dental journal 64.3: 48-54.

for mri studies on juvenile disc displacemet have a look at:

D. P., Sousa Melo, S. L., de Andrade Freitas Oliveira, L. S., Ramos-Perez, F. M. de M., & Campos, P. S. F. (2015). Evaluation of temporomandibular joint disk displacement and its correlation with pain and osseous abnormalities in symptomatic young patients with magnetic resonance imaging. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 119(1), 107–12. http://doi.org/10.1016/j.oooo.2014.09.022

Bur you ave to keep in mind that TMD signs occur first in juvenile paitents no matter wether they have had orthodontic treatment or not.

Kind regards

Katja Kritzler

Home treatmet

1.NSAIDS

2.Use Moist Heat or Cold Packs

3.Soft Diet

4.Avoid extreme Jaw movements 

5.Dont rest your chin on your hand

6.keeping Teeth slightly apart while resting

7.Learn relaxation Technique

Traditional Treatment

1.Splints/Noght Guards

2.Prosthodontic Rehabilitation  of Missing teeth

Other Treatments

1.Transcutaneous  electrical Nerve Stimulation

2.Ultrasound

3.Trigger point injection 

4.Radiowave Therapy

5.Low level Laser Therapy

Surgical Treatment

1.Arthrocintesis

2.Arthroscopy

3.Open Joint Sugery

Dear Katja,

they should follow diet restrictions like soft diet will be given. mouth should not be open for long time for dental treatment. appliances are available commercially. trigger point injetion , laser therapy. surgically it can be corrected by arthroscopy and open joint surgery.

Hi dear, your first point is (when?) My answer, in that regard, is only when it is (symptomatic by the patient in form of pain), meaning that a radiographic or clinical evidences are not the determining factors to start your treatment but the patient complaint. Concerning (how?) It is according the cause, if it was only due to MPDS, the patient may benifit from analgesics, muscle relaxants & managing the para functional habits. However, if it was due to anatomical defects, in addition to the previously mentioned treatment lines, surgery may be indicated. The patient history, clinical diagnosis, in addition to MRI are the most important tools to reach the proper diagnosis and treatment.  

Hello Hala, I agree. If no dysfunction or pain can be diagnosed reciprocal clicking must not be treated because it represents an anatomical condition not an  disorder.  When the clicking joint is associated with pain or joint dysfunction in  most cases simple therapeutic interventions will be adequate to resolve the condition. These include patient education, self-care, physio-therapy, an occlusal appliance, and eventually pharmaco-therapy.

Dear Katja, one of the most valuable treatment lines is the low level laser therapy (LLLT) in reducing pain & inflammation in both TMJ & muscles of mastication by irradiating the trigger points with the proper energy density. In addition, LLLT also increases the blood supply to the affected area, besides, its beneficial effects on regeneration.

Dear Hala, if the pain is caused by joint dysfunction palliative treatment should not be conducted as the only treatment measure. In order to establish sound joint function anterior repositioning appliances might be indicated to prevent locking.

Best wishes

Katja