TMJ Disorder Leading To Sleep Disturbances In Haryana
Abstract
This study was conducted at GDC, Rohtak and Haryana in 102 patients of age group of 20 years to 30 years. We observed that Haryana females have more TJ problem as compared to males. In 65% of the females TMJ problems lead to sleep disturbances as compared to 37% of males.
Introduction
Temporamandibular joint disorders are the most misdiagnosed and mistracted maladies in medicine. Among many causative sources of chronic sleep disturbances two prominent dental factors include sleep disorder and neuromusculo-skeletal system pain (TMJ) disorder origin. Consequently, one of the effective treatment modalities as sleep disturbances is a 'Airway dilator' to keep airway open and 'intra oral orthatic' to relieve pain and muscle tension/spasm, which cause sleep disturbances.
Observations and Result
From the statistical data
We found that restriction in mouth opening is rarely a chief complain.
Sleep disorder due to TMJ problem is more common in females which is 65% as compared to males with 37% only. Two percent of people during dental treatment got pain and a prominent clicking sound.
In males, 81% were perfectionist, compulsive and domineering. 87% of females were more introverted, neurotic with more trait anxiety.
Etiology factor in Haryana patients
Discussion
In temporal mandibular dysfunction syndrome following four signs of Laskin's
Unilateral pain Muscular tenderness Clicking or popping noise Limitation of jaw function or deviation of the mandible on opening
Laskin emphasized that patient must also have these negative characteristics. Absence of clinical radiographic or biochemical evidences in TMJ. Lack of tenderness in TMJ area on palpation via external auditory meatus.
What defined TMD ?
Symptoms and signs of TMJ can include some or all the following :
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Jaw pain and stiffness
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Headache usually at temples and sides of head
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Vague tooth soreness or toot ache which often move around the mouth
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Sensitive teeth
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Painful or tender jaw joint
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Difficulty in opening jaw.
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Pan and fatigue when eating hard or chewing food.
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Clicking, popping or grinding sound in jaw joint.
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Ear pain
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Cervical neck tension and pain.
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Tooth wear.
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Awareness of grinding / clenching teeth while sleeping or awake.
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A pattern of breaking or cracking teeth with no other cause i.e. tooth decay or trauma.
Risk factors for sleep disturbances :
There are many factors that restrict the air flow and distract normal sleep pattern. The following are well known causes.
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Nasal obstruction (turbinate hypertrophy or deviate septum polyp)
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Hypertrophy in tonsils
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Enlarged tongue
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Floppy soft palate and uvula
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Overweight large neck size (17 inches or larger in men and 16 inches or larger in women).
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Heavy alcohol consumption.
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Heavy smoking
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Continuous stress
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Sleeping pills
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TMJ disorder
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Multiple missing teeth or malocclusion.
Radiological diagnosis :
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Panoramic radiography
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Tomograms
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Transcranial radiographs
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TMJ arthrography
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Computed radiography
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CT scan and MRI.
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Bone scintigram - Nuclear imaging
Management
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Counseling
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Education regarding the present illness. (Thorough explanation of problem to patient they are aware of condition so the doctor patient relationship extremely important as observed in case study (76%)
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Muscle relaxation techniques and muscle exercises like to tongue exercise.
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Stressful conditions.
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Pharmacotherapy :
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Pain control - analgesic such as Ibuprofen.
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Tranquilizers
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Antidepressants - Floxiten
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Valdecaxive - 20 mg BD
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Sedatives
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Alprazolam
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Dizapem
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Beclofen
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Hypnotics
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Corticosteroids
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NSAIDS
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Nemoslides 100 mg BD
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Biofeedback : Common device used is electromyographic biofeedback machine
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Bruxism prosthesis - Soft mouth guard
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Anterior occlusion prosthesis
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Lucia Jig
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Anterior bite plane
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Mandibular posterior coverage
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Complete maxillary or mandibular coverage
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Stress therapy
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Restrictive use
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Voluntary avoidance
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Hypotherapy
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Psychotherapy
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Physical medications
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Hot packs
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Massage
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Diathermy and ultrasound
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Phenophoresis
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Iontophoresis
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Electrical stimulation
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Oral myofunctional therapy
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Applied kinesiology
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Cold Laser
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Anesthesia
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L.A. into painful trigger zones
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Trigger zones found in masticatory muscles inject 0.5 ml of 2% LA without adrenaline (Muscle and Fascia)
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TMJ (Intracapsular and extracapsular) inject 0.5 ml of 0.5% xylocaine.
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Refrigerated spray
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Vapocoolent spray such as ethyl dichloride or fluromethane.
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Postural training
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Acupuncture
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Surgery
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Eminectomy zygomectomy, menisectomy followed by prosthesis
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High condylectomy
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Orthoplasty plus menisectomy
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Orthopedic stabilization
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Restoration
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Prosthodontic therapy
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Orthodontic therapy
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Orthoganthic surgery
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Conclusion
Temporomandibular region should be examined properly because patients (in Haryana) don't have direct complaints of TMJ problems. In Haryana, females had more TMJ problems leading to sleep disturbances as compared to males. Treatment may be suggested by a physician, oral surgeon, orthodontist, psychotherapist, physical therapist or prosthodontist.