Occlusion and Dysfunction of TMD

Temporomandibular Joint Dysfunction (TMD) and Craniofacial Pain


Temporomandibular Joint Dysfunction (TMD) is an uncommon disease in Portugal and therefore with many patients to diagnose. According to the US National Institutes of Health, more than ten million Americans suffer from TMD Disorders / Disorders. This is the most conservative estimate we can find.


Occlusion is the branch of dental medicine that studies the relationships of dental contact between the upper and lower dental arches. In the occlusion, the dynamic, morphological and functional relationship between all the components of the masticatory organ composed of the teeth, the support structures of the teeth, the neuromuscular system, the temporomandibular joints and the craniofacial skeleton are considered.


Normocclusion (“normal occlusion”): In order to have a correct occlusion, all teeth must have a correct position and relation, both between them and with the bone system in which they are inserted.


When this harmony does not occur, “Temporomandibular Joint Dysfunction” (TMD) appears with vulgar, sometimes unbearable complaints: headache, ear pain (mistaken for ear pain), TMJ noises, cervical spine pain , pain in the mastication muscles, facial pain, difficulty opening the mouth, dental attrition (sharp tooth wear). This situation should be diagnosed and treated as early as possible to avoid further complications.


TMD dysfunction is the result of the abnormal functioning of:
1- temporo-mandibular joint (TMJ),
2- ligaments,
3- chewing muscles (Temporal, Masseter, external and external Pterygoid),
4 – upper and lower jaw bone (mandible),
5- teeth,
6- dental support structures.


The articular disc is a tissue similar to the meniscus of the knee, positioned along the mandibular condyle and acts as a damper between the condyle and the skull.


Temporo-mandibular joints, when intact, are the only joints in the human body that work together (bilaterally) as a unit. These joints allow us to perform functions like opening and closing the mouth, chewing, swallowing, breathing, talking, etc …


All elements of TMJ are wisely programmed and designed to work together harmoniously without stress or strain.

When any of these elements is in imbalance, it causes the rest of the elements an additional effort to compensate and restore the balance. The human being has an inborn capacity to tolerate changes and imbalances of the organism, automatically creating adaptations to “overcome the difficulties”. However this tolerance and adaptability has limits and varies from person to person. When changes are many there may be difficulty in restoring balance and the disease arises with signs and symptoms.


When there is dysfunction, the patient complains of symptoms such as: headache (headache, “migraine”); earache; tinnitus and / or vertigo; pain and / or tiredness of chewing muscles; pain in the neck, shoulders or back; torticolos; noises of the TMJ (cracking or crackling near the ear); difficulty opening your mouth.


TMJ dysfunction is related to common habits such as involuntarily clenching teeth, bruxism (grinding teeth when sleeping), biting foreign objects, chewing gum, chewing gum, head posture (forward), holding the phone chin. It is also related to stress, anxiety, depression or anterior oro-facial trauma.


These patients present an often obscure clinical picture, due to the anatomical-functional complexity of the Stomatognathic System, which leads them to go through several medical specialties (ENT, Physiatry, Orthopedics, Neurology, Neurosurgery, Psychiatrist) and to undergo several complementary tests (RX, CT scan, magnetic resonance imaging, EEG, etc.). This dysfunction is found, most frequently in women, being approximately 9 women to 1 man. It is attempted to explain this high incidence, due to the fact that the woman is exposed to hormonal changes during the menstrual cycle and to the pregnancy; also, compared to men, seek medical help more often. Regarding age, it can occur in any age group, but it is more common from 30 to 40 years.
The parafunctional habits and the dental malocclusion induce micro-trauma in the TMJ, thus developing degenerative lesions in the condyle and in the articular disc. If you are suffering from DATM, it is very likely that you have spent years of your life in various consultations for relief and hearing explanations such as “have otitis,” “have migraine,” “have a herniated disc,” “have a herniated disc “” Have neuralgia, “” have depression, “etc., etc.


There are several treatment options:

  • explanation of the pathophysiology of the disease and “self-care”;
  • behavior modification, including relaxation techniques;
  • orthopedic therapy (relaxation plate);
  • occlusal therapy (orthodontics, oral rehabilitation, occlusal adjustment, etc.);
  • physical therapy;
  • very rarely medicines;
  • very rarely surgery.


The goals of treatment are:

  • reduce pain
  • restoring comfortable mandibular function
  • limit recurrence of pain
  • prevent irreversible joint damage