Temporomandibular joint disorders, the incidence rate is very high, but because the disease symptom diversity, causes diversity, diversity o
Temporomandibular joint disorders, the incidence rate is very high, but because the disease symptom diversity, causes diversity, diversity of treatment methods "so that many patients do not know how to Xunyiwenyao, a large number of patients complained in the network, but not the correct guidance, went to many hospitals, did not get a diagnosis and the exact treatment, as a treatment of this disease for the doctor, I want to use the most simple language to help you understand this disease, know what treatment direction, can find the most appropriate treatment for their.
There are many kinds of classification of temporomandibular disorders, from the symptoms of pain, limited mouth opening and joint ring, and some patients have a change of face.
From the professional diagnosis to classification, mainly for the 4 categories:
The first category is the soft tissue problem, which is the muscle problem (such patients with nuclear magnetic resonance imaging MRI is good for the structure of the disc), the symptoms of pain with or without mouth restriction. The proportion of such patients is not high, the largest proportion is in the second category (joint disc class). Some of the reasons for the muscle is caused by trauma, some of which are involved in inflammation of the mouth muscles, etc.. This kind of patients sometimes hot compress, their training or training in the mouth, eat anti-inflammatory drugs themselves slowly improved. But I have seen the trauma caused by avulsion of the masseter muscle, one yuan coin has the degree of masseter muscle hematoma, only 7mm, such a situation on its own is not good, our department used a lot of methods of treatment, after two weeks of normal diet can help mouth, a month is restored to the mouth 38mm. Some extraction after mouth pterygomandibular space infection, the patients of Department of Stomatology is very common, many eat anti-inflammatory drugs is good, but there are no normal mouth opening individual patient recovery, the longer the more difficult, it needs timely rehabilitation treatment, usually within 2 weeks can achieve the effect of comparison good.
The second category is the type of joint disc disorder, that is, we take the initiative to take the initiative to make their own MRI joint disc "complex displacement" or "non complex anterior displacement". On the relationship between the two and the practical significance can refer to my another article "can not be restored". This type of patients is the most simple, "said reducible shift" the patient is in the process of the existing joint section (snapping snapping is caused by other reasons, many may not sure is reversible, so the shift) snapping is actually around us there are a lot of people, because no effect of meal talk, a lot of people make it with your life. But there are a lot of people broke out in the joints, or that it affects your life, then you can go to the hospital to seek help, but the reality is that in the Department of Stomatology doctor snapping stage is not in need of treatment, I personally think that all oral treatment means more limited and indeed does not affect the function of patients, so direct patients to the suggestion of snapping. In fact, snapping is the change of articular disc space in a closed process and mandibular condyle and articular disc: in closing in with disc displacement in the state, in the process of opening reduction happened immediately snapping. I think that when patients are in need of treatment, rehabilitation and we have the technical means to handle many snapping patients. It can be treated. However, the longer the time, the effect is more uncertain, I personally dealt with 10 years of bilateral bomb ring patients, while not ringing, but on the other side is very stubborn, still playing. Because the elastic ring is a spatial relationship of movement related with a closed, so we need to fully understand the principle of patients, the patients were many incorrect posture and habits of corrective education, use the jaw pad with skilled control joint movement of their own, finally the ideal result is the elimination of snapping. We usually set the treatment cycle for two weeks, if the patient is still ringing in the ring for two weeks, or the patient is difficult to control the movement, then we end the treatment. Many patients can eliminate the snapping, there are a lot of patients did not eliminate snapping, but because to understand the reasons for snapping, also changed their bad habits and pose the greatest degree, is not because of fear and uneasiness, more important is to a great extent to avoid joint disease development will be said "no a complex shift" stage.
"Can't shift" is the most dreaded patients, these patients often have limited mouth opening, mouth obvious deviation, facial pain, face the change, it is not one of the highest proportion of classification. Many of these patients have a history of joint snapping, but when the joint opening mouth does not ring the moment, there will be a mouth stuck, Zhang is not the largest, mouth pain. "Can't shift" and "reversible shift", is to describe the process of closed Zhang disc position relationship, is also the disc displacement of mandibular condyle to the front, hindering the joint motion in the opening process, the popular saying that "stuck". Because the disc is a rear ligament restrict its excessive movement, position on the normal articular disc and condyle, now becomes the relationship between forward disc restraining sliding forward, condylar normal range of trismus, want more, want to condylar articular disc further, this has caused a great mechanical stress loading in the rear of the ligament of articular disc, causing pain. This is the main cause of mouth opening and pain.
However, the "non complex displacement" is not necessarily limited mouth opening and pain! Many people have the disc displacement, the body slowly made adjustment, relaxation of articular disc of the posterior ligament have adaptive variable length, and thus does not block the opening of condylar slide to the front of the mouth is normal, no pain no ligament stimulation, will not have any discomfort. This situation is very common, there is a high proportion of normal people is actually the disc displacement, most patients side of trismus and pain, pat MRI found on the other side are displaced, but never feel any discomfort should permit this.
In this paper, we introduce the concept of "non complex shift", and we continue to talk about the treatment of patients with "non complex displacement"
The main treatment has the following:
Surgery: for most patients, especially in patients with early, whether foreign or guide I personally do not recommend, but should not be taken without any treatment under way, because the surgical trauma may be worse than the original problem, the recurrence rate is very high (especially when arthroscopic surgery). Only after recurrence reoperation. Only when the joint serious wear and tear, facial deformation is obvious, conservative treatment can not solve the pain and mouth restriction, the patient also defined the risk and benefit of the case for surgical treatment.
Intra-articular injection: no matter what injection, injection is invasive treatment, not conservative treatment. Then the small joint cavity, the injection of a large number of liquid, also have certain damage to the joint capsule, but for disc adhesion, or joint inflammatory mediators in patients with obvious effect, often quickly obviously, you also need to know the risks and benefits, decide.
Hot compress: This is the Department of Stomatology doctor most mentioned, we can try to use the hot towel wet compress, no more than 10 minutes, two days if no effect, there is no effect. There are people with what AI Jiu, or other source, anyway, I don't pay attention to scald, seen clinic for treatment in patients with burn their ears ago.
Acupuncture: the understanding of Chinese medicine should be different from western medicine, can not make objective comments. Anyway, a treatment, two weeks without any effect, it should be considered to be effective on their own.
Rehabilitation: rehabilitation is not only a physical machine is so simple, but most of the rehabilitation treatment of this disease is to do physical therapy machine. In our country, we have carried out comprehensive rehabilitation treatment for patients with various types of temporomandibular joint disorders, and designed individualized treatment plans for different patients and patients. For "can't shift" patients, in the early two months still have a very high chance "is a manipulative reduction, hope completely restored to normal disc position, once again confirms the earlier treatment, the better. Because the shift time is too long, the joint capsule and other soft tissue has been connected to the contracture. But not every one of the early patients will be able to reset, nor is it that each of the "reset" patients will eventually be able to maintain a normal disc position. In clinic, we do not pursue the patient's "reset", to "reset" (the best treatment time is shorter, immediately relieve trismus and pain), not for manual reduction in patients with treatment, rehabilitation is to help patients to adapt to the new joint position, eliminate pain, mouth opening and recovery function, help to improve the symptoms of patients is the most important. Therefore, we should not blindly pursue the reset, to rational understanding of the way of treatment, but also can not simply think that "manual reduction is very simple, applicable to everyone"". Rehabilitation therapy is not only confined to the temporomandibular joint, the disease risk factors have a lot of bad posture, including incorrect understanding and psychological state, rehabilitation to help patients to correct and adjust. The Department of rehabilitation of patients should be the lowest recurrence rate, because from the onset of the source processing was done. Many patients had cervical problems, one of which is even the etiological factors of rehabilitation were treated in the Department, you can see a lot of patients in the exercise of various neck movements. Departemnt of rehabilitation of this disease intervention, to fill the gaps in the conservative treatment, will also be the most mainstream foreign comprehensive conservative treatment methods and ideas to each patient, the effect is obvious to people. There are a lot of nine hospital rehabilitation training of doctors put this back to our hospital, provides the same treatment for their patients in.
Oral exercises: in fact, there are many kinds of oral exercises, for different types of patients, suggest that you don't really do a lot of exercises to be quite different, only to the professional hospital, in order to get the most suitable for their own treatment.
Effect of various remedies can not be evaluated, but we remember that this disease is a lot of people will adapt their body, which is why the male patient is far less than that in female patients, their blind when toss for two weeks without any improvement, please do not continue to do treatment.
Drugs: mainly two categories, one category is anti-inflammatory pain, no pain generally do not need to eat, some patients have bone wear (that is, under the category of the pain of the third), or to eat a period of time. The other is the nutritional cartilage, if there is no indication of bone wear, do not need to eat.
Jaw pad treatment: jaw pad treatment is one of the most used methods for this disease in Department of Stomatology, treatment, therapeutic efficacy is positive, but because of many kinds of jaw pad, the individual difference of doctors is not consistent, the patient's condition is complicated, the effect is the It differs from man to man. But personally think that the treatment of this disease is only the treatment of joints, without changing the behavior and posture, really can not go to the root.
Orthodontic treatment: generally not as the main form of the disease, and orthodontic treatment of patients with disc displacement also suggested that patients with first treatment of joint disease.
Extraction: general is advised, is in the Department of Stomatology of professional medical advice, clear pain and trismus is because wisdom reason, decided not to pull out or pull.
Rest: many patients called tablets, actually very simple ordinary posture, everyone in the earth, is to surrender its gravitational pull, it must be a rest. It is emphasized that each patient must master and adapt. I don't know how to rest, I think it's hard to say.
According to the summary of "irreducible shift" for the treatment of patients, from the Department of rehabilitation, it is not so difficult, but the "sick longer, treatment compliance is low, lack of understand, with manual reduction and for the future must have enough sense of security, the pursuit of the perfect face, charming and melancholy" were really the true effect is hard to say...
The third category is bone wear, these patients can be combined in any of the above patients, usually in elderly patients, if you are not in the elderly patients with deficiency and the problem, so I only advice is to quickly learn and the rest who maintain good cervical posture, put the missing teeth up, avoid unilateral chewing, try not to eat hard. But many young patients, especially female patients are entangled in this issue, for bone erosion and deformation of the face of fear, let them around desperately also flooded the network in all kinds of speculation and fear everyone on the face after the deformation more serious, in fact, disc displacement happens face deformation, wear is not at this time but because of the bone, while no vertical height of articular disc around different mandibular length, mandibular left and right or not in the same plane occurrence of rotation, is generally to the ipsilateral rotation, face change. Changes in the face of the displacement of the articular disc after the occurrence of the change, is the occurrence of a more stable. However, if the rest of the study is not good, or chew hard objects, so that long-term compression of the joint bearing wear, it will be secondary to the wear of the bone, resulting in more severe deformation. So we must emphasize the importance of resting position. Some patients complained of muscle atrophy, joint inflammation may cause atrophy of muscle involvement, ill affected side joints with less muscle will shrink, but as long as the day slowly after the correct use of joints, muscles will slowly plump up strong. Tangled in patients with these problems I think psychological needs to be adjusted, to divert attention, and there are many people in the face is completely symmetrical, how many people will look at you from the front, the sick, only active treatment and adapt to diseases caused by physical change.
The fourth category is the joint dislocation, many patients will take this class and the articular disc can not be moved "confusion, which is totally two kinds of disease, joint dislocation is a too large closed up, not a little. The proportion of patients with dislocation of the joint is still relatively low, but the treatment of patients with dislocation is not very clear effect of treatment, where they hope to recover as soon as possible. This kind of patient I suggest or to check the occlusion problem, but also need to get rid of the habit of big mouth, learn good cervical posture.
This article is saved in my head for a long time, has been lazy did not write, but when I see too many patients so confused, I must be determined to write this article. I used to be a patient of this disease, the incidence rate is so high, not too hard...
I often in the Department and the patient that I had, in the first second days after the occurrence of chewing cane fatigue, morning joint stuck, trismus, I own a lot of comprehensive treatment, second days make their return to the articular disc of a relatively stable state, with 3 days of treatment complete recovery. As for what method, we do not need to ask, are very professional approach, really can not get their own.
In 2014 second, is only the beginning of the gums in eating cold food when acid bilges, I think most will not be assured of dental caries, but suddenly, a sharp pain in the night I woke up from sleep, is mainly manifested in several important pieces of masticatory muscle pain, I started to pay attention to first, his recent judgment is caused by poor muscle fatigue, cervical posture, also do the treatment, immediately to alleviate the symptoms, but the pain at night also suggested that there is inflammation, I immediately seek Department of Stomatology examination, to exclude the caries problem, finally to focus on my wisdom teeth, all my teeth all early long Qi, four only a slight positive, but there is no discomfort, the next two weeks I was feeling it was continuing to emerge, tilt it to the top front teeth, chewing pain began to exist, But it's not a bad night. Finally, I pulled out the tooth extraction, the doctor said that I should have before the inflammation of the gums. Therefore, before the night pain is caused by inflammation, then the pain is caused by chewing teeth. So many complicated problems happen to me, I also need to find two different departments of the Department of Stomatology doctor to help me determine the problem. This article was written in a week after the extraction, complete elimination of symptoms.
TMD really complicated, the same problem in different periods with completely different conditions, coupled with the psychological factors also affect the outcome of the disease, the diagnosis for clinicians, treatment and doctor-patient communication are put forward higher requirements, this paper hopes to help patients understand this disease, convenient medical treatment, selection treatment.