i

Modul 4

TEMPORO MANDIBULAR JOINT DISORDERTutor : Endah Lakminiwati, drg., M.S.

by :

Group E

Agustin Tri Lisdiana 021111150

Agustina Ayu K 021111101

Alexander Patera Nugraha 021111161

Dayanara Wiena Lopita 021111160

Hamida Yusuf 021111157

Haninda Iffatuz Zahrah 021111031

Haura Nadya Amalia 021111135

Muhammad Akbar Arsyah S 021111149

Deby Febrina 021111090

Muhammad Dimas R 021111381

Muhammad Ramadhan 021111164

Rizki Widyakartika Yuniarti 021111057

Rizqie Widira Arvianti 021111005

FACULTY OF DENTISTRY

AIRLANGGA UNIVERSITY

2012

ii

PREFACE

Thank God we pray the presence of Almighty God, because only with His

blessings and guidance of the paper can be done properly and on time. The author

would also like to thank the Endah Laksminiwati, drg., MS, Endrajana, drg., MS,

Sp.BM and Prof. Dr. Jenny Sunariani, drg., MS as lecturers as well others who

have helped in the preparation of this paper. The paper is organized as a task on a

course in Module 4 : TMJ Disorders, Faculty of Dentistry, Airlangga University

2011/2012. It is hoped this paper may provide information to increase knowledge

of the reader.

Authors realize that in writing this paper there are still many shortcomings

and mistakes. The authors therefore welcome any suggestions and constructive

criticism from various parties for the perfection of this paper. This paper thus

prepared, may be beneficial to the audience.

Surabaya, June 2012The authors

iii

CONTENT

COVER .................................................................................................... i

PREFACE ................................................................................................. ii

CONTENT .............................................................................................. iii

PICTURE CONTENT .............................................................................. vi

ABSTRACT ............................................................................................. vii

CHAPTER 1 INTRODUCTION ............................................................... 1

1.1 Background ......................................................................................... 1

1.2 Problems ............................................................................................ 2

1.3 Purpose ............................................................................................... 2

1.4 Benefit ................................................................................................ 2

1.5 Hypotesis ............................................................................................. 3

CHAPTER 2 THEORITICAL REVIEW ................................................... 4

2.1 Anatomy and Histology of Temporomandibular Joint .......................... 4

2.1.1 Mandibular Condyle.......................................................................... 5

2.1.2 Temporomandibular fossa (glenoid fossa) ......................................... 6

2.1.3 Articular Disc (meniscus).................................................................. 7

2.1.4 Joint capsule...................................................................................... 9

2.1.5 Ligaments ......................................................................................... 10

2.1.6 Muscles of Mastication ..................................................................... 12

2.2 Physiology of temporomandibular joint movement .............................. 15

2.2.1 Motion to open.................................................................................. 16

2.2.2 Motion to close ................................................................................. 16

2.2.3 Protusi............................................................................................... 17

2.2.4 Retention........................................................................................... 17

2.2.5 Lateral Motion .................................................................................. 18

2.2.6 Masticatory Function......................................................................... 18

2.2.7 Jaw Muscles and Movements ............................................................ 19

2.3 Pathology of Temporomandibular Joint................................................ 21

2.3.1 Neurogical Control............................................................................ 21

2.3.2 Normal Masticatory Movements ....................................................... 23

2.3.3 Electromyography (EMG) Activity During Mastication .................... 24

iv

2.3.4 Masticatory Function In Individuals Temporomandibular Disorders.. 26

2.4 Reatainer (Removable Orthodonthic) ................................................... 26

2.4.1 Problems Faced In Removable Orthodontic Care. ............................. 28

2.4.1.1 Patient ............................................................................................ 28

2.4.1.2. Device........................................................................................... 29

2.4.1.3. Movement Teeth ........................................................................... 30

2.5 Premature Contact................................................................................ 31

2.5.1 Direct effect ...................................................................................... 31

2.5.2 Indirect effect.................................................................................... 31

2.6 Definition of Myospasm ( Muscle Spasm )........................................... 33

2.6.1 Factors That Causing Myospasm....................................................... 33

2.6.2 Effect Of Myospasme........................................................................ 34

2.6.3 Muscle Pain ...................................................................................... 34

2.6.3.1 Psychological Factor ...................................................................... 35

2.6.4 Role of occlusion in facial pain ......................................................... 35

2.6.5 Nervous System Alterations in TMD................................................. 37

2.6.6 Trigger Points, Muscle Hypoperfusion and Muscle Pain.................... 39

2.6.7 Treatment or Management Of Myospasm.......................................... 40

2.7 Estrogen............................................................................................... 40

2.7.1 Definition.......................................................................................... 40

2.7.2 Types of estrogen .............................................................................. 42

2.7.2.1 Steroidal......................................................................................... 42

2.7.2.2 Nonsteroidal................................................................................... 42

2.7.3.Estrogen functions............................................................................. 42

2.7.4 Estrogen effect on bone metabolism .................................................. 43

2.7.5 Estrogen Effect on Temporo mandibular joint ................................... 44

2.7.6. Estrogen as an Antidepressant for Women........................................ 46

2.7.6.1 Types of estrogen as Antidepressant for Women With Depression . 47

2.7.7 Estrogen as Pain reliever ................................................................... 47

2.7.7.1. How to ease the joint pain ............................................................. 48

CHAPTER 3 CONCEPTUAL MAPPING ................................................ 49

CHAPTER 4 DISCUSSION ...................................................................... 50

v

CHAPTER 5 CLOSING

5.1 Conclusion........................................................................................... 55

5.2 Solution ............................................................................................... 55

REFERENCES ......................................................................................... 58

vi

PICTURE CONTENT

Figure 2.1 Structure of Temporomandibular Joint at Lateral Side............... 4

Figure 2.2 the Mandible ............................................................................. 6

Figure 2.3 The Temporomandibular fossa .................................................. 7

Figure 2.4 The articular disc of the TMJ .................................................... 9

Figure 2.5 The sphenomandibular ligament (indicated by the arrows) ........ 11

Figure 2.6 The Stylomandibular ligament (indicated by the arrows) ........... 11

Figure 2.7 The Temporalis; the zygomatic arch; Masseter removed ........... 13

Figure 2.8 The Pterygoidei; zygomatic arch; ramus mandible removed ...... 13

Figure 2.9 Muscles for mastication ............................................................ 20

Figure 2.10 Two basic chewing movements ............................................... 21

Figure 2.11 Premature contact on anterior teeth ......................................... 32

Figure 2.12 Premature contact on posterior teeth ....................................... 32

Figure 2.13 The integrated trigger point hypothesis.................................... 34

Figure 2.15 The expanded MTrP hypothesis. ............................................. 35

Figure 2.16 Psychological factor because of emotional stress..................... 35

Figure 2.17 Premature contact on prosterior teeth ...................................... 50

Figure 2.18 The Mechanism of blocking mandibular.................................. 50

vii

ABSTRACT

Temporomandibular joint disorder with premature contact symptom causes

discomfort feel that lead to stomatognatic system function, especially on

temporomandibular joint.

On the posterior tooth that occurs premature contact can increase amount of

load on temporomandibular joint. Most people who suffered temporomandibular

joint getting this clinically symptom. Premature contact teeth give an extra

pressure on chewing muscle, which causes spasms and make a pain and these all

lead to temporomandibular joint disorder.

Keywords: premature contact, muscle spasms, temporomandibular disorder