SUBJECTIVE

Temporo-mandibular joint disorders and homoeopathy

By Dr Priya Singh

Abstract: TMDs are the second most common musculoskeletal problem resulting in pain and disability.It can be really painful and disturbing in day today activities. People usually ignore the symptoms and opt for treatments only in severe cases.The homoeopathic literature is filled with lots of drugs that can help to manage signs and symptoms of this disorder and produce effective cures based on simillimum. This article deals with homoeopathic approach to management of TMDs.

Keywords: temporo-mandibular joint, temporo-mandibular joint disorders,treatment,homoeopathy Abbreviations: TMJ- temporo-mandibular joint, TMD- temporo-mandibular disease, DC/TMD- diagnostic criteria for temporomandibular disorders Introduction Depending on the practitioner and in the female population, compared the diagnostic methodology, the to males. Scientists relate to the he temporo-mandibular joint is term TMD has been used to charac- female structure, vitamin Tone of the most heavily utilised terise a wide range of conditions di- deficiencies, varying hormones, and underappreciated joints in the versely presented as pain in the face pain gene variant and internal stress human body. Mechanically, the or the jaw joint area, limited mouth management. Young females less TMJ is what allows you to open and opening, closed or open lock of the than 30 years old are at increased TMJ, abnormal occlusal wear, click- close your mouth,and extend and risk of temporo-mandibular joint ing or popping sounds in the jaw move your jaw from side to side. disorder.In contrast to the previous joints, and other complaints.[1] Functionally, it facilitates chewing, reports, some recent studies have talking, and facial expressions. shown that temporo-mandibular TMJ is formed by the articulation of Epidemiology: joint disorder prevalence reaches its the and the temporal bone Epidemiological studies have peak between 45 to 64 years of age, of the cranium, located anteriorly to estimated that approximately 50%– before decreasing with older age as the tragus of the ear, on the lateral 75% of the population exhibit signs older adults seemed to have milder aspect of the face. The squamous symptoms of temporo-mandibular of TMDs. Internal derangement portion of the temporal bone articu- joint disorder.[3] lates with the condyle of the man- (36.8%) may be subclinical and the dible at a juncture, separated by an patient might not try to relate this intra-articular meniscus. It is a syno- to an underlying jaw problem. In Pathophysiology: vial joint capable of both hinge and <15%–20% of the patients, the signs The etiology of TMD is slidingmovements. The mandible changed into symptoms for which multifactorial and includes has a horizontal part (the body) and the patient will seek treatment. biological, environmental, social, a vertical part (the ramus)meeting at The frequency to seek treatment emotional, and cognitive triggers. the mandibular angle. increases if the symptoms interfere Causes include parafunctional with day-to-day activities[2]. The habits like clenching, grinding, Temporomandibular prevalence of TMD is high in general cheek and tongue biting, emotional Joint Disorders: population (40%–60%). distress, sudden or direct trauma due to blows or impacts,whiplash Temporo-mandibular joint disor- According to a World Health ders are any disorder that affects injuries and occlusal factors. Organization (WHO) report, TMD or affected by deformity, disease, There is a constant association misalignment, or dysfunction of the is the third somatological disorder, with other pain conditions(like temporo-mandibular articulation. after dental caries and periodontal chronic headaches),fibromyalgia, TMD includesanatomical, histologi- diseases, to be considered autoimmune disorders (like Sjogren cal, and functional anomalies in the a populational disease. The syndrome, , and functioning of the muscular and/or symptoms of tempro-mandibular ), psychiatric articular componentsof the system. joint dysfunction are more common illness,and sleep apnea.

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TMD is categorised as intra-articular TMDs. The protocol is intended for 2. Osteoarthritis (within the joint) or extra-articular/ use within any clinical setting and B. Systemic arthritides masticatory muscle disorders (in- supports the full range of diagnostic volving the surrounding muscula- activities from screening to defini- C. Condylysis/idiopathic ture).Musculoskeletal conditions tive evaluation and diagnosis. It has condylar resorption are the most common cause of TMD, two components, Axis I and Axis II. D. Osteochondritis dissecans accounting for at least 50% of cases. Axis I protocol is used for screening Articular disc displacement involv- and differentiation of most common E. Ostronecrosis ing the condyle–disc relationship pain related TMDs and intraarticu- F. Neoplasm is the most common intra-articular lar disorders. The Axis II protocol is G. Synovial chondromatosis cause of TMD.[4] an easy method to assess jaw physi- cal functioning and to screen behav- 4. Fractures The displaced disc can degenerate, ioral and additional psychosocial 5. Congenital/developmental become mis-shaped, perforated, [7] status. disorders or even torn. If the patient cannot achieve proper treatment, internal The DC/TMD classification is as be- A. Aplasia derangement gets progressively low: B. Hypoplasia worse with time, inflammation C. Hyperplasia accompanied, and osteoarthritic I. changes ( of articular car- Disorders tilage and underlying bone, flat- II. Masticatory Muscle Disorders tening of articular surfaces, less 1. Joint pain 1. Muscle pain pronounced articular eminence, A. Arthralgia osteophyte formation, subchondral A. Myalgia B. Arthritis cyst, and resorption of the condyle) 1. Local myalgia occur. Several inflammatory media- 2. Joint disorders 2. Myofascial pain tors such as tumor necrosis factor-α, A. Disc disorders interleukin 1-β, prostaglandin E2, 3. Myofascial pain with referral etc. play crucial roles in the patho- 1. Disc displacement with B. Tendonitis genesis. [6] reduction C. Myositis 2. Disc displacement with TMD is characterised by clinical reduction with intermittent D. Spasm signs of pain or malfunctionoccur- locking 2. Contracture ring jointly or separately: 3. Disc displacement without 3. Hypertrophy • pain in the temporo-mandibular reduction with limited opening 4. Neoplasm joint(TMJ), 4. Disc displacement without 5. Movement disorders • articular sounds, reduction without limited A. Orofacial dyskinesia • pain in the muscles of opening B. Oromandibular dystonia mastication, anomalies in B. Other hypomobility mandibular movements, disorders 6. Masticatory muscle pain attributed to systemic/central • signs and symptoms that may 1. Adhesions / adherence be associated with orofacial pain disorders 2. Ankylosis pain and/ or cervico-scapular A. Fibromyalgia/ widespread problems. [5] a. Fibrous pain Diagnosis: b. Osseous C. Hypermobility disorders III. Headache No universal diagnostic criteria have yet been established. A com- 1. Dislocations 1. Headache attributed to TMD prehensive version, known as the a. Sublaxation diagnostic criteria for TMDs (DC/ IV. Associated Structures b. Luxation TMDs), has been proposed by Schiff- 1. Coronoid hyperplasia man et al. in 2014.DC/TMD includes 3. Joint diseases a valid and reliable screening ques- The diagnosis of TMD is based A. Degenerative joint disease tionnaire and diagnostic algorithms largely on history and physical for the most common pain-related 1. Osteoarthrosis examination findings. Clinicians

March 2021 | The Homoeopathic Heritage | 23 SUBJECTIVE should be vigilant in diagnosing doses of the simillimum selected Mez. Nat-m. Nux-v. Phos. Plat. TMD in patients who present with according to the patient’s totality of Rat. Rhus-t. Sars. Sel. Sil. Spig. pain in the TMJ area. Conditions the symptoms and his individuality. Verat. Zinc. that sometimesmimic TMD include One can select remedies 8. Face - stiffness dental caries or abscess, oral lesions according to the total picture of Arum-t. CAUST. Cupr. Cupr- (for example, herpes zoster, herpes the patient,including not only act. Gels Hyper. Ign. Kali-i. simplex, oral ulcerations, lichen symptoms but lifestyle,emotional Lach. Merc. Merc-c. Merc-i-f. planus), conditions resulting from and mental states, and otherfactors. Mez. Morph. Nat-c. NUX-V. muscle overuse (for example, Based on the same, homoeopathic Phyt. RHUS-T. Sil. STRY. Ther. clenching, , excessive medicines can be effectively Verat. chewing, spasm), trauma or used not only in the palliation of dislocation, maxillary sinusitis, symptoms of temporomandibular 9. Face - stiffness jaws lower salivary gland disorders, trigeminal joint disorders but produce effective CAUST. Cupr. Cupr-act. Gels. neuralgia, postherpetic neuralgia, cures and recovery following the Hyper. Ign. Kali-i. Lach. Merc. glossopharyngeal neuralgia, giant constitutional approach. Merc-c. Merc-i-f. Mez. Morph. cell arteritis, primary headache Some rubrics related to TMJ from Nat-c. NUX-V. Phyt. RHUS-T. syndrome, and pain associated with different repertories based on type Sil. STRY. Ther. Verat. [13] cancer. of pain. 10. Face – pain, jaws, drawing pain Acute fractures, dislocations, 1. Face - pain, jaws joint, opening Alumn. Aur. CARB-V. Con. and severe degenerative articular the mouth agg. Nux-v. Rhus-v. disease are often visible in plain alum. Am-c. am-m. CAUST. 11. Face - pain jaws lower drawing radiography (transcranial and Cor-r. dros. Dulc. Hep. Nicc. pain Sil. transmaxillary) views. Computed Sabad. Verat. Zinc. 12. Face – pain, jaws, burning anac. Tomography scan is superior to 2. Mouth - open difficult to Bov. Caust. Daph. Fl-ac. plain radiography for evaluation of subtle bony morphology. Magnetic Caust. LACH. Merc-c. Phos. 13. Face - pain jaws pressing pain resonance imaging is done for 3. Face - pain jaws joints dulc. Rutasymph. Tritic-vg. Vanil. comprehensive joint evaluation in Arum-t. Bapt. Bry. Caust. patients with signs and symptoms Cham. Rhus-t. Stry. 14. Face – pain, jaws, stitching of TMD.Ultrasonography is a low- pain acon. Agath-a. aids. Ambr. cost technique to diagnose internal 4. Face - pain, jaws Arge-pl. berb. Carb-an. Cimx. derangement of the TMJ when Aids. Alumn. CAUST. Nux-v. Ham. Heroin. Kalm. Op. thuj. magnetic resonance imaging is not Rhus-v. Sphing. Verat. Zinc. readily available.[4] 5. Face - pain, jaws joints, chewing Homoeopathic therapeutics: [9,10] agg Angustura vera: It is indicated in General Management acon. Alum. Am-c. am-m. bar-c. tensive pain in temporal muscles bell. Calc. coc-c. cor-r. dulc. when opening jaws. There is pain Supportive patient education is the Kali-s. puls. Sil. Spig. V-a-b. in articulation of jaw, in masseter recommended initial treatment for zinc. muscles, as if fatigued by chewing TMD. Adjunctive measures include 6. Face - pain, jaws upper too much. Person experiences jaw rest, soft diet, moist warm cramp-pain on the zygomatic arch. compresses, passive stretching Amph. Calc-ar. Calc-caust. The greatest craving for coffee is a exercises and occlusal splints. Calc-p. Calc-s. Cham. Euph-a. Kali-bi. Kali-cy. Kali-i. Kreos. characteristic symptom for the drug. Lyc. Spig. Spong. Verb. Patient complains of headache, with heat of face. Acute pain in cheeks Homoeopathic Approach 7. Face - pain, jaws lower and drawing in facial muscles. As mentioned by Dr Hahnemann Agn. Am-m. Anac. Anthraci. in his Organon of medicine, Ars. AUR. Bell. Bov. Bry. Carb- Alumina: Suited for tensive pain ‘Homoeopathy treats the patient an. Carb-v. Caust. Cocc. Colch. in articulation of jaw when and not the disease’. Homoeopathic Coloc. Dulc. Gels. Kalm. Lach. opening mouth or chewing.There treatment involves giving minimum M-ambo. M-arct. Meny. Merc. is twitching of lower jaw. Patient

24 | The Homoeopathic Heritage March 2021 SUBJECTIVE experiences rush of blood to face Ignatia amara: There is extraordinary neuralgiasespecially about teeth and after eating. Tension in skin of the spasmodic yawning with pain in face. There is bruised, weary feeling face as if egg albumen had dried maxillary joint as though it would in joints, with drawing and stiffness. thereon. Patient feels extraordinary be dislocated.Sleep so light that There are pains of various kinds, lassitude and fatigue, particularly patient hears everything. Restless with chilliness and sensitiveness from talking. Many complaints are sleep and great restlessness at night. to cold air. Bone pains. Hard work in afternoon and when sitting. He Extraordinary changeableness of all to talk. There is headache which feels best during moderate exercise, the symptoms. Patient experiences is worse from talking. There is in evening and in open air. dislocative pains in joints.There is violent neuralgia about face and cutting stitches, as from a sharp teeth, running towards ear, at night; Belladonna: There is faceache, with knife.Coffee, tobacco and brandy worse, eating; better near hot stove. intense cutting pains and half open aggravate the symptoms. The Pains shoot upward and seem to mouth.Pain is sharp and cutting in attacks arerenewed after dinner, draw patient up out of bed. Semi- nature, come and go quickly. The in evening after lying down, and lateral complaints. slightest touch renews the attacks and early in morning immediately upon intensifies the pains. All complaints awaking, they are diminished when Natrum sulphuricum: It is suited are consequences of taking cold. lying upon back,upon painful parts, for painfully stiff maxillary joints. The symptoms are intensified in or in general by a change of posture. There is tearing in cheek bones the afternoon and at night. Patient which is worse in cold air and experiences restlessness, delirium Magnetis polus rrticus: There is better by hard rubbing. Patient and somnolency. violent, spasmodic yawning, with experiences wandering and piercing pain in maxillary joints, as though pains,compressive,needle - like, Causticum: It is suited for pain in they would be torn out. Patient boring or tearing pain in almost any jaws, with difficulty in opening complains throbbing pain in lower part. Complaints are worse in wet mouth. There is pain in facial bones. jaw with burning while there is weather and dampness, morning Rheumatism of articulation of chilliness. Cramp – likepain in and evening during menses, lying on hollow teeth, with single jerks in lower jaw.This remedy manifests its left side, walking, motion, pressure right lower jaw. Jaws ache, with action mainly in chronic rheumatic, of clothes, rest,touch and better violent jerks, as theywould be torn arthritic and paralytic affections, by dry, open air, cloudy weather, out. Complaints are worse after indicated by the tearing, drawing momentarily, onchanging position, eating, in a warm room and better in pains in the muscular and fibrous after breakfast. tissues, with deformities about the open air. Nux vomica: It is indicated for joints; progressive loss of muscular Magnes artificialis: This remedy is bad effects of coffee, tobacco and strength, tendinous contractures. suited for dislocative pains in the spirituous liquors, of continuous Sensitive to drafts and cold. The maxillary joint.There isbruised pain mental exertion, night watching and symptoms are in tensified in evening, in joints, especially in side on which in open air and after drinking coffee. he does not lie. Patient hasasleep sedentary habits. There is tearing in feeling in the limbs with great jaws, extending into bones of face, Calcarea flourica: This remedy is tendency to take cold. renewed by cold drinks. Swelling useful in hard swelling on the cheek, of one cheek. Great debility or with pain or toothache and hard Menyanthes trifoliata: It is indicated irritability of entire nervous system. swelling on jaw-bone. in pain and cracking in maxillary Feeling of illness in periodically joint when chewing. Painless returning attacks. Easily takes cold, Euphrasia officinalis: It is indicated twitching of facial muscles. Person sensitive to drafts of air, complaints in stitches and stiffness of cheeks presents withpinching and sticking from taking cold. Every mental and lower jaw when talking and pain in the limbs and joints. Most exertion excites orheightens the chewing. Suited for bad effects of symptoms are intensified during symptoms. The complaints are by falls, blows or mechanical injuries restand toward evening,and are motion, slight touch and relieved by to external parts. Fleeing, itching better during motion and from the hard pressure. The symptoms are stitching here and there through layingon of hands. most intense early in morning upon entire night, with greatrestlessness. awaking and aftereating. Most complains are worse in Mezereum: This remedy is suited evening. for affections of bones and Petroleum: Indicated in cramp-like

March 2021 | The Homoeopathic Heritage | 25 SUBJECTIVE pain in the maxillary joint, or as forehead and temples down toears. is boring pain in zygoma which is though it would be dislocated, espe- Jaws crack when chewing. There better from touch.There are stitches cially when yawning. Inflammatory is easy dislocation of jaw. There is in limbs and joints with aversion swelling of sub-maxillary glands. swollen face with cheek bones sensi- to motion. All symptoms are often There is cracking, creaking and tive to touch. Facial neuralgia, with unilateral especially on left side. gouty stiffness of joints. chilliness which is worse in the eve- Warmth of bed intensifies many ning.The patient has sensation, as symptoms Attacks are usually worse Patient complains of weariness thoughsomething were torn loose in afternoon andat nightand are bet- early in the morning and evening. in inner parts. There is intolerance terduring rest. There is sensation of There is great emaciation. Aversion of cold (open)air as it excites stitches water tricking in many parts. to open air and takes cold easily. in joints. Convulsive twitching and There are complaints from riding in other symptoms appear after cold Complaints return annually.Many a carriage or ship. General internal, baths. All the symptoms are intensi- symptoms are relieved by turning- insufferably sick feeling, with trem- fied inthe evening and at night, af- from left to right side while lying bling and great weakness. ter midnight, during rest, from cold down. orbecoming cold and from getting it Phytolacca decandra: There is pain in Verbascum thapsus: There is tension while sweating. bones of face and in all joints with and violent pressure on zygoma feeling of coming on. Jaws Sabadilla: Person experiences crack- and articular eminences of tempo- ache.There is general soreness, with ing in both maxillary joints when ral bone, like prosopalgia. Face- tired aching and restlessness.Great opening mouth wide. There is burn- ache. Burning pressure and tension muscular debility, lassitude and ing heat, redness of face and sensi- extending over entire cheek, from desire to lie down. Affects the right tiveness to cold,which also inten- zygoma andmaxillary joint, espe- side.Pains appear and disappear sifies the symptoms. Pains move cially worse or excited by a change suddenly and are oftenfollowed by from right toleft. Aggravation of of temperature.Pains are mostly as- itching, burning or soreness. Smart- symptoms is there in forenoon or sociated with a feeling of numbness. ingsensations and all symptoms are in hoursbefore midnight as well as The symptomsare excited and inten- accompanied by heat. All the secre- during rest and in the cold. There is sified by changes of temperature, tions are greatlyincreased, tears.Pa- painful drawing in limbs, seemingly namely, whengoing from open air tient is worse from motion, raising in bones. Pains, especially in joints, into room and vice versa. up, wet weather, atnight, open air, are as though someone were scrap- pressure, at 11am. Complaints are ing about or cutting them insidewith Conclusion relieved byeating, warm and dry- a knife. weather. Homoeopathy is an emerging field Staphysagria: This remedy is suited of dental medicine that is useful Rheum: There is drawing,welling for bad effects of onanism or the in management of conditions up, almost a bubbling sensation in abuse of Mercury.There is easy dis- affecting orofacial structures. With lower jaw, extending into temples. location of the maxillary joint. Pain- advantages of minimal side effects Bubbling,gurgling sensation, as ful submaxillary glands with or and favourable treatment outcome, from small bubbles in muscles and without swelling. Inflammation of homoeopathy has emerged as one joints. All joints pain when moved. bones of face.Painfulness of muscles of the alternative therapy in cases of Asleep sensation inparts wherein to touch, and of joints to motion. treatment failure or poor response to he lies.Weakness and heaviness of Person suffers from great weariness conventional drugs. The knowledge entire body, as afterwaking from a and stiffness of all joints with contin- and understanding of homoeopathic deep sleep. ual inclination to lie down. Heavi- approach of treatment is still an ongoing process and further Rhus toxicodendron: Suited for ef- ness of limbs anddullness after the noon - day nap. research should be carried out in fects of excessive muscular exertion this regard. [8]Many clinical trials or contusions combined with over Thuja occidentalis: This remedy is and case-control studies have been - exertion. There is dislocation and indicated for bad effects of the use published about the effectiveness of dislocative pains in joints. Cramp of beer, fat, acids, sweets, tobacco, homoeopathic remedies for oral and like pain in the maxillary joint, or tea, wine and onions. Person expe- -facial problems, however, as though it would bedislocated, riences cracking in maxillary joint no specific study for TMDs and especially when yawning.Tearing homoeopathy has been done. pains externally especially from andswelled temporal arteries. There

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