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 jaw 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 mandible 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, rheumatoid arthritis, and functioning of the muscular and/or symptoms of tempro-mandibular lupus erythematosus), psychiatric articular componentsof the system. joint dysfunction are more common illness,and sleep apnea. 22 | The Homoeopathic Heritage March 2021 SUBJECTIVE 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. Temporomandibular Joint changes (abrasion 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 jaws 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, bruxism, 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.