Building confidence with Temporomandibular Disorder (TMD) management
Featured Products Promotional FeaturesPosted by: Dental Design 6th May 2022
Temporomandibular Joint (TMJ) problems are relatively common, affecting approximately 8-15% of the adult population.[i] It is consequently important for general dental practitioners (GDP) to facilitate early diagnosis and be confident in providing supportive therapies or referring patients to specialists where appropriate.
Dr Deepak Komath is one such specialist you may collaborate with. His job role is that of a Consultant Maxillofacial Surgeon, he is dual-qualified in dentistry and medicine. He is a renowned practitioner, lecturer and mentor within the fields of head and neck reconstruction after cancer or trauma, cosmetic facial surgery, skin cancer detection and treatment, oral surgery, dental implants and TMJ treatment.
According to Dr Komath, the common presentations in TMD are:
Pain
Specifically, pain experienced in the pre-auricular region and over the muscles of mastication, or non-specific jaw and neck pain which is communicated directly and obviously by patients to their GDP.
Limited mouth opening which is progressive
GDPs need be suspicious of internal derangement or arthritis of the TMJ in these cases, especially in females and patients presenting with a skeletal class II facial disproportion.
Clicking or crepitus
Adventitious sounds of the jaw are highly indicative of meniscal displacement and degeneration.
Poor jaw function
The inability to chew all textures of food or the restriction of jaw movement due to pain or mobility issues can be a sign of TMJ issues. Pain on loading the contralateral joint is a common presentation. The GDP will need to elicit these symptoms from patients through questions and/or movement tests in practice.
Opening and excursions
Deviated mouth opening with limited lateral excursion is another symptom to be aware of.
Some of the symptoms of TMD can be difficult to identify, especially if the patient has become very familiar with certain movements or sensations and does not recognise them as a problem to discuss. However, it is crucial that GDPs allocate sufficient time to comprehensively assess their patient’s TMJ and educate their patients on what to look out for. Dr Komath comments on the consequences of obtaining the early diagnosis:
“Without early diagnosis there is a risk of disease progression, pain and loss of function. There is strong evidence for better treatment outcomes following early intervention as opposed to late, plus treatment can often be less invasive and therefore carry fewer risks of significant morbidity to patients. From the GDP’s perspective, putting protocols in place to improve assessment and diagnosis also reduce the risk of litigation in the future due to missed TMD.”
Dr Komath goes on to say, adults are not the only patients who may be impacted by TMJ disorders:
“It is essential to not forget that children present with TMD too. In my practice, around 14% of cases I treat are paediatric. The youngest patient I have ever diagnosed with idiopathic mono arthritis of the jaw joint was only 7 years of age. My youngest total TMJ replacement was carried out in a 24-year-old patient.”
There is an array of treatment options available to manage TMD, the suitability of which will depend on each individual case. In mild cases, appropriately trained GDPs are able to support patients with simple solutions such as jaw exercises, physio therapy and dietary advice to manage pain or discomfort in the short-term. Should symptoms persist or progress, referral to a specialist is often required.
Dr Komath provides a spectrum of treatment options from his private practice, commenting:
“We always take a holistic and multi-disciplinary approach. This involves utilising the most conservative management techniques possible alongside education – which, of course, the GDPs I work with closely play a huge part in.”
Among the treatments Dr Komath provides for TMD patients are:
- Specialist splints specific to TMD
- Pain management
- Psychology support
- Specialist TMJ physiotherapy, including acupuncture/laser
- Rheumatology
- Paediatric service
- Injectables, including platelet-rich plasma (PRP)
- Cutting-edge regenerative therapy – using Bone Marrow Aspirate Concentrate (BMAC) injections which introduce stem cells into the joint space arthroscopically
- Advanced keyhole surgery allowing arthroplasty
- Open joint surgery
- Total TMJ replacements
“All the treatments we offer are backed by science,” Dr Komath continues. “For example, I have data on over 200 joints suggesting that superior outcomes can be achieved using PRP injections in comparison to steroids. Our total TMJ replacements also use customised titanium implants, which is the NICE recommended gold standard solution for end stage TMD treatment.
“Our surgical treatment options include minimally invasive keyhole surgery with the advanced Nexus CMF arthroscopes. These are only 1.9 mm in diameter and allow for intra-articular arthroplasty, debridement, biopsy and radiofrequency co ablation. I also use autologous regenerative agents like Platelet Rich Plasma and stem cells into the joint under direct vision through an arthroscope.”
Dr Komath works with Total TMJ for products such as the Nexus CMF arthroscopes, about which he adds:
“Total TMJ is a professional group of people I work with closely. They help enormously with my TMJ practice as well as custom implant practice.”
For GDPs who are interested in developing their skills and understanding of TMD management and treatment, Dr Komath offers a referral service and is happy to support those looking to develop their skills.
“I always welcome colleagues who wish to provide the best possible care for their patients. Please get in touch with nicky@facialsurgeon.co.uk for advice and requests for mentoring in management of TMD in your practice.”
For more details about Total TMJ and the products available, please call
01202 313701
[i] NHS Kings College Hospital. Temporomandibular dysfunction (TMD) Information for patients. https://www.kch.nhs.uk/Doc/pl%20-%20869.1%20-%20temporomandibular%20dysfunction%20(tmd).pdf [Accessed February 2022]
