Archive for September, 2008

Temporomandibular Joint Dysfunction Syndrome

Temporomandibular joint (TMJ) dysfunction syndrome is the name given to a range of disorders of the temporomandibular joint, the joint where the jaw attaches to the skull. The syndrome is characterized by facial pain, popping or clicking of the jaw, headache, problems with chewing, and incomplete range of motion of the jaw. The pain is often worse during chewing and when the mouth is open. The syndrome is relatively common, occurring in up to 10% of the population in the United States. It affects women about four times as often as men, and is most likely to affect young and middle-aged adults.

TMJ syndrome has many causes, and the treatment differs depending on the nature of the disease. Tension of the neck and jaw is a common cause, often leading to clenching and grinding of the teeth and to tension headaches. Other causes include misalignment of the upper and lower jaw, poor posture, traumatic injury, arthritis, displaced disks, degenerative bone disease, inflammation of connective tissue, and cancer.

TMJ syndrome is diagnosed via physical examination by a doctor, dentist, or oral surgeon. It involves checking the bite, the range of motion of the jaw, and the state of the teeth (to check for grinding). The medical practitioner will also take a medical history, and ask about sources of stress. If damage to the bone or soft tissue is suspected, X-ray or MRI scanning may be performed.

Conservative treatment involving stress reduction (relaxation exercises, meditation, deep breathing) is usually successful in alleviating the symptoms of TMJ syndrome. Some patients will benefit from physical therapy or psychological counselling. Medications which have been used successfully include anti-inflammatory painkillers, muscle relaxants, and antidepressants. Placement of mouth guards may be necessary for people who grind their teeth at night if the stress reduction therapy is unsuccessful. Surgery is occasionally necessary, especially for patients with chronic TMJ syndrome due to displaced disks or injury.

Burning Mouth Syndrome

Burning mouth syndrome is a general description for many conditions where the patient complains of a burning sensation in the lips, tongue, or entire mouth; the pain tends to become more severe later in the day. It is persistent and can last for years without treatment. It is most common in middle-aged and older women.

The syndrome has many causes, both physical and psychological. This makes the diagnosis difficult because the specific cause must be found before it can be treated. Causes include dry mouth (due to conditions such as diabetes or Sjögren’s syndrome or to long-term use of certain medications), oral candidiasis (thrush), nerve damage, hormonal changes associated with menopause, nutritional deficiencies, acid reflux, poorly fitting dentures, and anxiety and depression.

Diagnosis involves taking a full medical history and performing a thorough oral exam, including taking samples to test for thrush. Blood tests for nutritional deficiencies and allergies are also performed.

Successful treatment of burning mouth syndrome depends on finding and treating the underlying cause, although symptomatic treatment is possible if the cause cannot be found. Dry mouth due to drugs may be alleviated by changing the drugs; medications to treat dry mouth may also be helpful. Thrush can be treated with antifungal agents. Pain due to nerve damage may be treated with painkillers.
Hormonal changes are treated with hormone replacement therapy. Nutritional deficiencies can be addressed with nutritional supplements and advice about diet. Acid reflux is treated with antacids. Poorly fitted dentures can be adjusted or, if necessary, replaced. Psychological causes are treated with psychological counselling or with antianxiety or antidepressant medication. Treatment with benzodiazepines and tricyclic antidepressants has had good results.

Patients can minimise their symptoms by drinking plenty of water, sucking ice chips, chewing gum to encourage salivation, and avoiding spicy foods and alcohol. Rinsing the mouth with a mixture of hot pepper (capsaicin) and water has also been found to be helpful in some cases.

Pierre Robin sequence

Pierre Robin sequence (also known as Pierre Robin syndrome or malformation) is a birth defect characterized by an abnormally small jaw (micrognathia), usually with cleft soft palate. It is rare, occurring in around 1 in 8500 live births, and it affects males and females equally. It can occur alone or in combination with other syndromes such as Stickler syndrome or velocardiofacial syndrome (DiGeorge syndrome).

Peirre Robin sequenceIn this condition the tongue tends to rest at the back of the throat (glossoptosis) because there is insufficient room for it to lie flat in the very small jaw. This can lead to problems with breathing. The jaw does not remain small throughout life but grows to normal size during infancy. Many affected infants also have otitis media and other abnormalities of the auditory system.

The causes of Pierre Robin syndrome are unknown. There may be a genetic component, especially if the condition appears along with other abnormalities. When it appears alone, it seems not to have a genetic cause. There are several theories about the cause of isolated Pierre Robin syndrome, including intrauterine mechanical problems and teratogenic causes such as maternal alcohol consumption.
The condition is diagnosed by physical examination. Infants should be evaluated for other syndromes; if they are also present, a genetic consultation may be advised.

Since the jaw usually grows to normal size over the first two years of life, supportive care is generally sufficient but a tracheotomy may be needed to maintain the airway if the tongue is causing difficulty breathing. Because the tongue tends to fall back into the throat, these children must always sleep face down. In severe cases where oral nutrition is not possible, a gastrostomy tube may be placed for feeding. Surgery is needed to correct the cleft palate. In very severe cases, a surgical procedure called distraction osteogenesis may be performed to encourage new bone to grow without the need for bone grafts.