Limited Jaw Movement Research Articles

Temporomandibular joint reconstruction with alloplastic prosthesis: the outcomes of four cases

BackgroundThe purpose of this study is to evaluate the outcomes of four patients receiving stock Biomet TMJ prosthesis for reconstruction of the TMJs.MethodsTMJ reconstruction with stock Biomet TMJ prosthesis was performed in four patients who had joint damages by trauma, tumor, resorption, and ankylosis, which represent the indications of alloplastic prosthesis.ResultsLoss of condyle from trauma and resorption of joint are good indications for prosthesis, but the patients should be informed about limitation of jaw movement. In case of structural damage of TMJ by tumor, tumor recurrence should be considered before planning TMJ reconstruction. Considering heterotopic bone formation in case of ankylosis, periodic follow-up and special surgical technique are required.ConclusionsGiven careful treatment planning and understanding the functional limitation of TMJ prosthesis, alloplastic prosthesis is a safe and effective management option for the reconstruction of TMJs.

IncobotulinumtoxinA Injection for Temporomandibular Joint Disorder.

Temporomandibular disorder (TMD) involves dysfunction of the temporomandibular joint and associated muscles of mastication causing pain with chewing, limitation of jaw movement, and pain. While the exact pathophysiology of TMD is not completely understood, it is thought that hyperfunction of the muscles of mastication places stress on the temporomandibular joint, leading to degeneration of the joint and associated symptoms. We hypothesize that chemodenervation of the muscles of mastication with IncobotulinumtoxinA (Xeomin) will decrease the stress on the temporomandibular joint and improve pain associated with temporomandibular joint and muscle disorder (TMJD). Twenty patients were randomized to IncobotulinumtoxinA (170 units) or saline injection of the masticatory muscles. Patient-reported pain scale (0-10) was recorded at 4-week intervals following injection for 16 weeks. Patients who received saline injection initially were assessed for reduction in pain at the first 4-week interval and if still had significant pain were rolled over into the IncobotulinumtoxinA arm. Preinjection pain scores were similar between patients. While there was a statistically significant reduction in pain score in the placebo group one month, there was an overall larger drop in average pain scores in those patients injected with IncobotulinumtoxinA initially. All patients initially injected with placebo crossed over into the IncobotulinumtoxinA group. Similar results were seen when examining the composite masticatory muscle tenderness scores. There was no significant change in usage of pain medication. We demonstrate utility of IncobotulinumtoxinA in treating patients with TMD with pain despite pain medication usage and other conventional treatments.

Temporomandibular joint involvement in psoriatic arthritis

Psoriasis is a chronic, papulosquamous, and an inflammatory skin disease. It has been found that between 5% and 24% of patients develop psoriatic arthritis (PA) at the same time after or even prior to skin findings. The involvement of temporomandibular joint (TMJ) is a rare condition. In this report, a-46-year-old male patient was referred to our clinic with the complaint of pain in the bilateral TMJs, and a limited jaw movement. Medical anamnesis revealed he had psoriasis for the last 21 years, and developed a seronegative polyarthritis with destructive changes for 8 years. On extra-oral examination, crepitation at TMJs and limitation of jaw movements was detected. The radiographic examination with cone-beam CT revealed the bilaterally decreased joint spaces, erosion, and the loss of cortical edge of the joint on the condylar heads. The definitive diagnosis of PA was made with the help of patient's history and radiological findings. The uses of non-steroidal anti-inflammatory drugs and occlusal splint have been suggested for conservative treatment.

Effect of pre-operatory low-level laser therapy on pain, swelling, and trismus associated with third-molar surgery.

BackgroundThe extraction of impacted third molars is commonly associated to pain, edema, trismus, limited jaw opening and movements. The aim of this retrospective study is to verify if pre-surgical low-level laser therapy (LLLT) associated with the extraction of impacted lower third molars could add benefits to the postoperative symptoms respect LLLT performed only after surgery.Material and MethodsData from 45 patients subjected to a surgical extraction of lower third molars were pooled and divided into three groups. Patients that received only routine management were inserted in the control group. Group 1, were patients that received LLLT immediately after surgery and at 24 hours. In group 2 were included patients treated with LLLT immediately before the extraction and immediately after the end of the procedure. Data were analyzed using linear regression and descriptive statistics.ResultsBoth laser-treated groups were characterized by minor events of post-surgery complications of pain, edema, trismus. The use of NSAIDs in the first 24 hours was significantly inferior in Group 2.ConclusionsPre-surgical LLLT treatment seems to increase the analgesic effect of LLLT. However, trismus and edema were reduced in both laser treated groups, independently from the period of irradiation. Key words:Laser, LLLT, pain, surgery, extraction, third molars, wisdom teeth.

Decreased face primary motor cortex (face-M1) excitability induced by noxious stimulation of the rat molar tooth pulp is dependent on the functional integrity of face-M1 astrocytes.

Acute inflammatory dental pain is a prevalent condition often associated with limited jaw movements. Mustard oil (MO, a small-fiber excitant/inflammatory irritant) application to the rat molar tooth pulp induces increased excitability (i.e., central sensitization) of trigeminal medullary dorsal horn (MDH) nociceptive neurons that can be modulated by MDH application of the astrocytic inhibitor methionine sulfoximine (MSO). The objectives of the study were to determine whether MO application to the rat right maxillary first molar tooth pulp affects left face-M1 excitability manifested as altered intracortical microstimulation thresholds for evoking electromyographic activity in the right anterior digastric (RAD, jaw-opening muscle), and whether MSO application to face-M1 can modulate this MO effect. Under Ketamine general anesthesia, Sprague-Dawley male rats had a microelectrode positioned at a low-threshold (≤30 μA) face-M1 site. Then MO (n = 16) or control solution (n = 16) was applied to the previously exposed tooth pulp, and RAD threshold was monitored for 15 min. MSO (0.1 mM, n = 8) or saline (n = 8) was then applied to the face-M1, and RAD thresholds were monitored every 15 min for 120 min. ANOVA followed by post hoc Bonferroni was used to analyze data (p < 0.05). Within 15 min of MO (but not control) pulp application, RAD thresholds increased significantly (p < 0.001) as compared to baseline. One hour following MSO (but not saline) application to the face-M1, RAD thresholds decreased significantly (p = 0.005) toward baseline. These novel findings suggest that acute inflammatory dental pain is associated with decreased face-M1 excitability that may be dependent on the functional integrity of face-M1 astrocytes and related to mechanisms underlying limited jaw movements in acute orofacial pain conditions.

Gene Mutations Associated with Temporomandibular Joint Disorders: A Systematic Review.

BackgroundThe temporomandibular joint (TMJ) is a bilateral synovial joint between the mandible and the temporal bone of the skull. TMJ disorders (TMDs) are a set of complicated and poorly understood clinical conditions, in which TMDs are associated with a number of symptoms including pain and limited jaw movement. The increasing scientific evidence suggests that genetic factors play a significant role in the pathology of TMDs. However, the underlying mechanism of TMDs remains largely unknown.ObjectiveThe study aimed to determine the associated genes to TMDs in humans and animals.MethodsThe literature search was conducted through databases including Medline (Ovid), EMBASE (Ovid), and PubMed (NLM) by using scientific terms for TMDs and genetics in March 2015. Additional studies were identified by searching bibliographies of highly relevant articles and Scopus (Elsevier).ResultsOur systematic analyses identified 31 articles through literature searches. A total of 112 genes were identified to be significantly and specifically associated with TMDs.ConclusionOur systematic review provides a list of accurate genes associated with TMDs and suggests a genetic contribution to the pathology of TMDs.

Computed tomography scan evaluation of adequacy for reduction of zygomatic arch fracture using Gillie's temporal approach

Aim: The zygomatic bone is the key component of the structural facial aesthetics as it constitutes the prominence of the cheek bone. Also, the most frequent clinical findings in zygomatic arch fracture includes limitation of jaw movement and flattening of cheek. So it is necessary to elevate the arch precisely. Therefore, a prospective study was conducted toevaluate adequacy for reduction of zygomatic arch fracture using Gillie’s temporal approach with the help of pre-operative and post-operative CT scan. Materials & methods: 4 patients, who received surgical treatment of zygomatico-maxillary complex (ZMC) fractures at the Department of Oral and Maxillofacial Surgery were examined for displacement of zygomatic arch pre-operatively with CT scan then re-evaluated the same site post-operatively. Results: The pre-operative mean displacement at the zygomatic arch, in millimetres (mm), was M = 2.8, SD = 3.011. After reduction, the post-operative displacement was M = 0.4, SD = 0.699. The percentage of reduction was M = 85, SD = 24.15. Conclusion: Gillie’s temporal approach for zygomatic arch fracture reduction is precisely considerable due to its simple and effective method and cosmetically more acceptable. Keywords: Zygomatic fractures, Zygomatico-maxillary complex, Fracture

A comparative study on the impact of intra-articular injections of hyaluronic acid, tenoxicam and betametazon on the relief of temporomandibular joint disorder complaints

ObjectiveThe aim of this study was to compare the efficacy of intra-articular injections of three different agents with well known anti-inflammatory properties. Materials and methodBetween April 2010 and January 2013 a total of 100 patients who were diagnosed as temporomandibular joint disorder in the Department of Otolaryngology at Bozok University School of Medicine were prospectively studied. Patients with symptoms of jaw pain, limited or painful jaw movement, clicking or grating within the joint, were evaluated with temporomandibular CT to investigate the presence of cartilage or capsule degeneration.In the study group there were 55 female and 45 male patients who were non-responders to conventional anti-inflammatory treatment for TMJ complaints. The patients were randomly divided into four groups consisting of a control group and three different groups who underwent intra-articular injection of one given anti-inflammatory agent for each group. We injected saline solution to intra-articular space in the control group. Of three anti-inflammatory agents including hyaluronic acid (HA, Hyalgan intra-articular injection, Sodium hyaluronate 10 mg/ml, 2 ml injection syringe, Bilim Pharmaceutical Company, Istanbul, Turkey); betamethasone (CS, Diprospan flacon, 7.0 mg betamethasone/1 ml, Schering-Plough Pharmaceutical Company, Istanbul, Turkey) and; tenoxicam (TX, Tilcotil flacon, 20 mg tenoxicam/ml, Roche Pharmaceutical Company, Istanbul, Turkey) were administered intra-articularly under, ultrasonographic guidance. Following the completion of injections the, changes in subjective symptoms were compared with visual analogue scales, (VAS) scores at 1st and 6th weeks' follow-up visits between four groups. ResultsThe HA group did significantly better pain relief scores compared to the, other groups at 1st and 6th weeks (p < 0.05). TX and CS groups' pain scores were better than control group values (p < 0.05, for both agents). The pain relief effect of TX was noted to decrease significantly between the 1st and 6th week (p < 0.05) (Fig. 1). We did not observe the same pattern in HA, CS and control (saline) groups between 1st and 6th week (p > 0.05). ConclusionWe found that HA produced better pain relief scores when compared to the other anti-inflammatory agents studied. The main disadvantage of HA is its relatively higher cost. Additionally it does not have a reimbursement status by state or private health insurance systems in Turkey. Despite the lower VAS scores, intra-articular TX and CS may be assessed as more economic alternatives to intra-articular HA injections.

Functional Evaluation of the Use of Total TMJ Custom Prothesis in the Treatment of Fracture of the Middle Cranial Fossa by Condylar Impaction

Fracture of the middle cranial fossa by dislocation of mandibular condyle is a rare type of trauma, and only a few cases are reported in literature. This injury is more common among children and young adults than among the elderly. Most of these fracture have been treated in a open reduction, and variable outcomes have been reported, primarily the functional recovery of these patients. The aim of this paper is to present a follow-up of 2 years of a fracture of the cranial fossa by impaction of mandibular condyle treated with TMJ custom prothesis, where we perform the functional assessment preoperative and postoperative, analyzing the maximum incisal opening (MIO), protrusive (P), lateral excursive movements right and left (LR/LL) and deviation (D). Measurements of mandibular movements were made by the same professional using a caliper, the evaluation of the facial asymmetry and occlusion was performed by clinical and radiographic evaluation and pain assessment was performed using a specific questionnaire. The data were subjected to direct analysis of data and measures of central tendency. The patient evaluated had 19 year-old, female, victim of a motorcycle accident. The patient presented with pain, limited jaw movements, facial asymmetry and malocclusion. We did not observe neurological and ENT injuries. Evolved in right subcondilar fracture and middle cranial fossa by dislocation of the left condyle. Surgery was performed through open reduction with IRF on the right side and on the left a total TMJ custom prosthesis. There were no local or neurological complications during surgery and the patient underwent rehabilitation physiotherapy for 6 months and accompanied by two years. In functional evaluation pre and postoperative respectively had the following results: MIO increase 2mm to 40mm (38mm) LR increase 0mm to 3mm (3mm), LL increase 0mm to 5mm (5mm) and P increase 2mm to 5mm (5mm). The patient after clinical and radiographic evaluation showed no facial asymmetry and had good occlusion. The pain questionnaire answered by it showed that the patient did not have significant pain. The use of Total TMJ custom prosthesis for treatment of cases of fracture of the middle cranial fossa by impaction of the mandibular condyle, without neurological complications, seems an excellent choice, especially in functional recovery.

Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders

The purpose of this study was to address the following question: among patients with acute or chronic temporomandibular disorders (TMD), does low-level laser therapy (LLLT) reduce pain intensity and improve maximal mouth opening? The sample comprised myogenic TMD patients (according Research Diagnostic Criteria for TMD). Inclusion criteria were: male/female, no age limit, orofacial pain, tender points, limited jaw movements and chewing difficulties. Patients with other TMD subtypes or associated musculoskeletal/rheumatologic disease, missing incisors teeth, LLLT contra-indication, and previous TMD treatment were excluded. According to disease duration, patients were allocated into two groups, acute (<6 months) and chronic TMD (≥ 6 months). For each patient, 12 LLLT sessions were performed (gallium-aluminum-arsenide; λ = 830 nm, P = 40 mW, CW, ED = 8 J/cm(2)). Pain intensity was recorded using a 10-cm visual analog scale and maximal mouth opening using a digital ruler (both recorded before/after LLLT). The investigators were previously calibrated and blinded to the groups (double-blind study) and level of significance was 5% (p < 0.05). Fifty-eight patients met all criteria, 32 (acute TMD), and 26 (chronic TMD). Both groups had a significant pain intensity reduction and maximal mouth opening improvement after LLLT (Wilcoxon test, p < 0.001). Between the groups, acute TMD patient had a more significant pain intensity reduction (Mann-Whitney test, p = 0.002) and a more significant maximal mouth opening improvement (Mann-Whitney test, p = 0.011). Low-level laser therapy can be considered as an alternative physical modality or supplementary approach for management of acute and chronic myogenic temporomandibular disorder; however, patients with acute disease are likely to have a better outcome.

Radiological study of three cases of loose bodies in the temporomandibular joint

According to the literature, loose bodies in the temporomandibular joint (TMJ) primarily prompt to synovial chondromatosis (SC). SC is a cartilaginous metaplasia of the mesenchymal remnants of the synovial tissue of the joints. Its main characteristic is the formation of cartilaginous nodules in the synovium and inside the articular space, described as loose bodies. The main symptoms are pain, limitation of jaw movement, crepitation and inflammation. Diagnosis is made by panoramic radiograph, computed tomography scan and mainly magnetic resonance imaging. SC is usually monoarticular. We report two cases of bilateral loose bodies in TMJ and one monoarticular evaluated through plain radiograph and cone beam volumetric tomography (CBVT). Clinical and radiologic findings are reviewed and discussed. References for diagnosis of SC affecting TMJ are supported. Patients presenting preauricular swelling, pain and restriction of TMJ movements should be evaluated with plain radiography, CBVT and if necessary, magnetic resonance imaging. If loose bodies are found, synovial chondromatosis must be the first suspicion. The definitive diagnosis depends on histology. A differential diagnosis of chondrosarcoma should be considered because of the life-threatening features of chondrosarcoma.

The Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD)

For musculoskeletal disorders like low back pain and fibromyalgia, evidence is growing for fear of movement to play an important role in the development of chronic pain. In temporomandibular disorder (TMD) patients, however, this construct has not received any attention yet. Therefore, in this paper, (1) a generally used instrument to measure fear of movement, the Dutch version of the Tampa Scale for Kinesiophobia (TSK), was adapted for its use in TMD patients (and translated for equivalence to English), (2) the psychometric properties of the Dutch version of the TSK-TMD were assessed, and (3) the association of various symptoms of TMD (i.e., pain, joint sounds, and limited jaw movements) with fear of movement was evaluated. In a sample of TMD patients ( N = 301), confirmatory factor analysis indicated that a two-factor model based on 12 items provides the best fit of the TSK-TMD, with activity avoidance and somatic focus as its subscales. This two-factor solution of the Dutch TSK-TMD has generally good reliability and convergent validity. Multiple regression analysis showed that TMD functional problems (i.e., temporomandibular joint sounds or a stuck/locked feeling) were more strongly associated with fear of movement than with pain. This finding leads to new perspectives regarding the interplay between musculoskeletal complaints, cognition, and avoidance behavior. The results provide a basis for use of the 12-item version for routine assessment of fear of movement in TMD patients, and for future clinical studies, for example, to the role of fear of movement in TMD-treatment success.

Early Surgical Treatment in Unilateral Coronoid Hyperplasia and Facial Asymmetry

Unilateral coronoid hyperplasia is a rare condition in the pediatric age. It may be an unrecognized cause of restricted mouth opening in children.The limited jaw movement is due to the enlargement of the coronoid process of the mandible that impinges on the zygomatic arch during mouth opening. This pathologic condition is still unknown and often misdiagnosed.Although in the past the term osteochondroma has been used to describe most of the unilateral and a few of the bilateral cases, there is no histologic evidence that the process has a neoplastic origin.Microscopic examination of the removed coronoid process has revealed hyperplastic compact bone covered with a thin layer of normal cartilage.There are multiple causes of mandibular hypomobility, each of them associated with different anatomic structures and etiologies, and a large number of cases, mostly bilateral, are idiopathic in nature.Several theories of pathogenesis have been proposed: temporomandibular joint dysfunctions, mandibular hypomobility, temporalis hyperactivity, hormonal stimulus, persistent cartilage growth center, genetic inheritance, and family factors.Unilateral coronoid hyperplasia is usually due to a trauma or a pathologic condition and is associated with facial asymmetry, being more frequently seen in women with histologic chondromatous or neoplastic changes. A thorough clinical history should include information about the onset and progression of pain and other subjective symptoms.In this study, we present a case of unilateral hyperplasia of the coronoid process in a 3 year-old female who, to the best of our knowledge, is the youngest patient so far reported with such anomaly.Our findings support the recommendation that early surgical treatment and aggressive postoperative physical therapy should be taken into account to allow for recovery of morphology and growth function in children.

Synovial Chondromatosis of the Temporomandibular Joint

Synovial chondromatosis is a cartilaginous metaplasia of the mesenchymal remnants of the synovial tissue of the joints. Its main characteristic is the formation of cartilaginous nodules in the synovium and inside the articular space (loose bodies). Synovial chondromatosis mainly affects big synovial joints such as the elbow and knee and is uncommon in the temporomandibular joint. The main symptoms are pain, limitation of jaw movement, crepitation, and inflammation. Diagnosis is made by panoramic radiograph, computed tomography scan, and mainly magnetic resonance imaging. Surgery is the therapeutic choice. The authors describe their experience in the treatment and in the follow up of a patient with unilateral synovial chondromatosis.

Misdiagnosed fibrosarcoma of the mandible mimicking temporomandibular disorder: a rare condition

The jawbones can be sites of various neoplastic conditions. Given the variety of processes affecting this particular anatomical area, formulation of a precise diagnosis can be challenging to clinicians. Limited jaw movement, pain, and facial asymmetry are common signs among patients, especially those with temporomandibular disorder (TMD). This paper reports a case of primary fibrosarcoma affecting the mandible and surrounding structures in a 14-year-old girl presenting signs and symptoms similar to TMD. Her condition was misdiagnosed, and she was treated for TMD over an extended period before the correct diagnosis was made for fibrosarcoma. The patient underwent surgical resection with postsurgical radiotherapy and chemotherapy and now is being followed up. Although malignant lesions are rare in the temporomandibular joint (TMJ) region, dentists are advised to be aware of the condition and to keep in mind that patients who are admitting for TMD can also possibly be affected from neoplasms. Hence, those patients have to be examined meticulously to avoid misdiagnosis and mistreatment.

Infrared Thermography in the Assessment of Temporomandibular Joint Dysorder

Background: Temporomandibular joint disorder (TMD) is a group of musculoskeletal conditions characterized by pain in the pre-auricular area, limitation of jaw movement a nd palpable muscle tenderness. Thermography is a nonionizing, noninvasive diagnostic alternative for the evaluation of TMD. This study was conducted to evaluate the usefulness of thermography in the assessment of TMD. Methods: Thermography was conducted on the 61 patients who had been diagnosed with TMD, and on the 34 normal symptom-free volunteers. The temperature differences between opposite sides of the temporomandibular joint (ΔTTMJ) and the masseter muscle (ΔTMST ) were calculated. The sensitivity and specificity of thermography was calculated at the cut off values of 0.2, 0.3, and 0.4 o C. Results: In the patient group, the ΔTTMJ was 0.42 ± 0.38 o C and the ΔTMST was 0.38 ± 0.33 o C, whereas in the control group the ΔTTMJ was 0.10 ± 0.07 o C and the ΔTMST 0.15 ± 0.10 o C. In addition, the patient group demonstrated a significantly lower level of thermal symme try than the control group (P ＜ 0.001) in both the temporomandibular joints and the masseter muscles. The sensitivity of thermography at the cut off values of 0.2, 0.3 and 0.4 o C was 67.2, 49.2, and 42.6% in the temporomandibular joint (TMJ) and 60.7, 49.2 and 37.7% in the masseter muscle, respectively. The specificity of therm ography at the cut off values of 0.2, 0.3 and 0.4 o C was 88.2, 100, and 100% in the TMJ and 61.8, 91.2 and 100% in the masseter muscles, respectively. The accuracy of thermography at the cut off values of 0.2, 0.3 and 0.4 o C was 74.7, 67.4, and 63.2% in TMJ and 61.1, 64.2 and 60.0% in the masseter muscles, respectively. Conclusions: Temperature differences exist between the opposite sides of the TMD and masseter muscles in patients with TMD. Although the sensitivity of thermography in the diagnosis of TMD is low, it has high specificity in the evaluation of TMD, and is therefore applicable to patients with TMD. (Korean J Pain 2007; 20: 163�� 168)

Predicting Trouble in Airway Management

Predicting Trouble in Airway Management

O.251 Eminectomy for habitual dislocation under local Anaesthesia: an experience with 11 cases

A 71-year-old man was referred to the Department of Oral and Maxillofacial Surgery at Westmead Hospital for investigation of limited jaw movement and facial pain after a cerebrovascular event eight weeks previously. He was found to have bilateral dislocations of the temporomandibular joints (TMJ) and was successfully treated with a combination of intermaxillary fixation (IMF) screws and botulinum toxin A.

Secondary enlargement of the mandibular coronoid process.

Abstract Enlargement of the coronoid process of the mandible is a rare cause of limited jaw movement. Primary causes fall into two categories: benign tumours and developmental hyperplasia. Two cases of clinically important enlargement of the coronoid process secondary to other longstanding causes of difficulty in opening the mouth are described. It is suggested that significant appositional bone growth secondary to abnormal stresses mediated by the tendon of the temporalis muscle does occur.

Non‐surgical treatment of sports‐related temporomandibular joint disorders in basketball players

In this study, 18 basketball players (11 female, seven male; age range 14-32 years) with temporomandibular joint (TMJ) problems who had a history of sport injuries related to head or jaw region were evaluated and the results of the treatment were presented. A standardized functional examination of the masticatory system was performed including measurement of maximal jaw movements, recording of joint sounds, pain on movement of the jaw as well as tenderness to palpation of the both TMJ or masticatory muscles. Patients were also evaluated periodontally. Diagnosis was made according the criteria, described by Okeson, and appropriate treatment was applied using different kind of splints. At the end of treatment only one patient continued with right TMJ reduction with slight pain. Except for that patient, none of the patients had pain after treatment. The maximum opening of the jaws and the maximal jaw movements were statistically increased after treatment. Patients with TMJ problems also showed periodontal problems, most likely due to inadequate oral hygiene because of the limited jaw movements and pain. Periodontal parameters including probing depth (PD), Plaque index (PI), and Sulcus Bleeding Index (SBI) improved after treatment. Sports-related TMJ injuries may result in complex problems such as pain, TMJ sounds, limitation in maximal jaw movements and maximum opening of the mouth, difficulty in chewing. With the appropriate diagnosis this could be treated non-surgically in 6-8 months. This study also showed that the TMJ disorders may cause periodontal problems, which may affect all teeth and also the general health of the athlete.