TMD – temporo-manibular joint dysfunction

This disorder is made up by a number of symptoms:

The temporo-mandibular dysfunction (synonyms: cranio-mandibular dysfunction, myoarthopathy of the stomatognathic systems, Costen-syndrome) is a condition that can be expressed in many forms. It is seen as a significant civic problem. There are no writings in the history of traditional medicine that describe this combination of symptoms or how to handle them with an adequate therapy. For sure there are a series of records that indicate therapies that can improve the separate symptoms, but they do not treat the cause of the problem. Maybe this explains the therapeutic helplessness that we can find in many places in relation to TMD.

This condition was first described in the 30s:

The ear- nose- and throat surgeon Costen first described this condition in the 1930s.

It can affect different structures:

The temporo-mandibular joint dysfunction can affect different structures in the field of dentistry.


  • Arthritic origin: e.g. articular disc displacement, degenerative arthritic changes of the jaw joint or changes of the capsular structures (different forms of capsulitis, compression or distraction joints). Common symptoms are crepitus (crackling) and/or clicking of the joints, jaw lock, jaw joint pain, ear aches and tinnitus.
  • Myogenic origin: here tension in the chewing and accessory muscles, sometimes in combination with limited jaw opening occurs. These can trigger pain in other areas of the body or cause severe tension headaches. A psychosomatic component in this group is not uncommon.
  • Occlusal origin: deviations of the bite, forced occlusal position or atypical periodontal diseases that are caused by early contacts can be found in this category. They can be caused by the incorrect bite of a prosthesis or incorrect shape of a filling, orthodontic treatment that did not take the jaw joints into account, or by disbalances generated during the growth period. Changes in the body posture, unbalanced pelvic, cervical spine blockages due to accidents can also cause secondary early contacts of single or groups of teeth. Wear facetts , multiple caries free cervical tooth defects or single gingival recessions in an otherwise healthy mouth often can be observed.
  • Mixed origin: TMD of arthritic, myogenic and occlusal origin are often related.

The aim of the therapy is to achieve a centric position of the jaw joints.

Splint therapy is predominantly used for the oral part of TMD therapy. It is used to adjust the neuromuscular centric positioning of the mandible.

Once the position is reached, the orthodontist can balance out the deviations in the bite with orthodontic treatment. If a lot of crowns or large restorations need to be renewed, this adjustment will be done prosthtetically by a prosthodontist. A combination of these two procedures may be necessary, when the deviation is very large and neither the orthodontists  nor  the prosthodontist alone are able to guarantee/ensure the deficit can be adjusted. In extreme dysgnathic cases, a surgical procedure, such as an orthognathic surgery, may be necessary to achieve a good position of the jaws to each other, prior to the orthodontic and/or prosthetic rehabilitation.