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Evolution, Epidemiology and Etiology of Temporomandibular Joint Disorders
Evolution, Epidemiology and Etiology of Temporomandibular Joint Disorders
Evolution, Epidemiology and Etiology of Temporomandibular Joint Disorders
5005/jp-journals-10011-1061 JIAOMR
Evolution, Epidemiology and Etiology of Temporomandibular Joint Disorders
REVIEW ARTICLE
ABSTRACT
The temporomandibular joint (TMJ) is unique to mammals, but among different mammalian groups, its morphology and function vary enormously. It
is likely that various species show less loading of jaw joints during chewing than humans do. It took approximately 130 million years for the
evolutionary process to stabilize this composite, basic vertebrate head skeleton to the jaws. Very little documentations are noted on anthropology of
TMJ. When it is concerned with epidemiology, temporomandibular disorders (TMDs) have a number of consistent findings and various causative
factors that can contribute to TMDs. The aim of the following article is to provide detailed information regarding its evolution, epidemiology and
various causative factors leading to TMDs.
Key Message: The masticatory system is extremely complex.
Keywords: Temporomandibular joint, TMDs, Epidemiology, Biomechanics, Animal, Mastication.
INTRODUCTION secondary cartilage with a fibrous skin derived from the periosteum.
TMJ is a unique joint in which translatory as well as rotational Another nearly constant feature is the intra-articular disk. The disk,
movements are possible, and where both the ends of bone articulate even when incomplete, is associated with the lateral pterygoid
in the same plane with that of other bone. It is also called as muscle,5 which has led some authors to speculate that it arose as a
ginglymodiarthroidal type of joint wherein it has sliding movement tendon, which later formed the new joint.6
between bony surfaces, in addition to hinge movement, common
Origin of the Vertebrate Head
to diarthroidal joint.1
Jaws and jaw joints hold a particular importance in the history A complete vertebrate is a species not only with backbone but
of vertebrates. Comparative studies of many different species have also with biting jaws. The first vertebrates had no biting apparatus
also documented to understand the idea of perpetual change over but the process of cephalization also produced the singular
time. Complicating features of jaws and their joints leading to structures called the jaws. Furthermore, complete mammals have
those of mammals have derived by selective playing with adaptive long been distinguished from all other vertebrates and from
modifications of several original elements.2 The following article animals2 very nearly mammalian largely on the basis of their jaw
provides detailed information regarding its evolution along with ear structure. However, there is an even greater significance to
the epidemiology and etiology of TMDs. jaw joints in vertebrate evolution. The true diarthrodial joint was
first formed in fishes, and its basic structure remained essentially
DISCUSSION unchanged when it was appropriated by the limbs of land animals.
The masticatory system is extremely complex. It is primarily made Diarthrognathus7and Probainognathus8 have contact between
of bones, muscles, ligaments and teeth. Movement of mandible two bones, squamosal and dentary, which form the jaw joint in
needs coordination between them to maximize function and mammals.
minimize the damage to surrounding structures. This movement Diarthroses are the most complex joints with a wide single
occurs as a complex series of interrelated three-dimensional articular cavity surrounded by a specialized sleeve lined with a
rotational and translational activities, which is determined by synovial membrane.2 Schizarthrosis are joints made more mobile
combined activities of both TMJs. This complex biomechanics of by several small separated splits or joint spaces interrupting their
TMJ makes it difficult to understand the insight of temporomandi- bonding tissues. The simplest joints are synarthroses in which the
bular joint.3 parts are made slightly movable by a binding of cartilage,
Temporomandibular joint (TMJ) is a cardinal feature that fibrocartilage or connective tissue between them.2
separates mammals from other vertebrates. As befits its late
evolutionary origin, the TMJ also makes a tardy developmental Evolutionary Stages
appearance.4 The primary jaws were modified gill arches that were connected
The TMJ is interesting because of its constituent bones, at their caudal ends by a simple hinge joint. There was an obvious
mandible and squamous temporal, which are intramembranous in mechanical deficiency in this sort of arrangement because the joint
origin. Thus, the tissue that covers each articulating surface is a was left hanging-free, protruding slightly on each side like
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Evolution, Epidemiology and Etiology of Temporomandibular Joint Disorders
group of reptiles which later gave rise to mammals - the ‘mammal- tooth bearing bone or dentary has a strictly limited extension distal
like reptiles diverged at an early stage from the main reptilian stem, to the tooth row; the other bones of the jaw are well-developed
and by the Permian, some 250 million years ago, were widespread and comprise the posterior third of the jaw. The quadrate—the
and might reasonably be regarded as the ‘Lords of Creation’. Later skull bone which forms with the articular in the lower jaw, the
their place has been taken by the dinosaurs, which remained the jaw hinge, is a large bone with a considerable dorsoventral
dominant group until the latest Cretaceous. The mammal like extension.17
reptiles did not, however, quite disappear. Small members of the
group survived, perhaps in areas where there was insufficient food Mammalian Architectural Theme
for the large dinosaurs, or by eating items of food too trivial for The viscerocranium provides roofs and walls to the upper food
their notice. In this group of tiny mammal-like reptiles, a number way, the neurocranium houses the brain whereas the mandible is
of changes took place, all probably associated with the acquisition a long, straight, level bar with its fulcrum, the jaw joint at the
of the ability to maintain a body temperature above that of their backend. The mandible walls the upper food way, which is roofed
surroundings. This increased their activity and their ability to avoid above by the palate and floored below by a muscular hammock
their enemies, but it carried the penalty that it vastly increased the hung between the bony bodies of both sides. This is the basic
food requirement.17 characteristic of mammalian skull, from it, two adaptive feeding
Reptilia2 have loss of bony parts (Figs 2A to D). In the modifications labeled carnivores as opposed to herbivores exist.2
Pelycosauria, the lower jaw is of an essentially reptilian form. The The early American forms are grouped as the Pelycosauria,
comprising carnivorous, piscivorous and herbivorous forms. The
herbivores are of interest as they were the first group of vertebrates
to exploit plant life directly as food. The specialization of the teeth
and masticatory apparatus is such in herbivorous forms that their
capacity for further evolution is limited, so that major evolutionary
changes are always initiated by carnivorous or insectivorous
A
forms.17
Austrolopithecus africanus skull (Fig. 3) is the least differen-
tiated. The jaws protrude sharply housing a short cheek teeth. The
upper jaw has outstanding canine buttresses whereas the lower
jaw is fairly shallow. The zygomatic arches are quite slender. The
teeth are broad, spatulate, bulky and long rooted as they project
from their sturdy buttresses.2 Austrolopithecus boisei skull
(Fig. 4) is considerably differentiated. The skull dorsum is deeply
vaulted in a short asymmetrical arch, the supraorbital ridges are
B bulky, jaws are severely retruded, no canine buttresses, and massive
zygomatic buttresses give the face a “dished” in frontal plane.
The teeth are smaller and occlusal surfaces are more than three
times greater than in modern man.2
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Evolution, Epidemiology and Etiology of Temporomandibular Joint Disorders
TMD increased with age (35% at age 7, 61% at age 11, and 66% somatization, anxiety, and low self esteem. Combination therapy
at age 15), 60% of the sample reported one or more TMD (education, pharmacotherapy, trigger point therapy, physiotherapy
symptoms, 66% reported one or more symptoms at age 15. and intraoral appliances and relaxation therapy) may be helpful in
providing a better outcome.
Etiology
The causes of TMD range from traumatic injury to immune- REFERENCES
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