The TMJ Triad Why is it that some people with horrendous malocclusions suffer no TMJ symptoms, while others with a moderate or even a mild malocclusion suffer from severe TMJ symptoms? The answer to this question revolves around 3 aetiological factors called "The TMJ Triad.
" That is to say 3 factors that have to be present, all at the same time, to initiate a TMJ response.
They are: 1) Predisposition 2) Tissue Alteration 3) Psychological dependence.
So let us take a closer look at this triad.
1) Predisposition.
Predisposition is "a condition of special susceptibility.
" Furthermore, predisposition can be intrinsic, or extrinsic.
a) Intrinsic.
This would involve inherited abnormality or weakness of muscles, tendons, ligaments etc b) Extrinsic.
Traumatic, or pathological changes in the tissues relevant to correct function 2) Tissue Alteration.
The kinds of tissue alteration includes: Arthritic changes Occlusal relationships Loss of posterior support Iatrogenic changes TMJ / skeletal relationships etc etc 3) Psychological Dependence.
This is probably the most difficult to understand.
TMJ personalities are said to exist - often described as tense, depressed, obsessive etc.
It is during such periods of stress that TMJ sufferers indulge in oral parafunction such as bruxing and clenching.
The relevance of the TMJ Triad has been alluded to earlier in this article..
..
all 3 components of the triad must be present at the same time.
This means that the removal of just 1 component will stop all TMJ symptoms.
* Now clearly there is nothing to be gained by trying to work with predisposition.
* The stress component can be resolved with the correct treatment.
* That leaves us with tissue alteration, or as you and I would call it - the occlusion.