Subluxation of Temporomandibular Joint: Symptoms and Causes and Treatment with Homeopathic Medicine
Abstract: Though numerous dental conditions like toothache, swelling gums, etc. can be treated with homoeopathy. This article is also an attempt to show the effectiveness of homoeopathic medicines in dental conditions like subluxation of the temporomandibular joint.
Keywords: temporo-mandibular joint (TMJ), subluxation, orthopantomogram (OPG), pain jaw, homoeopathy, Causticum.
Abbreviations: temporo-mandibular joint (TMJ), orthopantomogram (OPG), Saccharum lactis (SL), thrice a day (TDS).
Introduction: Hyperextension of TMJ usually results in subluxation or luxation of the joint which may, along with anatomical predisposition to the maximally open mouth position. It is not associated with a specific pathological characteristic of the joint.[1] The condition may be acute or chronic.
Apart from discomfort, a subluxation can also cause pain. The movement of the condyle close to and over the individual opening limit can lead to stiffness of joints and the inability to open the mouth (open lock), which is a prominent clinical sign of TMJ luxation.[1]
Pathophysiology of subluxation
In a luxation or dislocation of the TMJ, the mouth opens over its normal boundary, the mandible is blocked and it is called open lock or spontaneous luxation of the condyle and the disk complex. The excessive opening of the mouth upon yawning, singing, or during dental procedures leads to this condition. In a spontaneous luxation, the patient cannot close the mouth independently and permits a previously long-lasting subluxation (hypermobility) on wider mouth opening. [1,2]
Case history:
Case of a person aged 22 years male approached on dated 6/9/2020 with complaints of continuous pain over temporomandibular joint from last 3-4 months. Previously felt on right side, accompanied by left side. When the patient did brushing+2 and yawning+3; the joint gets stuck on+3 and it takes few minutes to close the mouth. Pain and pressing feeling while having meals and difficulty while chewing+2.
Onset- not known.
Frequency- Episodes almost on daily basis, mainly while doing brushing and cleaning tongue.
When the dental doctor was consulted for the defined problem, he wants to check the X-ray temporomandibular region, so advised OPG (orthopantomogram). After OPG, the patient was said that there is mandatory to do sittings for jaw alignment/ splinting, which is for 2 years. Patient wasn’t ready for the procedure, thus approached to homoeopathic physician.
Physical generals:
His appetite was good, drank plenty of water, stools were satisfactory, but constipated when took lots of spicy food+2. Sweat was slightly offensive, non-staining. Thermals: chilly+2
Mental generals:
Emotionally weak, weeping+1 at the sufferings of others. Anxious about his future+2. Weak concentration while studies+2, continuous thoughts came to mind preventing concentration. [No other mental symptoms is ruled out]
Oral examination:
- No signs of gum swelling, gum bleeding absent, signs of pain due to wisdom tooth absent. [nothing abnormal detected]
- No history of tobacco chewing/ gum chewing/ or others.
- No history of any old /recent injury.
Orthopantomogram findings:
No marked pathological changes visible. Mild space narrowing on right side.
Diagnosis: Subluxation of temporomandibular joint [2] [as per dental doctor opinion].
Analysis and evaluation of symptoms:
| Symptom classification | Miasmatic analysis[3,4] | |
| Temporomandibular joint get stuck on+3 <- brushing+2 and yawning+3 | Common symptom/ particular symptom | Psoric |
| Pain and pressing feeling+2 on opening mouth+3, while having meals+2 and difficulty while chewing+2. | Common symptom/ particular symptom | Psoric |
| Constipation <- spicy food+2 | Physical generals | Psoric |
| Anxious about his future+2. | Mental generals | Psoric |
| Weak concentration while studies+2, continuous thoughts. | Mental generals | Psoric |
| Weeping at the sufferings of others+1 | Mental generals | Psoric |
As no peculiar striking symptoms were available, only a few maze of common symptoms were found while case taking. So, decided to refer homoeopathic repertory.
Rubric selection [5]: FACE- PAIN- jaw- articulation- opening mouth
| Reference from materia medica |
| Allen’s Encyclopedia of Pure Materia Medica[6]: |
| He could separate the jaws only with great difficulty, and could not open the mouth as usual; it seemed as if the throat below the jaw were swollen or tense.Sensation of tension and pain in the jaws, so that she could only with difficulty open the mouth, and also could not eat well, because a tooth seemed too long.Painfulness of the right inferior maxillary joint (after half an hour). |
| Hahnemann’s Materia Medica Pura[7]: |
| Rheumatic pains in the lower jaw (after a quarter of an hour). Burning pains in the lower jaw.Prickling-digging in the lower jaw.Drawing, first from the right, then from the left ramus of the lower jaw, towards the chin, and thence back again in the direction of the angle of the mouth, on each side.Tearing in the right lower jaw. |
| Boericke’s New Manual of HoMoeopathic Materia Medica[8]: |
| Pain in jaws, with difficulty in opening mouth.Rheumatism of articulation of lower jaw. |
Selection of remedy/ dose/ potency:
As Causticum covering thermals of the patient and carrying maximum marks was also somewhat suited to the emotional background of the patient. So selected after remedial differentiation to materia medica. Also it was mentioned that where maze of symptoms, we may prescribe a partially indicated remedy based on the recent symptoms.[3] And as the susceptibility was mild to moderate in terms of pathology and absence of peculiar mental & physical symptoms. So, 200 potency was selected [according to Organon of medicine 5th edition] [4] Multiple-dose stimulation should be reserved for cases in which single-dose stimulation is considered to be insufficient. And as soon as adequate response is obtained, further stimulation should be suspended.[3]
Prescription:
[6-9-2020] Rx Causticum 200/ 1 dose/statSL 30/TDS/ 20 days
Follow-up:
| 1/10/2020 | Received on phone Slight relief in pain while brushing ~30-40% but jaw locked while yawning- SQ | Rx Causticum 200/ 1 dose/ stat SL 30/ TDS/ 20 days |
| 25/10/2020 | Decrease frequency and intensity of the presenting complaint. Relief present. No episode in last 20-25 days | Rx SL 30/ TDS/ 20 days |
| 15/12/2020 | Otherwise better than before, but sometimes pain felt on sudden episodes of yawning. Patient also notice some changes at concentration level, no random thoughts disturb. | Rx Causticum 200/ 1 dose/ stat SL 30 /TDS/ 20 days |
| 15/02/2020 | No pain and jaw lock present while brushing. But once in 10-15 days may occur while yawning. | Rx Causticum 200/1 dose/stat SL 30 /TDS/ 1 week |
Result and conclusion: Homoeopathic medicine when selected only on the maze of common symptoms reduced the frequency of painful episodes while yawning and chewing, and could seem constitutional because the concentration level of the person improves. Sometimes, when no peculiar marked modalities are present while case taking, careful assessment and good repertorial command brought the cure itself. Thus, this is an attempt to show the effectiveness of homoeopathic medicines in dental conditions.
References:
1- BadelT, LaškarinM, ZadravecD, Cimic S, PavicinIS. Subluxation of temporomandibular joint- a clinical view. Journal of Dental problems and Solution.2018; 5(2):29-34.
2- Okeson JP. Management of Temporomandibular Disorders and Occulusion. 8th Edition. China. 2020 [pdf]
3- Dhawale ML. Principles & Practice of Homoeopathy. Volume 1. Bombay: Karnatak publishing house. 1967. P.no- 91, 412.
4- Hahnemann S. Organon of medicine. 5th edition. New Delhi: B. Jain (P) Ltd; 2016.
5- Schroyens Synthesis 9.0, RADAR 10.5 [Homoeopathic Software].
6- Allen TF. The Encyclopedia of Pure Materia Medica. NewYork: Boericke & Tafel; 1879.
7- Hahnemann S. Materia Medica Pura. New Delhi: B.Jain publishers (P) Ltd.
8- Boericke W. Boericke’s new manual of Homoeopathic Materia Medica with Repertory. Third revised & augmented edition based on ninth edition. New Delhi: B.Jain Publishers (P) Ltd; 2007.
About Author:
Dr Sonia Tuteja, Associate Professor, Department of Materia Medica,
Swasthya Kalyan Homoeopathic Medical College and Research Centre, Sitapura, Jaipur (Rajasthan).
Dr Mehak, M.D.(PGR), Department of Materia Medica
Swasthya Kalyan Homoeopathic Medical College and Research Centre, Sitapura, Jaipur (Rajasthan).
