In normal rest position (1), the
temporalis should be relaxed enough to allow for a "freeway space" between
the teeth (commonly describing as "lips together, teeth apart"). Curiously,
most diagrams representing the temporalis (Slide 1:
images 1, 3, 10) show the teeth in occlusion, meaning that the temporalis
is contracted. If one lateral pterygoid were to contract (2*)
without the of contraction of a temporalis, the mandible would simply move
sideways, without any resistance (i.e., tooth contact) to the lateral pterygoids
attempts. If the temporalis' were to contract in the absence of lateral
pterygoid contraction
(3*), the
mandible
would be elevated until the teeth occlude. When one temporalis contracts
in conjunction with an opposite lateral pterygoid (4), the result
is a functional movement, necessary for mastication. Once
the teeth contact, the movement is complete, and the contraction should
cease.
Continued contraction of the temporalis following
occluding of the teeth (3a) is a functionless act, that is, parafunction,
and is referred to as clenching. The resultant degree of symptoms
(headache, stiff/sore jaw, stiff/sore neck) is a function of the intensity,
duration, and frequency of the activity.
Following a functional movement (4), the
musculature is intended to relax, before continuing with another functional
masticatory movement. Vigorous alternating contractions of the lateral
pterygoids during the occluding of the teeth (by the temporalis) results
in grinding the teeth, commonly referred to as bruxism. The
more intense the contraction of the temporalis (clenching the jaws together),
the more resistance there is to lateral pterygoid activity, thereby allowing
more intense contractions of the lateral pterygoids and more severe the
signs of bruxism. The severity of bruxism is dependent on the intensity
of the temporalis contraction.
When one lateral pterygoid positions the mandible
excursively while the opposite temporalis contracts to stabilize the mandible,
the isometric contraction of the lateral pterygoid can place significant
strain on the ipsilateral TMJ (4a) (E).
This "excursive clenching" is the most damaging activity to the structures
that lateral pterygoids are attached to: the TMJ complex, and the pterygoid
plate of the sphenoid bone (often presenting as sinus and facial symptoms).
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