title: James Buchanan Duke

text: At the start of the 1900s, Duke tried to conquer the British market as he had done the American, eventually forcing the then divided British manufacturers to merge into the Imperial Tobacco Company of Great Britain and Ireland, Ltd (Imperial Tobacco). After two years of intense competition in Great Britain, Imperial Tobacco took the fight to the U.S. market, forcing American Tobacco to look for a settlement. This resulted in an agreement whereby American Tobacco controlled the American trade, Imperial Tobacco controlled the trade in the British territories, and a third, cooperative venture named the British-American Tobacco Company was set up between the two to control the sale of tobacco in the rest of the world.


title: James Buchanan Duke

text: During this time, Duke was repeatedly sued by business partners and shareholders. In 1906, the American Tobacco Company was found guilty of antitrust violations, and was ordered to be split into four separate companies: American Tobacco Company, Liggett & Myers, R. J. Reynolds, and the P. Lorillard Company. In 1911, the U.S. Supreme Court upheld an order breaking up the American Tobacco Company's monopoly. The company was then divided into several smaller enterprises, of which only the British-American Tobacco Company remained in Duke's control.


title: James Buchanan Duke

text: In 1892, the Dukes opened their first textile firm in Durham, North Carolina, which was run by his brother Benjamin. At the turn of the century, Buck organized the American Development Company to acquire land and water rights on the Catawba River. In 1904, he established the Catawba Power Company and the following year he and his brother founded the Southern Power Company, which became known as Duke Power, the precursor to the Duke Energy conglomerate. The company supplied electrical power to the Duke's textile factory and within two decades, their power facilities had been greatly expanded and they were supplying electricity to more than 300 cotton mills and other industrial companies. Duke Power established an electrical grid that supplied cities and towns in the Piedmont Region of North and South Carolina. Lake James, a power-generating reservoir in Western North Carolina, was created by the company in 1928 and named in Duke's honor. Buck Steam Station in Rowan County, North Carolina, built in 1926, was also named for Duke.


title: James Buchanan Duke

text: Duke was married twice, first in 1904 to Lillian Fletcher McCredy (also known as Lillian Nanette Duke). They divorced in 1906 and had no children. In 1907 he married the widow Nanaline Holt Inman, with whom he had his only child, a daughter, Doris, born November 22, 1912. Doris was raised at Duke Farms located in Hillsborough, New Jersey, where her father had worked with landscapers such as James Leal Greenleaf (a member of the firm of Frederick Law Olmsted), and Horatio Buckenham to transform more than of farmland and woodlots into an extraordinary landscape containing 2 conservatories, 9 lakes, 35 fountains, 45 buildings, countless pieces of sculpture, over of stone walls and more than of roadway.


title: James Buchanan Duke

text: Duke died in New York City on October 10, 1925, and is interred with his father and brother in the Memorial Chapel on the campus of Duke University. He resided at his home, Lynnwood in Charlotte, North Carolina during the last five years of his life. It was listed on the National Register of Historic Places in 1978.


title: James Buchanan Duke

text: In December 1924, Duke established The Duke Endowment, a $40 million trust fund (equivalent to $ in ), some of which was to go to Trinity College. The University was renamed Duke University in honor of his father. The James B. Duke Library, the main campus library at Furman University, is also named for him because of his philanthropic relationship with the university.


title: James Buchanan Duke

text: On his death, he left approximately half of his huge estate to the Duke Endowment, adding another $67 million (equivalent to $ in ) to the trust fund. In the indenture of trust, Duke specified that he wanted the endowment to support Duke University, Davidson College, Furman University, Johnson C. Smith University; non-profit hospitals and children's homes in the two Carolinas; and rural United Methodist churches in North Carolina, retired pastors, and their surviving families.


title: James Buchanan Duke

text: Much of the remainder of Duke's approximately $100 million (equivalent to $ in ) estate went to his daughter Doris Duke, who became "the richest girl in the world". In 1927, Doris sued her mother for control of the family house in Manhattan and won. Doris also successfully sued for control of the Duke Farms estate. Associating Duke Farms with fond memories of her father, Doris Duke made few major changes to the property other than the adaptation of her father's Conservatory to create Display Gardens in his honor. These gardens showcased her father's extensive sculpture collection and were open to the public from 1964 until closed by her foundation trustees in May 2008.


title: Custodian of the Two Holy Mosques

text: Custodian of the Two Holy Mosques (abbreviation "CTHM"; , '), Servant of the Two Noble Sanctuaries or Protector of the Two Holy Cities"', is a royal style that has been used by many Muslim rulers, including the Ayyubids, the Mamluk sultans of Egypt, the Ottoman sultans, Kings of Hejaz and in the modern age, Saudi Arabian kings. The title was sometimes regarded to denote the "de facto" Caliph of Islam, but it mainly refers to the ruler taking the responsibility of guarding and maintaining the two holiest mosques in Islam: Al-Haram Mosque (, "The Sacred Mosque") in Mecca and the Prophet's Mosque () in Medina, both of which are in the Hejazi region of Saudi Arabia.


title: Custodian of the Two Holy Mosques

text: After defeating the Mamluks and gaining control of the Mecca and Medina in 1517, the Ottoman Sultan Selim I adopted the title. Rather than style himself the "Ḥākimü'l-Ḥaremeyn" (, "Ruler of The Two Holy Cities"), he accepted the title "Ḫādimü'l-Ḥaremeyn" (, "Servant of The Two Holy Cities").


title: Custodian of the Two Holy Mosques

text: The first King of Saudi Arabia to assume the title was Faisal bin Abdul Aziz (1906–1975). His successor Khalid did not use the title, but the latter's successor Fahd did, replacing the term "His Majesty" with it. The current king, Salman bin Abdulaziz Al Saud, took the same title after the death of King Abdullah, his half brother, on 23 January 2015.


title: Princess Marie of Denmark

text: Princess Marie of Denmark, Countess of Monpezat, ("née" Marie Agathe Odile Cavallier, born 6 February 1976) is a member of the Danish royal family. She is the second wife of Prince Joachim of Denmark, the younger son of Queen Margrethe II of Denmark.


title: Princess Marie of Denmark

text: Marie Cavallier was born in Paris, France. She is the only child of Alain Cavallier, partner in an advertising agency, and Françoise Grassiot ("née" Moreau), owner of the Château de la Vernède, near Avignon. She is the paternal granddaughter of Claude Cavallier (stepson of Baron de Limnander de Nieuwenhove) and Baroness Odile Brunet de Sairigné ("née" Labesse). She moved to Geneva, Switzerland with her mother following the divorce of her parents.


title: Princess Marie of Denmark

text: After her parents divorced, Marie was sent to the Collège Alpin International Beau Soleil boarding school in Switzerland. She attended Babson College in Wellesley, Massachusetts, in the US for a brief time, to study international business and economics and then went on to study economics in Geneva. Marie earned a Bachelor of Arts at Marymount Manhattan College. During her years in college, Marie worked for Estée Lauder, as assistant to the public relations manager in 1994, and as an assistant to the managing director of ING Numismatic Group SA in Geneva.


title: Princess Marie of Denmark

text: After graduating, she started working for DoubleClick Inc, an international advertising agency, in New York as international marketing coordinator. Back in France, she worked for advertising agency Media Marketing. She then worked for Reuters financial news agency Radianz in Switzerland, took a position with REInvest in Geneva and worked as executive secretary in ING Numismatic Group SA until the engagement.


title: Princess Marie of Denmark

text: Marie first came to public attention when she was photographed with Prince Joachim in August 2005 on a private holiday in Avignon, France. In January 2007, Marie accompanied Prince Joachim and his children on a ski holiday in Switzerland. Later that year, Marie joined the royal family for Easter at Marselisborg Palace, where she met Joachim's mother, Queen Margrethe II, for the first time. Marie increasingly made weekend visits from Geneva to Denmark in 2007.


title: Princess Marie of Denmark

text: On 3 October 2007, it was officially announced that Marie Cavallier was engaged to Prince Joachim. The wedding took place on 24 May 2008 in Møgeltønder Church. Upon her marriage to Joachim, Marie's title is "Her Royal Highness Princess Marie of Denmark, Countess of Monpezat". Upon marrying Joachim, Marie, who had been a French citizen and a member of the Roman Catholic Church, became a Danish citizen and converted to the Evangelical-Lutheran Church of Denmark. Marie's wedding gown was designed by Spanish-Italian fashion house Arasa Morelli, and was sewn by a Danish woman working for the company.


title: Princess Marie of Denmark

text: The couple have two biological children, Henrik (born 4 May 2009) and Athena (born 24 January 2012), and Marie is stepmother to Joachim's two sons from his former marriage, Nikolai and Felix.


title: Princess Marie of Denmark

text: Marie's first engagement and trip abroad was to Morocco on 28 October 2008, when she handed out Lego toys to orphanage children in Rabat. After this trip abroad, the Princess accompanied Prince Joachim to Russia. The Princess' third official trip was to Hong Kong and China together with Prince Joachim in November 2009. In March 2010, Marie undertook her fourth official visit abroad to Mexico City with Prince Joachim. In April 2010, Marie paid a working visit to the UNESCO Headquarters in Paris as patron for the organisation.


title: Princess Marie of Denmark

text: Marie's first patronage came shortly after her son's birth, when her patronage of Tønder Festival was announced. Tønder Festival is an international folk music festival near her official residence Schackenborg Manor in Møgeltønder, where the Princess resided with her family. Shortly afterwards, Marie took over one of the Prince Consort's duties as Patron of the Annual Literature Prize that awards an annual prize for French-language literature in Copenhagen. Marie also became a patron of Syddansk Universitet in September 2009. In January 2010, the Danish Ski Federation named Princess Marie official patron. Princess Marie was presented on 17 November 2009 as patron of "The Danish National Commission for UNESCO".


title: Princess Marie of Denmark

text: Additionally, she is patron of the Danish Epilepsy Association, Kattegatcentret, the AIDS Foundation, and Autism Denmark.


title: Princess Marie of Denmark

text: Marie enjoys bike-riding, running and skiing. She also shares a passion for racing with Prince Joachim.


title: Princess Marie of Denmark

text: Since her marriage, Marie has been known as "Her Royal Highness Princess Marie of Denmark, Countess of Monpezat".


title: Jacob Vargas

text: Vargas was born in Michoacán, Mexico, and raised in Pacoima, Los Angeles, California. He was raised in a devout Roman Catholic family. He attended high school at San Fernando High School in San Fernando, California.


title: Jacob Vargas

text: In 1992, Vargas appeared in "American Me". In 1995, Vargas won the very first ALMA Award (for Emerging Artist of the Year) for his work in both Allison Anders' "Mi Vida Loca", and Gregory Nava's "My Family". In 1995, Vargas would appear in "Get Shorty". In 1997, Vargas appeared in "Romy and Michele's High School Reunion". In 1999, Vargas became the voice of Max Steel.


title: Jacob Vargas

text: In 2000, Vargas played Benicio del Toro's partner Manolo in director Steven Soderbergh's drug trafficking pic "Traffic", which earned him a Screen Actors Guild Award and another ALMA Award. The same year he also played the Joker from the Joker Brothers in the "Next Friday". He played A.B. Quintanilla, the brother of the late Tejano singer Selena in the biopic film of the same name. In 2002, Vargas would play Caesar Chavez in FX Network's movie "RFK". In 2004, Vargas played Sammy the chef in John Moore's "Flight of the Phoenix".


title: Jacob Vargas

text: In 2005, Vargas co-starred with Paul Walker and Laurence Fishburne in "The Death and Life of Bobby Z". and also played Marine sniper Cortez in Sam Mendes' war drama "Jarhead". In 2006, Vargas played a politically charged busboy in Emilio Estevez's historical drama "Bobby". In 2011, Vargas played the father of Water Enrique Murciano and Power Nicholas Gonzalez in this true story.


title: Jacob Vargas

text: From 2013 to 2014, Vargas played Montez on two seasons of "Sons of Anarchy" and six episodes of "Mayans M.C."


title: Jacob Vargas

text: In 2014, Vargas played Richard Chavez opposite Michael Peña in the biopic "Cesar Chavez" directed by Diego Luna.


title: Jacob Vargas

text: In 2015, Vargas played Edison "Elvis" Peña in the film "The 33", It is the true story of the 33 Chilean miners that were trapped for 69 days.


title: Jacob Vargas

text: In 2016, Vargas reoccurred as Domingo Colon in the Netflix series "Luke Cage". In 2016, Vargas also reoccurred in "Colony", Amazon Studio's "Hand of God" and he co-stars in Hulu's "Crushed". In 2019, Vargas co-starred in Max Carlson's "Princess of the Row" opposite Martin Sheen and Ana Ortiz. He also co-starred in "Peel".


title: Jacob Vargas

text: In 2020, Jacob Vargas and Justina Machado were Masters of Ceremonies at the National Hispanic Media Coalition Impact Awards.


title: Jacob Vargas

text: He is married to Sylvia Arzate. They have two daughters, Rosa, born in 2004 and Victoria, born in 2011. Vargas has four brothers and one sister.


title: Chikmagalur

text: Chikmagalur, known officially as Chikkamagaluru, is a city and the headquarters of Chikmagalur district in the Indian state of Karnataka. Located on the foothills of the Mullayanagiri peak of the Western Ghats, the city attracts tourists from around the state for its pleasant and favourable hill station climate, tropical rainforest and coffee estates.


title: Chikmagalur

text: As of 2011 Indian Census, Chikmagalur city had a total population of 118,401, of which 58,702 were males and 59,699 were females. Population within the age group of 0 to 6 years was 11,633. The total number of literates in Chikmagalur was 96,359, which constituted 81.4% of the population with male literacy of 83.7% and female literacy of 79.1%. The effective literacy rate of 7+ population of Chikmagalur was 90.3%, of which male literacy rate was 93.1% and female literacy rate was 87.5%. The Scheduled Castes and Scheduled Tribes population was 16,423 and 1,734 respectively. Chikmagalur had 28545 households in 2011.


title: Chikmagalur

text: Chikmagalur is connected to other parts of the state through roads. National Highway 173 (India) passes through the town connecting with port city Mangalore, located away. State Highway 57 (Karnataka) connects Mysore via Hassan connects Shimoga via Kadur. A railway line connects Chikmagalur to Kadur Junction. The nearest international airport is Mangalore International Airport.


title: Chikmagalur

text: Chikmagalur is situated in the Malenadu region of Karnataka in the Deccan plateau in the foothills of the Western Ghats. It is situated at an elevation of above mean sea level. The Yagachi River has its source near the town and flows in the south-easterly direction before uniting with the Hemavati river. Chikmagalur generally has a moderate to cool climate. The temperature of the city varies from 11-20 °C during winter to 25-32 °C during summer.


title: Evanescence discography

text: American rock band Evanescence has released five studio albums, two live albums, one compilation album, two demo albums, three extended plays, eighteen singles, nine promotional singles, two video albums, and eighteen music videos. Evanescence was formed in Little Rock, Arkansas in 1995 by Amy Lee and Ben Moody. After several changes over the years, the band's lineup comprises Lee, guitarist Tim McCord, guitarist Troy McLawhorn, drummer Will Hunt, and bassist Emma Anzai. As of 2014, the band has sold over 25 million albums worldwide.


title: Evanescence discography

text: Evanescence's early recordings as a duo were released in the late 1990s through independent label Bigwig Enterprises, beginning with their self-titled EP in 1998, followed by the "Sound Asleep" EP the following year, which they sold at their live shows. The band recorded and released a demo album in 2000, titled "Origin". 2,500 copies of "Origin" were pressed, and went on sale for high prices online soon after the release of their debut studio album. The band signed to Wind-up Records in January 2001. In early 2003, they released the "Mystary" EP.


title: Evanescence discography

text: Evanescence's debut studio album, "Fallen", was released in March 2003. It spawned the singles "Bring Me to Life", "Going Under", "My Immortal", and "Everybody's Fool". "Bring Me to Life" and "My Immortal" peaked in the top ten in multiple countries, and respectively were certified triple platinum and platinum by the RIAA. In the US, "Fallen" sold 141,000 copies in its first week, and peaked at number three on the "Billboard" 200. It has sold over 17 million units worldwide, and was certified diamond by the RIAA in 2022 for selling 10 million units in the US. The success of the album and its singles garnered Evanescence two Grammy Awards (for Best New Artist and Best Hard Rock Performance). While touring "Fallen", the band recorded their live show in Paris, which was released on the live album and concert DVD "Anywhere but Home" (2004). The record was certified gold in the US, and sold over one million units worldwide.


title: Evanescence discography

text: Their second album, "The Open Door", was released in 2006 and debuted at number one on four national charts, including the "Billboard" 200, selling over 447,000 copies in its first week in the United States. "The Open Door" spawned four singles. The lead single, "Call Me When You're Sober", attained chart success similar to "Bring Me to Life" and "My Immortal", and was certified platinum by the RIAA. "Call Me When You're Sober" was followed by the singles "Lithium", "Sweet Sacrifice", and "Good Enough". "Sweet Sacrifice" earned a nomination at the 50th Grammy Awards in 2008 for Best Hard Rock Performance. "The Open Door" has sold over five million units worldwide. It has sold 2.1 million units in the United States, and has been certified double platinum by the RIAA.


title: Evanescence discography

text: "Evanescence", their third studio album, was released in 2011. It debuted at number one on the "Billboard" 200, where its US sales had reached 127,000 copies in its first week. It also peaked in the top five in ten other countries. The first single, "What You Want", was released in August, attaining moderate chart success. The second single, "My Heart Is Broken", was released in October. The last single from the album, "Lost in Paradise", was released in May 2012, and "The Other Side" followed as a promotional single the following month. By August 2012, "Evanescence" had sold over 421,000 copies in the United States. In December 2020, the album was certified gold by the RIAA for earning over 500,000 units in the country.


title: 100 Greatest NHL Players

text: In 2017, the National Hockey League commemorated its 100th anniversary with a list of the 100 Greatest NHL Players. The list was made through voting compiled by a panel of 58 people, including media members, NHL alumni and NHL executives. The list is in alphabetical order rather than ranked.


title: 100 Greatest NHL Players

text: The first 33, representing players who played prior to 1966, were unveiled during a pre-game ceremony at the NHL Centennial Classic outdoor game on January 1, 2017. The remaining players were announced on January 27, 2017, at a special "NHL 100 Gala" ceremony held at the Microsoft Theater in Los Angeles, two days before the 2017 NHL All-Star Game.


title: 100 Greatest NHL Players

text: The inclusions of Duncan Keith, Jonathan Toews and Patrick Kane, all of them then-active players and three-time Stanley Cup champions, were considered controversial. Evgeni Malkin, Ed Belfour, Dale Hawerchuk, Joe Thornton, Jarome Iginla, Zdeno Chara, Pierre Pilote and Michel Goulet were considered to be notable players omitted from the list. Malkin responded to his omission by joking that he could be the 101st best player, and remarked that all who were featured on the list earned the honour.


title: 100 Greatest NHL Players

text: Of the players on the list, 39 are centremen, 21 are defencemen, 15 are goaltenders, 15 are right wingers and 10 are left wingers. There are 21 players who started their NHL career in the decade of the 1980s, and 22 who last played in the NHL during the decade of the 2000s, the most by decade for each category. The player on the list with the shortest NHL career is goaltender Bill Durnan, who played for six seasonswinning the Vezina Trophy and selected to the NHL First All-Star team in every season. The two players on the list with the longest NHL career, at 26 seasons each, are: right winger Gordie Howe, over a 33 year period, having retired for two seasons before returning to the World Hockey Association for six seasons, closing with a final year in the NHL; and defenceman Chris Chelios, over a 27 year period, playing in the International Hockey League during the cancelled 2004–05 NHL lockout season.


title: Temporomandibular joint dysfunction

text: Temporomandibular joint dysfunction (TMD, TMJD) is an umbrella term covering pain and dysfunction of the muscles of mastication (the muscles that move the jaw) and the temporomandibular joints (the joints which connect the mandible to the skull). The most important feature is pain, followed by restricted mandibular movement, and noises from the temporomandibular joints (TMJ) during jaw movement. Although TMD is not life-threatening, it can be detrimental to quality of life; this is because the symptoms can become chronic and difficult to manage.


title: Temporomandibular joint dysfunction

text: In this article, the term "temporomandibular disorder" is taken to mean any disorder that affects the temporomandibular joint, and "temporomandibular joint dysfunction" (here also abbreviated to TMD) is taken to mean symptomatic (e.g. pain, limitation of movement, clicking) dysfunction of the temporomandibular joint. However, there is no single, globally accepted term or definition concerning this topic.


title: Temporomandibular joint dysfunction

text: TMDs have a range of causes and often co-occur with a number of overlapping medical conditions, including headaches, fibromyalgia, back pain, and irritable bowel. However, these factors are poorly understood, and there is disagreement as to their relative importance. There are many treatments available, although there is a general lack of evidence for any treatment in TMD, and no widely accepted treatment protocol. Common treatments include provision of occlusal splints, psychosocial interventions like cognitive behavioral therapy, physical therapy, and pain medication or others. Most sources agree that no irreversible treatment should be carried out for TMD.


title: Temporomandibular joint dysfunction

text: About 20% to 30% of the adult population are affected to some degree. Usually people affected by TMD are between 20 and 40 years of age, and it is more common in females than males. TMD is the second most frequent cause of orofacial pain after dental pain (i.e. toothache).


title: Temporomandibular joint dysfunction

text: TMD is considered by some to be one of the 4 major symptom complexes in chronic orofacial pain, along with burning mouth syndrome, atypical facial pain and atypical odontalgia. TMD has been considered as a type of musculoskeletal, neuromuscular, or rheumatological disorder. It has also been called a functional pain syndrome, and a psychogenic disorder. Others consider TMD a "central sensitivity syndrome", in reference to evidence that TMD might be caused by a centrally mediated sensitivity to pain. It is hypothesized that there is a great deal of similarity between TMD and other pain syndromes like fibromyalgia, irritable bowel syndrome, interstitial cystitis, headache, chronic lower back pain and chronic neck pain. These disorders have also been theorized to be caused by centrally mediated sensitivity to pain, and furthermore they often occur together.


title: Temporomandibular joint dysfunction

text: Frequently, TMD has been treated as a single syndrome, but the prevailing modern view is that TMD is a cluster of related disorders with many common features. Indeed, some have suggested that, in the future, the term "TMD" may be discarded as the different causes are fully identified and separated into different conditions. Sometimes, "temporomandibular joint dysfunction" is described as the most common form of temporomandibular disorder, whereas many other sources use the term "temporomandibular disorder" synonymously, or instead of the term "temporomandibular joint dysfunction". In turn, the term "temporomandibular disorder" is defined as "musculoskeletal disorders affecting the temporomandibular joints and their associated musculature. It is a collective term which represents a diverse group of pathologies involving the temporomandibular joint, the muscles of mastication, or both". Another definition of temporomandibular disorders is "a group of conditions with similar signs and symptoms that affect the temporomandibular joints, the muscles of mastication, or both." "Temporomandibular disorder" is a term that creates confusion since it refers to a group of similarly symptomatic conditions, whilst many sources use the term "temporomandibular disorders" as a vague description, rather than a specific syndrome, and refer to any condition which may affect the temporomandibular joints (see table). The temporomandibular joint is susceptible to a huge range of diseases, some rarer than others, and there is no implication that all of these will cause any symptoms or limitation in function at all.


title: Temporomandibular joint dysfunction

text: The preferred terms in medical publications is to an extent influenced by geographic location. For example, in the United Kingdom, the term "pain dysfunction syndrome" is in common use. In the United States, the term "temporomandibular disorder" is generally favored. The American Academy of Orofacial Pain uses "temporomandibular disorder", whilst the National Institute of Dental and Craniofacial Research uses "temporomandibular joint disorder". A more complete list of synonyms for this topic is extensive, with some being more commonly used than others. In addition to those already mentioned, examples include "temporomandibular joint pain dysfunction syndrome", "temporomandibular pain dysfunction syndrome", "temporomandibular joint syndrome", "temporomandibular dysfunction syndrome", "temporomandibular dysfunction", "temporomandibular disorder", "temporomandibular syndrome", "facial arthromyalgia", "myofacial pain dysfunction syndrome", "craniomandibular dysfunction" (CMD), "myofacial pain dysfunction", "masticatory myalgia", "mandibular dysfunction", and "Costen's syndrome".


title: Temporomandibular joint dysfunction

text: The lack of standardization in terms is not restricted to medical papers. Notable internationally recognized sources vary in both their preferred term, and their offered definition. For example:


title: Temporomandibular joint dysfunction

text: It has been suggested that TMD may develop following physical trauma, particularly whiplash injury, although the evidence for this is not conclusive. This type of TMD is sometimes termed "posttraumatic TMD" (pTMD) to distinguish it from TMD of unknown cause, sometimes termed "idiopathic TMD" (iTMD). Sometimes muscle-related (myogenous) TMD (also termed myogenous TMD, or TMD secondary to myofascial pain and dysfunction) is distinguished from joint-related TMD (also termed arthogenous TMD, or TMD secondary to true articular disease), based upon whether the muscles of mastication or the TMJs themselves are predominantly involved. This classification, which effectively divides TMD into 2 syndromes, is followed by the American Academy of Orofacial Pain. However, since most people with TMD could be placed into both of these groups, which makes a single diagnosis difficult when this classification is used. The Research Diagnostic Criteria (RDC/TMD) allows for multiple diagnoses in an attempt to overcome the problems with other classifications. RDC/TMD considers temporomandibular disorders in 2 axes; axis I is the physical aspects, and axis II involves assessment of psychological status, mandibular function and TMD-related psychosocial disability. Axis I is further divided into 3 general groups. Group I are muscle disorders, group II are disc displacements and group III are joint disorders, although it is common for people with TMD to fit into more than one of these groups.


title: Temporomandibular joint dysfunction

text: Sometimes distinction is made between acute TMD, where symptoms last for less than 3 months, and chronic TMD, where symptoms last for more than 3 months. Not much is known about acute TMD since these individuals do not typically attend in secondary care (hospital).


title: Temporomandibular joint dysfunction

text: Signs and symptoms of temporomandibular joint disorder vary in their presentation. The symptoms will usually involve more than one of the various components of the masticatory system, muscles, nerves, tendons, ligaments, bones, connective tissue, or the teeth.


title: Temporomandibular joint dysfunction

text: TMJ dysfunction is commonly associated with symptoms affecting cervical spine dysfunction and altered head and cervical spine posture.


title: Temporomandibular joint dysfunction

text: Other signs and symptoms have also been described, although these are less common and less significant than the cardinal signs and symptoms listed above. Examples include:


title: Temporomandibular joint dysfunction

text: TMD is a symptom complex (i.e. a group of symptoms occurring together and characterizing a particular disease), which is thought to be caused by multiple, poorly understood factors, but the exact etiology is unknown. There are factors which appear to predispose to TMD (genetic, hormonal, anatomical), factors which may precipitate it (trauma, occlusal changes, parafunction), and also factors which may prolong it (stress and again parafunction). Overall, two hypotheses have dominated research into the causes of TMD, namely a psychosocial model and a theory of occlusal dysharmony. Interest in occlusal factors as a causative factor in TMD was especially widespread in the past, and the theory has since fallen out of favor and become controversial due to lack of evidence.


title: Temporomandibular joint dysfunction

text: In people with TMD, it has been shown that the lower head of lateral pterygoid contracts during mouth closing (when it should relax), and is often tender to palpation. To theorize upon this observation, some have suggested that due to a tear in the back of the joint capsule, the articular disc may be displaced forwards (anterior disc displacement), stopping the upper head of lateral pterygoid from acting to stabilize the disc as it would do normally. As a biologic compensatory mechanism, the lower head tries to fill this role, hence the abnormal muscle activity during mouth closure. There is some evidence that anterior disc displacement is present in a proportion of TMD cases. Anterior disc displacement with reduction refers to abnormal forward movement of the disc during opening which reduces upon closing. Anterior disc displacement without reduction refers to an abnormal forward, bunched-up position of the articular disc which does not reduce. In this latter scenario, the disc is not intermediary between the condyle and the articular fossa as it should be, and hence the articular surfaces of the bones themselves are exposed to a greater degree of wear (which may predispose to osteoarthritis in later life).


title: Temporomandibular joint dysfunction

text: The general term "degenerative joint disease" refers to arthritis (both osteoarthritis and rheumatoid arthritis) and arthrosis. The term arthrosis may cause confusion since in the specialized TMD literature it means something slightly different from in the wider medical literature. In medicine generally, arthrosis can be a nonspecific term for a joint, any disease of a joint (or specifically degenerative joint disease), and is also used as a synonym for osteoarthritis. In the specialized literature that has evolved around TMD research, arthrosis is differentiated from arthritis by the presence of low and no inflammation respectively. Both are however equally degenerative. The TMJs are sometimes described as one of the most used joints in the body. Over time, either with normal use or with parafunctional use of the joint, wear and degeneration can occur, termed osteoarthritis. Rheumatoid arthritis, an autoimmune joint disease, can also affect the TMJs. Degenerative joint diseases may lead to defects in the shape of the tissues of the joint, limitation of function (e.g. restricted mandibular movements), and joint pain.


title: Temporomandibular joint dysfunction

text: Emotional stress (anxiety, depression, anger) may increase pain by causing autonomic, visceral and skeletal activity and by reduced inhibition via the descending pathways of the limbic system. The interactions of these biological systems have been described as a vicious "anxiety-pain-tension" cycle which is thought to be frequently involved in TMD. Put simply, stress and anxiety cause grinding of teeth and sustained muscular contraction in the face. This produces pain which causes further anxiety which in turn causes prolonged muscular spasm at trigger points, vasoconstriction, ischemia and release of pain mediators. The pain discourages use of the masticatory system (a similar phenomenon in other chronic pain conditions is termed "fear avoidance" behavior), which leads to reduced muscle flexibility, tone, strength and endurance. This manifests as limited mouth opening and a sensation that the teeth are not fitting properly.


title: Temporomandibular joint dysfunction

text: Persons with TMD have a higher prevalence of psychological disorders than people without TMD. People with TMD have been shown to have higher levels of anxiety, depression, somatization and sleep deprivation, and these could be considered important risk factors for the development of TMD. In the 6 months before the onset, 50–70% of people with TMD report experiencing stressful life events (e.g. involving work, money, health or relationship loss). It has been postulated that such events induce anxiety and cause increased jaw muscle activity. Muscular hyperactivity has also been shown in people with TMD whilst taking examinations or watching horror films.


title: Temporomandibular joint dysfunction

text: Others argue that a link between muscular hyperactivity and TMD has not been convincingly demonstrated, and that emotional distress may be more of a consequence of pain rather than a cause.


title: Temporomandibular joint dysfunction

text: Bruxism is an oral parafunctional activity where there is excessive clenching and grinding of the teeth. It can occur during sleep or whilst awake. The cause of bruxism itself is not completely understood, but psychosocial factors appear to be implicated in awake bruxism and dopaminergic dysfunction and other central nervous system mechanisms may be involved in sleep bruxism. If TMD pain and limitation of mandibular movement are greatest upon waking, and then slowly resolve throughout the day, this may indicate sleep bruxism. Conversely, awake bruxism tends to cause symptoms that slowly get worse throughout the day, and there may be no pain at all upon waking.


title: Temporomandibular joint dysfunction

text: The relationship of bruxism with TMD is debated. Many suggest that sleep bruxism can be a causative or contributory factor to pain symptoms in TMD. Indeed, the symptoms of TMD overlap with those of bruxism. Others suggest that there is no strong association between TMD and bruxism. A systematic review investigating the possible relationship concluded that when self-reported bruxism is used to diagnose bruxism, there is a positive association with TMD pain, and when more strict diagnostic criteria for bruxism are used, the association with TMD symptoms is much lower. Self-reported bruxism is probably a poor method of identifying bruxism. There are also very many people who grind their teeth and who do not develop TMD. Bruxism and other parafunctional activities may play a role in perpetuating symptoms in some cases.


title: Temporomandibular joint dysfunction

text: Other parafunctional habits such as pen chewing, lip and cheek biting (which may manifest as morsicatio buccarum or linea alba), are also suggested to contribute to the development of TMD. Other parafunctional activities might include jaw thrusting, excessive gum chewing, nail biting and eating very hard foods.


title: Temporomandibular joint dysfunction

text: Trauma, both micro and macrotrauma, is sometimes identified as a possible cause of TMD; however, the evidence for this is not strong. Prolonged mouth opening (hyper-extension) is also suggested as a possible cause. It is thought that this leads to microtrauma and subsequent muscular hyperactivity. This may occur during dental treatment, with oral intubation whilst under a general anesthetic, during singing or wind instrument practice (really these can be thought of as parafunctional activities). Damage may be incurred during violent yawning, laughing, road traffic accidents, sports injuries, interpersonal violence, or during dental treatment, (such as tooth extraction).


title: Temporomandibular joint dysfunction

text: It has been proposed that a link exists between whiplash injuries (sudden neck hyper-extension usually occurring in road traffic accidents), and the development of TMD. This has been termed "post-traumatic TMD", to separate it from "idiopathic TMD". Despite multiple studies having been performed over the years, the cumulative evidence has been described as conflicting, with moderate evidence that TMD can occasionally follow whiplash injury. The research that suggests a link appears to demonstrate a low to moderate incidence of TMD following whiplash injury, and that pTMD has a poorer response to treatment than TMD which has not developed in relation to trauma.


title: Temporomandibular joint dysfunction

text: Occlusal factors as an etiologic factor in TMD is a controversial topic. Abnormalities of occlusion (problems with the bite) are often blamed for TMD but there is no evidence that these factors are involved. Occlusal abnormalities are incredibly common, and most people with occlusal abnormalities do not have TMD. Although occlusal features may affect observed electrical activity in masticatory muscles, there are no statistically significant differences in the number of occlusal abnormalities in people with TMD and in people without TMD. There is also no evidence for a causal link between orthodontic treatment and TMD. The modern, mainstream view is that the vast majority of people with TMD, occlusal factors are not related. Theories of occlusal factors in TMD are largely of historical interest. A causal relationship between occlusal factors and TMD was championed by Ramfjord in the 1960s. A small minority of dentists continue to prescribe occlusal adjustments in the belief that this will prevent or treat TMD despite the existence of systematic reviews of the subject which state that there is no evidence for such practices, and the vast majority of opinion being that no irreversible treatment should be carried out in TMD (see Occlusal adjustment).


title: Temporomandibular joint dysfunction

text: TMD does not obviously run in families like a genetic disease. It has been suggested that a genetic predisposition for developing TMD (and chronic pain syndromes generally) could exist. This has been postulated to be explained by variations of the gene which codes for the enzyme catechol-O-methyl transferase (COMT) which may produce 3 different phenotypes with regards pain sensitivity. COMT (together with monoamine oxidase) is involved in breaking down catecholamines (e.g. dopamine, epinephrine, and norepinephrine). The variation of the COMT gene which produces less of this enzyme is associated with a high sensitivity to pain. Females with this variation, are at 2–3 times greater risk of developing TMD than females without this variant. However this theory is controversial since there is conflicting evidence.


title: Temporomandibular joint dysfunction

text: Since females are more often affected by TMD than males, the female sex hormone estrogen has been suggested to be involved. The results of one study suggested that the periods of highest pain in TMD can be correlated with rapid periods of change in the circulating estrogen level. Low estrogen was also correlated to higher pain. In the menstrual cycle, estrogen levels fluctuate rapidly during ovulation, and also rapidly increases just before menstruation and rapidly decreases during menstruation. Post-menopausal females who are treated with hormone replacement therapy are more likely to develop TMD, or may experience an exacerbation if they already had TMD. Several possible mechanisms by which estrogen might be involved in TMD symptoms have been proposed. Estrogen may play a role in modulating joint inflammation, nociceptive neurons in the trigeminal nerve, muscle reflexes to pain and μ-opioid receptors.


title: Temporomandibular joint dysfunction

text: TMD has been suggested to be associated with other conditions or factors, with varying degrees of evidence and some more commonly than others. E.g. It has been shown that 75% of people with TMD could also be diagnosed with fibromyalgia, since they met the diagnostic criteria, and that conversely, 18% of people with fibromyalgia met diagnostic criteria for TMD. A possible link between many of these chronic pain conditions has been hypothesized to be due to shared pathophysiological mechanisms, and they have been collectively termed "central sensitivity syndromes", although other apparent associations cannot be explained in this manner. Recently a plethora of research has substantiated a causal relationship between TMD and Obstructive Sleep Apnea (OSA). Severe TMD restricts oral airway opening, and can result in a retrognathic posture that results in glossal blockage of the oropharynx as the tongue relaxes in sleep. This mechanism is exacerbated by alcohol consumption, as well as other chemicals that result in reduced myotonic status of the oropharynx.


title: Temporomandibular joint dysfunction

text: The temporomandibular joints are the dual articulation of the mandible with the skull. Each TMJ is classed as a "ginglymoarthrodial" joint since it is both a ginglymus (hinging joint) and an arthrodial (sliding) joint, and involves the condylar process of the mandible below, and the articular fossa (or glenoid fossa) of the temporal bone above. Between these articular surfaces is the articular disc (or meniscus), which is a biconcave, transversely oval disc composed of dense fibrous connective tissue. Each TMJ is covered by a fibrous capsule. There are tight fibers connecting the mandible to the disc, and loose fibers which connect the disc to the temporal bone, meaning there are in effect 2 joint capsules, creating an upper joint space and a lower joint space, with the articular disc in between. The synovial membrane of the TMJ lines the inside of the fibrous capsule apart from the articular surfaces and the disc. This membrane secretes synovial fluid, which is both a lubricant to fill the joint spaces, and a means to convey nutrients to the tissues inside the joint. Behind the disc is loose vascular tissue termed the "bilaminar region" which serves as a posterior attachment for the disc and also fills with blood to fill the space created when the head of the condyle translates down the articular eminence. Due to its concave shape, sometimes the articular disc is described as having an anterior band, intermediate zone and a posterior band. When the mouth is opened, the initial movement of the mandibular condyle is rotational, and this involves mainly the lower joint space, and when the mouth is opened further, the movement of the condyle is translational, involving mainly the upper joint space. This translation movement is achieved by the condylar head sliding down the articular eminence, which constitutes the front border of the articular fossa. The function of the articular eminence is to limit the forwards movement of the condyle. The ligament directly associated with the TMJ is the temporomandibular ligament, also termed the lateral ligament, which really is a thickening of the lateral aspect of the fibrous capsule. The stylomandibular ligament and the sphenomandibular ligament are not directly associated with the joint capsule. Together, these ligaments act to restrict the extreme movements of the joint.


title: Temporomandibular joint dysfunction

text: The muscles of mastication are paired on each side and work together to produce the movements of the mandible. The main muscles involved are the masseter, temporalis and medial and lateral pterygoid muscles.


title: Temporomandibular joint dysfunction

text: They can be thought of in terms of the directions they move the mandible, with most being involved in more than one type of movement due to the variation in the orientation of muscle fibers within some of these muscles.


title: Temporomandibular joint dysfunction

text: Each lateral pterygoid muscle is composed of 2 heads, the upper or superior head and the lower or inferior head. The lower head originates from the lateral surface of the lateral pterygoid plate and inserts at a depression on the neck of mandibular condyle, just below the articular surface, termed the pterygoid fovea. The upper head originates from the infratemporal surface and the infratemporal crest of the greater wing of the sphenoid bone. The upper head also inserts at the fovea, but a part may be attached directly to the joint capsule and to the anterior and medial borders of the articular disc. The 2 parts of lateral pterygoid have different actions. The lower head contracts during mouth opening, and the upper head contracts during mouth closing. The function of the lower head is to steady the articular disc as it moves back with the condyle into the articular fossa. It is relaxed during mouth closure.


title: Temporomandibular joint dysfunction

text: Noises from the TMJs are a symptom of dysfunction of these joints. The sounds commonly produced by TMD are usually described as a "click" or a "pop" when a single sound is heard and as "crepitation" or "crepitus" when there are multiple, grating, rough sounds. Most joint sounds are due to internal derangement of the joint, which is instability or abnormal position of the articular disc. Clicking often accompanies either jaw opening or closing, and usually occurs towards the end of the movement. The noise indicates that the articular disc has suddenly moved to and from a temporarily displaced position (disk displacement with reduction) to allow completion of a phase of movement of the mandible. If the disc displaces and does not reduce (move back into position) this may be associated with locking. Clicking alone is not diagnostic of TMD since it is present in high proportion of the general population, mostly in people who have no pain. Crepitus often indicates arthritic changes in the joint, and may occur at any time during mandibular movement, especially lateral movements. Perforation of the disc may also cause crepitus. Due to the proximity of the TMJ to the ear canal, joint noises are perceived to be much louder to the individual than to others. Often people with TMD are surprised that what sounds to them like very loud noises cannot be heard at all by others next to them. However, it is occasionally possible for loud joint noises to be easily heard by others in some cases and this can be a source of embarrassment e.g. when eating in company.


title: Temporomandibular joint dysfunction

text: Pain symptoms in TMD can be thought of as originating from the joint (arthralgia), or from the muscles (myofascial), or both. There is a poor correlation between TMD pain severity and evidence of tissue pathology.


title: Temporomandibular joint dysfunction

text: Pain originating from the muscles of mastication as a result of abnormal muscular function or hyperactivity. The muscular pain is frequently, but not always, associated with daytime clenching or nocturnal bruxism.


title: Temporomandibular joint dysfunction

text: The jaw deviates to the affected side during opening, and restricted mouth opening usually signifies that both TMJs are involved, but severe trismus rarely occurs. If the greatest reduction in movement occurs upon waking then this may indicate that there is concomitant sleep bruxism. In other cases the limitation in movement gets worse throughout the day.


title: Temporomandibular joint dysfunction

text: Limitation of mandibular movement itself may lead to further problems involving the TMJs and the muscles of mastication. Changes in the synovial membrane may lead to a reduction in lubrication of the joint and contribute to degenerative joint changes. The muscles become weak, and fibrosis may occur. All these factors may lead to a further limitation of jaw movement and increase in pain.


title: Temporomandibular joint dysfunction

text: Degenerative joint disease, such as osteoarthritis or organic degeneration of the articular surfaces, recurrent fibrous or bony ankylosis, developmental abnormality, or pathologic lesions within the TMJ. Myofascial pain syndrome.


title: Temporomandibular joint dysfunction

text: Sometimes TMD pain can radiate or be referred from its cause (i.e. the TMJ or the muscles of mastication) and be felt as headaches, earache or toothache.


title: Temporomandibular joint dysfunction

text: Due to the proximity of the ear to the temporomandibular joint, TMJ pain can often be confused with ear pain. The pain may be referred in around half of all patients and experienced as otalgia (earache). Conversely, TMD is an important possible cause of secondary otalgia. Treatment of TMD may then significantly reduce symptoms of otalgia and tinnitus, as well as atypical facial pain. Despite some of these findings, some researchers question whether TMJD therapy can reduce symptoms in the ear, and there is currently an ongoing debate to settle the controversy.


title: Temporomandibular joint dysfunction

text: Joint noises may require auscultation with a stethoscope to detect. Clicks of the joint may also be palpated, over the joint itself in the preauricular region, or via a finger inserted in the external acoustic meatus, which lies directly behind the TMJ.


title: Temporomandibular joint dysfunction

text: The differential diagnosis is with degenerative joint disease (e.g. osteoarthritis), rheumatoid arthritis, temporal arteritis, otitis media, parotitis, mandibular osteomyelitis, Eagle syndrome, trigeminal neuralgia, oromandibular dystonia, deafferentation pains, and psychogenic pain.


title: Temporomandibular joint dysfunction

text: Various diagnostic systems have been described. Some consider the Research Diagnostic Criteria method the gold standard. Abbreviated to "RDC/TMD", this was first introduced in 1992 by Dworkin and LeResche in an attempt to classify temporomandibular disorders by etiology and apply universal standards for research into TMD. This method involves 2 diagnostic axes, namely axis I, the physical diagnosis, and axis II, the psychologic diagnosis. Axis I contains 3 different groups which can occur in combinations of 2 or all 3 groups, (see table).


title: Temporomandibular joint dysfunction

text: The International Headache Society's diagnostic criteria for "headache or facial pain attributed to temporomandibular joint disorder" is similar to the above:


title: Temporomandibular joint dysfunction

text: The advantages brought about by diagnostic imaging mainly lie within diagnosing TMD of articular origin. Additional benefits of imaging the TMJ are as follows:


title: Temporomandibular joint dysfunction

text: When clinical examination alone is unable to bring sufficient detail to ascertain the state of the TMJ, imaging methods can act as an adjuvant to clinical examination in the diagnosis of TMD.


title: Temporomandibular joint dysfunction

text: This method of imaging allows the visualisation of the joint's mineralised areas, therefore excluding the cartilage and soft tissues. A disadvantage of plain radiography is that images are prone to superimposition from surrounding anatomical structures, thereby complicating radiographic interpretation. It was concluded that there is no evidence to support the use of plain radiography in the diagnosis of joint erosions and osteophytes. It is reasonable to conclude that plain film can only be used to diagnose extensive lesions.


title: Temporomandibular joint dysfunction

text: The distortion brought about by panoramic imaging decreases its overall reliability. Data concluded from a systematic review showed that only extensive erosions and large osteophytes can be detected by panoramic imaging.


title: Temporomandibular joint dysfunction

text: Studies have shown that tomography of the TMJ provided supplementary information that supersedes what is obtainable from clinical examination alone. However, the issues lies in the fact that it is impossible to determine whether certain patient groups would benefit more or less from a radiographic examination.


title: Temporomandibular joint dysfunction

text: The main indications of CT and CBCT examinations are to assess the bony components of the TMJ, specifically the location and extent of any abnormalities present.


title: Temporomandibular joint dysfunction

text: The introduction of cone beam computed tomography (CBCT) imaging allowed a lower radiation dose to patients, in comparison to conventional CT. Hintze et al. compared CBCT and CT techniques and their ability to detect morphological TMJ changes. No significant difference was concluded in terms of their diagnostic accuracy.


title: Temporomandibular joint dysfunction

text: MRI is the optimal choice for the imaging of soft tissues surrounding the TMJ. It allows three-dimensional evaluation of the axial, coronal and sagittal plane. It is the gold standard method for assessing disc position and is sensitive for intra-articular degenerative alterations.


title: Temporomandibular joint dysfunction

text: Indications for MRI are pre-auricular pain, detection of joint clicking and crepitus, frequent incidents of subluxation and jaw dislocation, limited mouth opening with terminal stiffness, suspicion of neoplastic growth, and osteoarthritic symptoms. It is also useful for assessing the integrity of neural tissues, which may produce orofacial pain when compressed.


title: Temporomandibular joint dysfunction

text: MRI provides evaluation of pathology such as necrosis and oedema all without any exposure to ionizing radiation. However, there is a high cost associated with this method of imaging, due to the need for sophisticated facilities. Caution should be taken in patient selection, as MRI is contraindicated in those with claustrophobic tendencies, pacemakers and metallic heart valves, ferromagnetic foreign bodies and pregnant women.


title: Temporomandibular joint dysfunction

text: Where internal TMJ disorders are concerned, ultrasound (US) imaging can be a useful alternative in assessing the position of the disc While having significant diagnostic sensitivity, US has inadequate specificity when identifying osteoarthrosis. Moreover, it is not accurate enough for the diagnosis of cortical and articular disc morphology based on the findings done related to morphological alterations. However, with US, identification of effusion in individuals with inflammatory conditions associated with pain is possible and confirmed by MRI


title: Temporomandibular joint dysfunction

text: US can be a useful alternative in initial investigation of internal TMJ dysfunctions especially in MRI contraindicated individuals despite its limitations. in addition to being less costly, US provides a quick and comfortable real-time imaging without exposing the individual to ionizing radiation


title: Temporomandibular joint dysfunction

text: US is commonly assessed in the differential diagnosis of alterations of glandular and neighbouring structures, such as the TMJ and the masseter muscle. Symptoms of sialendenitis and sialothiasis cases can be confused with Eagle syndrome, TMD, myofascial and nerve pain, and other pain of the orofacial region.


title: Temporomandibular joint dysfunction

text: US assessment is also indicated where there is need to identify the correct position of the joint spaces for infiltrative procedures, arthrocentesis, and viscosupplementation. This is due to the fact that US provides a dynamic and real-time location of the component of the joints, while providing adequate lubrication and washing, which can be confirmed by the joint space increase post-treatment.


title: Temporomandibular joint dysfunction

text: TMD can be difficult to manage, and since the disorder transcends the boundaries between several health-care disciplines – in particular, dentistry and neurology, the treatment may often involve multiple approaches and be multidisciplinary. Most who are involved in treating and researching TMD now agree that any treatment carried out should not permanently alter the jaw or teeth, and should be reversible. To avoid permanent change, over-the-counter or prescription pain medications may be prescribed.


title: Temporomandibular joint dysfunction

text: Given the important role that psychosocial factors appear to play in TMD, psychosocial interventions could be viewed to be central to management of the condition. There is a suggestion that treatment of factors that modulate pain sensitivity such as mood disorders, anxiety and fatigue, may be important in the treatment of TMD, which often tends to attempt to address the pain directly.


title: Temporomandibular joint dysfunction

text: Cognitive Behavioral Therapy (CBT) has been used in TMD and has been shown to be efficacious by meta analyses.


title: Temporomandibular joint dysfunction

text: Hypnosis is suggested by some to be appropriate for TMD. Studies have suggested that it may even be more beneficial than occlusal splint therapy, and has comparable effects to relaxation techniques.


title: Temporomandibular joint dysfunction

text: Relaxation techniques include progressive muscle relaxation, yoga, and meditation. It has been suggested that TMD involves increased sensitivity to external stimuli leading to an increased sympathetic ("fight or flight") response with cardiovascular and respiratory alterations. Relaxation techniques cause reduced sympathetic activity, including muscle relaxation and reducing sensitivity to external stimuli, and provoke a general sense of well-being and reduced anxiety.


title: Temporomandibular joint dysfunction

text: Occlusal splints (also termed bite plates or intra-oral appliances) are often used by dentists to treat TMD. They are usually made of acrylic and can be hard or soft. They can be designed to fit onto the upper teeth or the lower teeth. They may cover all the teeth in one arch (full coverage splint) or only some (partial coverage splint). Splints are also termed according to their intended mechanism, such as the anterior positioning splint or the stabilization splint. Although occlusal splints are generally considered a reversible treatment, sometimes partial coverage splints lead to pathologic tooth migration (changes in the position of teeth). Normally splints are only worn during sleep, and therefore probably do nothing for people who engage in parafunctional activities during wakefulness rather than during sleep. There is slightly more evidence for the use of occlusal splints in sleep bruxism than in TMD. A splint can also have a diagnostic role if it demonstrates excessive occlusal wear after a period of wearing it each night. This may confirm the presence of sleep bruxism if it was in doubt. Soft splints are occasionally reported to worsen discomfort related to TMD. Specific types of occlusal splint are discussed below.


title: Temporomandibular joint dysfunction

text: A stabilization splint is a hard acrylic splint that forces the teeth to meet in an "ideal" relationship for the muscles of mastication and the TMJs. It is claimed that this technique reduces abnormal muscular activity and promotes "neuromuscular balance". A stabilization splint is only intended to be used for about 2–3 months. It is more complicated to construct than other types of splint since a face bow record is required and significantly more skill on the part of the dental technician. This kind of splint should be properly fitted to avoid exacerbating the problem and used for brief periods of time. The use of the splint should be discontinued if it is painful or increases existing pain. A systematic review of all the scientific studies investigating the efficacy of stabilization splints concluded the following:


title: Temporomandibular joint dysfunction

text: Partial coverage splints are recommended by some experts, but they have the potential to cause unwanted tooth movements, which can occasionally be severe. The mechanism of this tooth movement is that the splint effectively holds some teeth out of contact and puts all the force of the bite onto the teeth which the splint covers. This can cause the covered teeth to be intruded, and those that are not covered to over-erupted. I.e. a partial coverage splint can act as a Dahl appliance. Examples of partial coverage splints include the NTI-TSS ("nociceptive trigeminal inhibitor tension suppression system"), which covers the upper front teeth only. Due to the risks involved with long term use, some discourage the use of any type of partial coverage splint.


title: Temporomandibular joint dysfunction

text: An anterior positioning splint is a splint that designed to promote an anteriorly displaced disc. It is rarely used. A 2010 review of all the scientific studies carried out to investigate the use of occlusal splints in TMD concluded:


title: Temporomandibular joint dysfunction

text: Ear canal inserts are also available, but no published peer-reviewed clinical trials have shown them to be useful.


title: Temporomandibular joint dysfunction

text: Medication is the main method of managing pain in TMD, mostly because there is little if any evidence of the effectiveness of surgical or dental interventions. Many drugs have been used to treat TMD pain, such as analgesics (pain killers), benzodiazepines (e.g. clonazepam, prazepam, diazepam), anticonvulsants (e.g. gabapentin), muscle relaxants (e.g. cyclobenzaprine), and others. Analgesics that have been studied in TMD include non-steroidal anti-inflammatory drugs (e.g. piroxicam, diclofenac, naproxen) and cyclo-oxygenase-2 inhibitors (e.g. celecoxib).


title: Temporomandibular joint dysfunction

text: Other drugs that have been described for use in TMD include glucosamine hydrochloride/chondroitin sulphate and propranolol. Low-doses of anti-muscarinic tricyclic antidepressants such as amitriptyline, or nortriptyline have also been described.


title: Temporomandibular joint dysfunction

text: Despite many randomized control trials being conducted on these commonly used medications for TMD a systematic review carried out in 2010 concluded that there was insufficient evidence to support or not to support the use of these drugs in TMD.


title: Temporomandibular joint dysfunction

text: In a subset of people with TMD who are not helped by either noninvasive and invasive treatments, long term use of opiate analgesics has been suggested, although these drugs carry a risk of drug dependence and other side effects. Examples include morphine, fentanyl, oxycodone, tramadol, hydrocodone, and methadone.


title: Temporomandibular joint dysfunction

text: Injections of local anesthetic, sometimes combined with steroids, into the muscles (e.g. the temoralis muscle or its tendon) are also sometimes used. Local anesthetics may provide temporary pain relief, and steroids inhibit pro-inflammatory cytokines. Steroids and other medications are sometimes injected directly into the joint (See Intra-articular injections).


title: Temporomandibular joint dysfunction

text: Botulinum toxin solution ("Botox") is sometimes used to treat TMD. Injection of botox into the lateral pterygoid muscle has been investigated in multiple randomized control trials, and there is evidence that it is of benefit in TMD. It is theorized that spasm of lateral pterygoid causes anterior disc displacement. Botulinum toxin causes temporary muscular paralysis by inhibiting acetylcholine release at the neuromuscular junction. The effects usually last for a period of months before they wear off. Complications include the creation of a "fixed" expression due to diffusion of the solution and subsequent involvement of the muscles of facial expression, which lasts until the effects of the botox wear off.


title: Temporomandibular joint dysfunction

text: Physiotherapy (physical therapy) is sometimes used as an adjuvant to other methods of treatment in TMD. There are many different approaches described, but exercises aiming to increase the range of mandibular movements are commonly involved. Jaw exercises aim to directly oppose the negative effects of disuse that may occur in TMD, due to pain discouraging people from moving their jaw. After initial instruction, people are able to perform a physical therapy regimen at home. The most simple method is by regular stretching within pain tolerance, using the thumb and a finger in a "scissor" maneuver. Gentle force is applied until pain of resistance is felt, and then the position is held for several seconds. Commercial devices have been developed to carry out this stretching exercise (e.g. the "Therabite" appliance). Over time, the amount of mouth opening possible without pain can be gradually increased. A baseline record of the distance at the start of physical therapy (e.g. the number of fingers that can be placed vertically between the upper and lower incisors), can chart any improvement over time.


title: Temporomandibular joint dysfunction

text: It has been suggested that massage therapy for TMD improves both the subjective and objective health status. "Friction massage" uses surface pressure to causes temporary ischemia and subsequent hyperemia in the muscles, and this is hypothesized to inactivate trigger points and disrupt small fibrous adhesions within the muscle that have formed following surgery or muscular shortening due to restricted movement.


title: Temporomandibular joint dysfunction

text: Occasionally physiotherapy for TMD may include the use of transcutaneous electrical nerve stimulation (TENS), which may override pain by stimulation of superficial nerve fibers and lead to pain reduction which extends after the time where the TENS is being actually being applied, possibly due to release of endorphins. Others recommend the use of ultrasound, theorized to produce tissue heating, alter blood flow and metabolic activity at a level that is deeper than possible with surface heat applications. There is tentative evidence that low level laser therapy may help with pain.


title: Temporomandibular joint dysfunction

text: The goals of a PT in reference to treatment of TMD should be to decrease pain, enable muscle relaxation, reduce muscular hyperactivity, and reestablish muscle function and joint mobility. PT treatment is non-invasive and includes self-care management in an environment to create patient responsibility for their own health.


title: Temporomandibular joint dysfunction

text: Therapeutic exercise and Manual Therapy (MT) are used to improve strength, coordination and mobility and to reduce pain. Treatment may focus on poor posture, cervical muscle spasms and treatment for referred cervical origin (pain referred from upper levels of the cervical spine) or orofacial pain . MT has been used to restore normal range of motion, promoting circulation, stimulate proprioception, break fibrous adhesions, stimulate synovial fluid production and reduce pain. Exercises and MT are safe and simple interventions that could potentially be beneficial for patients with TMD. No adverse events regarding exercise therapy and manual therapy have been reported.


title: Temporomandibular joint dysfunction

text: There have been positive results when using postural exercises and jaw exercises to treat both myogenous (muscular) and arthrogenous (articular) TMJ dysfunction. MT alone or in combination with exercises shows promising effects.


title: Temporomandibular joint dysfunction

text: It is necessary that trials be performed isolating the type of exercise and manual techniques to allow a better understanding of the effectiveness of this treatment. Additionally, details of exercise, dosage, and frequency as well as details on manual techniques should be reported to create reproducible results. High quality trials with larger sample sizes are needed.


title: Temporomandibular joint dysfunction

text: There is some evidence that some people who use nighttime biofeedback to reduce nighttime clenching experience a reduction in TMD.


title: Temporomandibular joint dysfunction

text: This is the adjustment or reorganizing of the existing occlusion, carried out in the belief that this will redistribute forces evenly across the dental arches or achieve a more favorable position of the condyles in the fossae, which is purported to lessen tooth wear, bruxism and TMD, but this is controversial. These techniques are sometimes termed "occlusal rehabilitation" or "occlusal equilibration". At its simplest, an occlusal adjustment involves selective grinding (with a dental drill) of the enamel of the occlusal surfaces of teeth, with the aim of allowing the upper teeth to fit with the lower teeth in a more harmonious way. However, there is much disagreement between proponents of these techniques on most of the aspects involved, including the indications and the exact goals. Occlusal adjustment can also be very complex, involving orthodontics, restorative dentistry or even orthognathic surgery. Some have criticized these occlusal reorganizations as having no evidence base, and irreversibly damaging the dentition on top of the damage already caused by bruxism. A "middle ground" view of these techniques is that occlusal adjustment in most cases of TMD is neither desirable nor helpful as a first-line treatment, and furthermore, with few exceptions, any adjustments should be reversible. However, most dentists consider this unnecessary overtreatment, with no evidence of benefit. Specifically, orthodontics and orthognathic surgery are not considered by most to be appropriate treatments for TMD. A systematic review investigating all the scientific studies carried out on occlusal adjustments in TMD concluded the following:


title: Temporomandibular joint dysfunction

text: These conclusions were based largely on the fact that, despite many different scientific studies investigating this measure as a therapy, overall no statistically significant differences can be demonstrated between treatment with occlusal adjustment and treatment with placebo. The reviewers also stated that there are ethical implications if occlusal adjustment was found to be ineffective in preventing TMD.


title: Temporomandibular joint dysfunction

text: Orthodontic treatment, as described earlier, is sometimes listed as a possible predisposing factor in the development of TMD. On the other hand, orthodontic treatment is also often carried out in the belief that it may treat or prevent TMD. Another systematic review investigating the relationship between orthodontics and TMD concluded the following:


title: Temporomandibular joint dysfunction

text: A common scenario where a newly placed dental restoration (e.g. a crown or a filling) is incorrectly contoured, and creates a premature contact in the bite. This may localize all the force of the bite onto one tooth, and cause inflammation of the periodontal ligament and reversible increase in tooth mobility. The tooth may become tender to bite on. Here, the "occlusal adjustment" has already taken place inadvertently, and the adjustment aims to return to the pre-existing occlusion. This should be distinguished from attempts to deliberately reorganize the native occlusion.


title: Temporomandibular joint dysfunction

text: Attempts in the last decade to develop surgical treatments based on MRI and CAT scans now receive less attention. These techniques are reserved for the most difficult cases where other therapeutic modalities have failed. The American Society of Maxillofacial Surgeons recommends a conservative/non-surgical approach first. Only 20% of patients need to proceed to surgery.


title: Temporomandibular joint dysfunction

text: Examples of surgical procedures that are used in TMD, some more commonly than others, include arthrocentesis arthroscopy, meniscectomy, disc repositioning, condylotomy or joint replacement. Invasive surgical procedures in TMD may cause symptoms to worsen. Meniscectomy, also termed discectomy refers to surgical removal of the articular disc. This is rarely carried out in TMD, it may have some benefits for pain, but dysfunction may persist and overall it leads to degeneration or remodeling of the TMJ.


title: Temporomandibular joint dysfunction

text: Acupuncture is sometimes used for TMD. There is limited evidence that acupuncture is an effective symptomatic treatment for TMD. A short-term reduction in muscular pain of muscular origin can usually be observed after acupuncture in TMD, and this is more than is seen with placebo. There are no reported adverse events of acupuncture when used for TMD, and some suggest that acupuncture is best employed as an adjuvant to other treatments in TMD. However, some suggest that acupuncture may be no more effective than sham acupuncture, that many of the studies investigating acupuncture and TMD have significant risk of bias, and that the long term efficacy of acupuncture for TMD is unknown.


title: Temporomandibular joint dysfunction

text: Chiropractic adjustments (also termed manipulations or mobilizations) are sometimes used in the belief that this will treat TMD. Related conditions that are also claimed to be treatable by chiropractic include tension headaches and neck pain. Some sources suggest that there is some evidence of efficacy of chiropractic treatment in TMD, but the sources cited for these statements were case reports and a case series of only 9 participants. One review concluded "inconclusive evidence in a favorable direction regarding mobilization and massage for TMD". Overall, although there is general agreement that chiropractic may be of comparable benefit to other manual therapies for lower back pain, there is no credible evidence of efficacy in other conditions, including TMD. However, there is some evidence of possible adverse effects from cervical (neck) vertebral manipulation, which sometimes may be serious.


title: Temporomandibular joint dysfunction

text: It has been suggested that the natural history of TMD is benign and self-limiting, with symptoms slowly improving and resolving over time. The prognosis is therefore good. However, the persistent pain symptoms, psychological discomfort, physical disability and functional limitations may detriment quality of life. It has been suggested that TMD does not cause permanent damage and does not progress to arthritis in later life, however degenerative disorders of the TMJ such as osteoarthritis are included within the spectrum of TMDs in some classifications.


title: Temporomandibular joint dysfunction

text: TMD mostly affects people in the 20 – 40 age group, and the average age is 33.9 years. People with TMD tend to be younger adults, who are otherwise healthy. Within the catchall umbrella of TMD, there are peaks for disc displacements at age 30, and for inflammatory-degenerative joint disorders at age 50.


title: Temporomandibular joint dysfunction

text: About 75% of the general population may have at least one abnormal sign associated with the TMJ (e.g. clicking), and about 33% have at least one symptom of TMD. However, only in 3.6–7% will this be of sufficient severity to trigger the individual to seek medical advice.


title: Temporomandibular joint dysfunction

text: For unknown reasons, females are more likely to be affected than males, in a ratio of about 2:1, although others report this ratio to be as high as 9:1. Females are more likely to request treatment for TMD, and their symptoms are less likely to resolve. Females with TMD are more likely to be nulliparous than females without TMD. It has also been reported that female caucasians are more likely to be affected by TMD, and at an earlier age, than female African Americans.


title: Temporomandibular joint dysfunction

text: According to the most recent analyses of epidemiologic data using the RDC/TMD diagnostic criteria, of all TMD cases, group I (muscle disorders) accounts for 45.3%, group II (disc displacements) 41.1%, and group III (joint disorders) 30.1% (individuals may have diagnoses from more than one group). Using the RDC/TMD criteria, TMD has a prevalence in the general population of 9.7% for group I, 11.4% for group IIa, and 2.6% for group IIIa.


title: Temporomandibular joint dysfunction

text: Temporomandibular disorders were described as early as ancient Egypt. An older name for the condition is "Costen's syndrome", eponymously referring to James B. Costen. Costen was an otolaryngologist, and although he was not the first physician to describe TMD, he wrote extensively on the topic, starting in 1934, and was the first to approach the disorder in an integrated and systematic way. Costen hypothesized that malocclusion caused TMD, and placed emphasis on ear symptoms, such as tinnitus, otaglia, impaired hearing, and even dizziness. Specifically, Costen believed that the cause of TMD was mandibular over-closure, recommending a treatment revolving around building up the bite. The eponym "Costen syndrome" became commonly used shortly after his initial work, but in modern times it has been dropped, partially because occlusal factors are now thought to play little, if any, role in the development of TMD, and also because ear problems are now thought to be less associated with TMD. Other historically important terms that were used for TMD include "TMJ disease" or "TMJ syndrome", which are now rarely used.


title: Malcolm Jenkins

text: Malcolm Jenkins (born December 20, 1987) is a former American football safety who played for 13 seasons in the National Football League (NFL). He played college football at Ohio State, earning consensus All-American honors, and winning the Jim Thorpe Award as a senior. He was drafted by the New Orleans Saints in the first round of the 2009 NFL Draft and played for the Philadelphia Eagles from 2014 to 2019.


title: Malcolm Jenkins

text: Jenkins grew up in Piscataway, New Jersey and played high school football at Piscataway Township High School, where he helped lead his team to three consecutive state championships. He played both wide receiver and defensive back for the Chiefs football team. He also excelled at track, winning the state title in the 400 metres as a junior.


title: Malcolm Jenkins

text: Considered a three-star recruit by Rivals.com, Jenkins was listed as No. 61 cornerback prospect in the nation in 2005.


title: Malcolm Jenkins

text: During his freshman season at Ohio State, Jenkins spent most of his time in the nickelback position. He finished the season with 37 tackles in 10 games. In 2006, he started all 13 games at corner and was a consensus first-team All-Big Ten. He finished '06 with 55 tackles and four interceptions. As a junior in 2007 Jenkins recorded 47 tackles and four interceptions and was named a first-team All-American by "Pro Football Weekly" and a first-team All-Big Ten for the second consecutive year. As a senior in 2008 he won the Jim Thorpe Award, which is given to the nation's best defensive back, after recording 57 tackles and three interceptions.


title: Malcolm Jenkins

text: Jenkins is a member of Omega Psi Phi Fraternity. He was vice president, stepmaster, and chaplain of the Ohio State chapter; he has prominent fraternity brands on his upper left arm, and another one on his chest.


title: Malcolm Jenkins

text: Jenkins was considered one of the top two defensive backs available in the draft (alongside Vontae Davis), and drew comparisons to Terence Newman. However, after Jenkins ran a comparably slow 40-yard dash, some scouts considered him better suited for the safety position.


title: Malcolm Jenkins

text: The New Orleans Saints selected Jenkins in the first round (14th overall) of the 2009 NFL Draft. Jenkins was the first cornerback to be drafted by the Saints in the first round since Oregon's Alex Molden went eleventh overall in the 1996 NFL Draft.


title: Malcolm Jenkins

text: On August 9, 2009, the New Orleans Saints signed Jenkins on a five-year, $19 million contract that includes $10.59 million guaranteed. Their agreement ended Jenkins' 11-day training camp holdout.


title: Malcolm Jenkins

text: Jenkins entered training camp late and was slated as a backup, but competed for a job as a starting cornerback against Jabari Greer. Head coach Sean Payton named Jenkins the third cornerback on the depth chart to begin the regular season, behind Tracy Porter and Jabari Greer.


title: Malcolm Jenkins

text: He made his professional regular season debut in the New Orleans Saints' season-opener against the Detroit Lions and made one solo tackle in their 45–27 victory. He made first career tackle on running back Aaron Brown and stopped him from scoring on an 87-yard kick return in the third quarter. He was inactive for the Saints' Week 4 victory against the New York Jets after spraining his ankle the previous week. Jenkins was sidelined for Week 6 after further aggravating his ankle injury. On November 22, 2009, Jenkins earned his first career start and recorded seven combined tackles, two pass deflections, and intercepted his first career pass during a 38–7 victory at the Tampa Bay Buccaneers in Week 11. Jenkins intercepted a pass attempt by quarterback Josh Freeman that was originally intended for wide receiver Antonio Bryant and returned it for a 14-yard gain in the second quarter. He earned his first start after Jabari Greer sustained a groin injury in Week 9 and Tracy Porter sprained his MCL in Week 10. Jenkins remained the starter for the next six games after Greer was sidelined for the next seven games (Weeks 10–16) and Porter was sidelined for the next four games (11–14) In Week 13, he collected a season-high nine solo tackles and broke up a pass in a 33–30 win at the Washington Redskins. On December 27, 2009, Jenkins made a season-high ten combined tackles (eight solo) in the Saints' 20–17 loss to the Tampa Bay Buccaneers in Week 16. Jenkins finished his rookie season in 2009 with 55 combined tackles (49 solo), four pass deflections, and an interception in 14 games and six starts.


title: Malcolm Jenkins

text: The New Orleans Saints finished first in the NFC South with a 13–3 record, clinching a first round bye and home-field advantage throughout the playoffs. On January 16, 2010, Jenkins appeared in his first career playoff game as the Saints' defeated the Arizona Cardinals 45–14 in the NFC Divisional Round. The Saints reached the Super Bowl after winning the NFC Championship Game in a 31–28 win (Bountygate) against the Minnesota Vikings. On February 7, 2010, Jenkins appeared in Super Bowl XLIV and recorded five solo tackles and a pass deflection in the Saints' 31–17 victory against the Indianapolis Colts.


title: Malcolm Jenkins

text: On May 8, 2010, head coach Sean Payton stated his intentions to move Jenkins to safety while addressing the media at the Saints' rookie minicamp press conference. He was moved after the Saints' drafted Patrick Robinson in the first round of the 2010 NFL Draft. With the addition of Robinson, Jenkins would've entered camp as the fifth cornerback on the roster behind Jabari Greer, Tracy Porter, Randall Gay, and Patrick Robinson. During training camp, he competed to be a backup safety against Usama Young. Head coach Sean Payton named Jenkins the starting free safety to start the season after Darren Sharper underwent microfracture surgery and was placed on the physically unable to perform list.


title: Malcolm Jenkins

text: On October 3, 2010, Jenkins recorded four solo tackles and made his first career sack on quarterback Jimmy Clausen during a 16–14 win against the Carolina Panthers in Week 4. In Week 7, he collected a season-high nine combined tackles in the Saints' 30–17 loss to the Cleveland Browns. He was inactive for the Saints' Week 11 victory against the Seattle Seahawks due to a neck injury he sustained the previous game. On November 25, 2010, Jenkins recorded four combined tackles and made a key play in the fourth quarter to spark a comeback by the Saints in a 30–27 victory over the Dallas Cowboys in Week 12. Jenkins forced a fumble by wide receiver Roy Williams and recovered it with less than 3:20 remaining and the Saints down 27–23. Saints' head coach Sean Payton said Jenkins performed "one of those plays that inspires everybody on the team". Jenkins was named NFC Defensive Player of the Week for his performance. In Week 14, he made four solo tackles, three pass deflections, two interceptions, and his first career touchdown during a 31–13 victory against the St. Louis Rams in Week 14. He returned an interception by Sam Bradford for a 96-yard touchdown in the third quarter. Jenkins received NFC Defensive Player of the Week honors for the second time in 2010 for his performance. Jenkins injured his knee in the Saints' Week 17 loss to the Tampa Bay Buccaneers and was forced to miss the NFC Wildcard Game. He finished his first season as a safety with 64 combined tackles (54 solo), 12 pass deflections, two interceptions, a forced fumble, a fumble recovery, a sack, and a touchdown in 15 games and 15 starts.


title: Malcolm Jenkins

text: He entered training camp as the "de facto" starting free safety after the Saints chose not to re-sign Darren Sharper during the offseason. Defensive coordinator Gregg Williams retained Jenkins as the starting free safety to begin the 2012 regular season, alongside strong safety Roman Harper.


title: Malcolm Jenkins

text: In Week 8, Jenkins recorded five solo tackles, a pass deflection, and sacked quarterback Sam Bradford in the Saints' 31–21 loss at the St. Louis Rams. On December 11, 2011, Jenkins collected a season-high ten combined tackles (eight solo) during a 22–17 victory at the Tennessee Titans in Week 14. Jenkins was inactive in Week 17 and was rested by head coach Sean Payton as the Saints had already clinched a playoff berth with a 12–3 record. Jenkins completed the 2011 season with 77 combined tackles (63 solo), nine passes defensed, and a sack in 15 games and 15 starts.


title: Malcolm Jenkins

text: The New Orleans Saints finished first in the NFC South with a 13–3 record. On January 7, 2012, Jenkins started his first career playoff game and recorded five combined tackles during a 45–28 win against the Detroit Lions in the NFC Wildcard Game. The following week, he started in the NFC Divisional Round and made eight solo tackles, a pass deflection, and sacked quarterback Alex Smith in the Saints' 36–32 loss.


title: Malcolm Jenkins

text: The New Orleans Saints hired Steve Spagnuolo as their new defensive coordinator after Gregg Williams was indefinitely suspended for his involvement in the New Orleans Saints bounty scandal. Head coach Sean Payton was also suspended for the 2012 season and named linebackers coach Joe Vitt the interim head coach. Vitt named Aaron Kromer the interim head coach for the first six weeks after he received a suspension for the first six regular season games for his part in the Bounty scandal. Jenkins and Roman Harper were both retained as the starting safeties despite the coaching changes.


title: Malcolm Jenkins

text: On November 5, 2012, he collected a season-high 13 combined tackles (seven solo) in the Saints' 28–13 victory against the Philadelphia Eagles in Week 9. In Week 11, Jenkins recorded six combined tackles, broke up a pass, and returned an interception for a touchdown during a 38–17 victory at the Oakland Raiders. He returned an interception by quarterback Carson Palmer, that was intended for tight end Brandon Myers, for a 55-yard touchdown in the first quarter. The touchdown was Jenkins' second pick six of his career. Jenkins was inactive for the last three regular season games (Weeks 15–17) due to a hamstring injury. Jenkins finished the 2012 season with 94 combined tackles (65 solo), seven pass deflections, an interception, and a touchdown in 13 games and 13 starts.


title: Malcolm Jenkins

text: The New Orleans Saints' new defensive coordinator Rob Ryan held a competition to name starting safeties between Jenkins, Roman Harper, and rookie 2013 first round pick Kenny Vaccaro throughout training camp. Head coach Sean Payton named Jenkins the starting free safety to begin the regular season, opposite strong safety Roman Harper.


title: Malcolm Jenkins

text: On October 13, 2013, Jenkins recorded eight combined tackles, a pass deflection, and earned a career-high 1½ sacks on Tom Brady during a 30–27 loss at the New England Patriots in Week 6. Jenkins was inactive for two games (Weeks 9–10) due to a back injury. In Week 13, he collected a season-high ten combined tackles (seven solo) in the Saints' 34–7 loss at the Seattle Seahawks. He finished the 2013 season with 68 combined tackles (44 solo), six pass deflections, 2½ sacks, and two interceptions in 14 games and 14 starts.


title: Malcolm Jenkins

text: The New Orleans Saints finished second in the NFC South with an 11–5 record and defeated the Philadelphia Eagles 26–24 in the NFC Wildcard Game. On January 11, 2014, Jenkins played in his last game as a member of the Saints and recorded five combined tackles during 23–15 loss at the Seattle Seahawks in the NFC Divisional Round.


title: Malcolm Jenkins

text: Jenkins became an unrestricted free agent for the first time in his career in 2014. He garnered interest from multiple teams, but did not receive a contract offer from the Saints. On March 11, 2014, the Philadelphia Eagles signed Jenkins to a three-year, $16.25 million contract that included $8.50 million guaranteed.


title: Malcolm Jenkins

text: He entered camp slated as the "de facto" starting free safety. Head coach Chip Kelly officially named him the starter to begin the regular season, along with strong safety Nate Allen.


title: Malcolm Jenkins

text: On September 28, 2014, Jenkins recorded seven combined tackles, a pass deflection, and returned an interception by quarterback Colin Kaepernick for a 53-yard touchdown during a 26–21 loss at the San Francisco 49ers in Week 4. The pick six marked his third touchdown of his career and was his third consecutive game with an interception. In Week 15, he collected a season-high eight solo tackles in the Eagles' 38–27 loss to the Dallas Cowboys. Jenkins finished the 2014 season with 80 combined tackles (64 solo), 15 passes defensed, three interceptions, a forced fumble, a fumble recovery, and a touchdown in 16 games and 16 starts.


title: Malcolm Jenkins

text: Jenkins returned as the starting free safety in 2015 and played alongside strong safety Walter Thurmond. On October 25, 2015, he made a season-high ten combined tackles (eight solo) and broke up a pass during a 20–19 loss to the Miami Dolphins in Week 10. On December 6, 2015, Jenkins recorded seven combined tackles, deflected a pass, and returned an interception for a touchdown in the Eagles 35–28 victory at the New England Patriots in Week 13. He intercepted a pass by quarterback Tom Brady, that was thrown to Danny Amendola at the goal line, and returned it for a 99-yard touchdown in the third quarter. It became Jenkins fourth career pick six and his performance earned him NFC Defensive Player of the Week. On December 28, 2015, the Philadelphia Eagles fired head coach Chip Kelly after finishing Week 16 with a 6–9 record. Jenkins finished his second and last season under defensive coordinator Billy Davis with a career-high 109 combined tackles (90 solo), ten pass deflections, two interceptions, three forced fumbles, and a fumble recovery in 16 games and 16 starts. Pro football focus gave Jenkins an overall grade of 85.8, which ranked second among all qualifying safeties in 2015.


title: Malcolm Jenkins

text: On February 22, 2016, the Philadelphia Eagles signed Jenkins to a four-year, $35 million contract extension with $16 million guaranteed and a signing bonus of $7.50 million. Jenkins also had a year remaining on his previous contract from 2014. In total, Jenkins is due $40.50 million over the next five seasons (2016–2020).


title: Malcolm Jenkins

text: The Philadelphia Eagles' new head coach Doug Pederson retained Jenkins as a safety, alongside Rodney McLeod. In Week 2, he collected five combined tackles, deflected a pass, and sacked quarterback Jay Cutler during a 29–14 win at the Chicago Bears. On October 16, 2016, Jenkins recorded six combined tackles, two pass deflections, and returned an interception for a touchdown in the Eagles' 27–20 loss at the Washington Redskins in Week 6. He intercepted a pass by Kirk Cousins that was initially intended for tight end Vernon Davis and returned it for a 64-yard touchdown in the second quarter. On December 22, 2016, Jenkins made six combined tackles, a season-high three pass deflections, intercepted two passes, and returned one for a touchdown in a 24–19 victory against the New York Giants in Week 16. He intercepted a pass by quarterback Eli Manning originally intended for tight end Will Tye and returned it for a 34-yard touchdown in the first quarter. It became Jenkins' sixth pick six of his career. Jenkins completed the 2016 season with 72 combined tackles (47 solo), nine passes defensed, three interceptions, two touchdowns, and a sack in 16 games and 16 starts. He was ranked the 90th best player in the league on the NFL Top 100 Players of 2017.


title: Malcolm Jenkins

text: Defensive coordinator Jim Schwartz retained Jenkins and Rodney McLeod as the starting safety duo to begin the 2017 season. In Week 7, Jenkins collected a career-high ten solo tackles and a sack during a 34–24 win against the Washington Redskins. In Week 12, he made two combined tackles, a pass deflection, and an interception during a 31–3 victory against the Chicago Bears. It marked Jenkins' second consecutive game with an interception. On December 19, 2017, it was announced that Jenkins was voted to the 2017 Pro Bowl. (He was unable to participate because the Eagles played in the Super Bowl.) He finished the 2017 season with 76 combined tackles (63 solo), eight pass deflections, two interceptions, and a sack in 16 games and 16 starts. Pro Football Focus gave Jenkins an overall grade of 84.2, which ranked 19th among all qualifying safeties in 2017. He was ranked 96th by his peers on the NFL Top 100 Players of 2018.


title: Malcolm Jenkins

text: The Philadelphia Eagles finished first in the NFC East with a 13–3 record and received a first round bye and home-field advantage throughout the playoffs. The Eagles advanced to the Super Bowl after defeating the Atlanta Falcons 15–10 in the NFC Divisional Round and the Minnesota Vikings 38–7 in the NFC Championship Game. On February 4, 2018, Jenkins started in Super Bowl LII and recorded four solo tackles and a pass deflection as the Eagles defeated the New England Patriots 41–33. The victory in Super Bowl LII marked Jenkins' second Super Bowl victory and became the second time he helped a team achieve its first Super Bowl win in franchise history.


title: Malcolm Jenkins

text: In week 2 against the Tampa Bay Buccaneers, Jenkins recorded 5 tackles and forced his first fumble of the season on wide receiver Mike Evans which was recovered by teammate Jordan Hicks during the 27–21 loss.


title: Malcolm Jenkins

text: In week 8 against the Jacksonville Jaguars in London, Jenkins recovered a fumble forced by teammate Avonte Maddox on wide receiver Keelan Cole during the 24–18 win.


title: Malcolm Jenkins

text: In week 12 against the New York Giants, Jenkins recorded his first interception of the season off a pass thrown by Eli Manning and returned it 25 yards during the 25–22 win.


title: Malcolm Jenkins

text: In the following week's game against the Washington Redskins, Jenkins recorded his first sack of the season on Colt McCoy during the 28–13 win.


title: Malcolm Jenkins

text: In week 15 against the Los Angeles Rams, Jenkins recorded a season high 12 tackles during the 30–23 win.


title: Malcolm Jenkins

text: Jenkins finished the season with 97 tackles (79 solo), one sack, three forced fumbles, one fumble recovery, eight pass deflections, and one interception in 16 games started.


title: Malcolm Jenkins

text: In the Wild Card Round of the playoffs against the Chicago Bears, Jenkins recorded 5 tackles during the 16–15 win which became known as Double Doink.


title: Malcolm Jenkins

text: In the Divisional Round of the playoffs against Jenkins' former team, the New Orleans Saints, he recorded a team high 10 tackles during the 20–14 loss.


title: Malcolm Jenkins

text: In week 6 against the Minnesota Vikings, Jenkins recorded a season high 8 tackles and forced a fumble on rookie running back Alexander Mattison which was recovered by teammate Kamu Grugier-Hill during the 38–20 loss.


title: Malcolm Jenkins

text: In week 12 against the Seattle Seahawks, Jenkins recorded 6 tackles and his first two sacks of the season on Russell Wilson during the 17–9 loss.