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TMD > 1. Introduction > Flashcards

1. Introduction Flashcards

1
Q

In a study, adults in the two most severe pain groups were likely to have (better/worse) health status, use (more/less) health care and and suffer from more_ than loss with less severe pain

A

worse…more…disability

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2
Q

Describe the transition from acute to chronic pain

A

More exposure to acute pain changes the brain chemistry and predisposes patients to chronic pain conditions

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3
Q

What causes the transition from acute to chronic pain

A

unclear

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4
Q

Up to _ in _ children and adolescents experience weekly musculoskeletal pain

A

1 in 3

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5
Q

Describe the prevalence of children that suffer from a chronic pain condition

A

20-46%

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6
Q

_% of children suffer from abdominal pain disorders

A

20%

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7
Q

T/F Pain is under-treated in kids and adolescents

A

t

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8
Q

Prevalence for constant/frequent pain in the US varies from as low as _% to as high as _%

A

11-47%

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9
Q

Measuring “persistent pain” is defined as

A

self-reported pain “every-day” or “most days” for the past 3 months

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10
Q

_% of American adults suffer from persistent pain

A

19%

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11
Q

(Women/Men) suffer from persistent pain more

A

women

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12
Q

What factors influence the rate of reporting of persistent pain

A
  • Race
  • Eduction
  • Health indicies (i.e anxiety/depression/fatigue)
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13
Q

The National Pain Strategy seeks to…

A

reduce the burden and prevalence of pain and to improve the treatment of pain

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14
Q

What are the universal features of TMDs

A
  • TMJs and masticatory muscles pain
  • Joint sounds
  • Restricted function
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15
Q

What is needed to make a dx of TMD

A
  • Interview with patient (good history)
  • Clinical exam
  • X-rays
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16
Q

What are the different treatment options for TMD

A
  • Biobehavioral therapy
  • Interocclusal appliances
  • Occlusal therapy
  • Physical therapy
  • Pharacological therapy
  • Surgical therapy
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17
Q

About what % of the population actually has TMD

A

10%

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18
Q

TMD involves what structures

A
  • TMJ (the joint)
  • masticatory muscles
  • All associated tissues
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19
Q

Define TMD

A

A GROUP OF musculoskeletal and neuromuscular conditions that involve the TMJ, masticatory muscles and all associated tissues

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20
Q

(Males/Females) have a higher prevalence of TMD (How much higher)

A

females ~2x higher

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21
Q

During what age is TMD most frequently diagnosed

A

During reproductive years (de cline after 40 y/o and post-menopause)

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22
Q

Define incidence and prevalence

A

Incidence= predicted number of people with TMD

Prevalence= Actual number of people with TMD

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23
Q

Which is higher the prevalence/incidence of TMD

A

Prevalence (this is counterintuitive)

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24
Q

Why is the prevalence higher for TMD than the incidence

A

Because TMD is a chronic condition and thus takes time to develop

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25
Q

OPPERA will follow people for _yrs to monitor their TMD condition

A

7

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26
Q

Main risk factor for TMD is

A

genetics

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27
Q

Incidence rate of TMD according to OPPERA is

A

3.9% / year

28
Q

(Women/men) report more frequent, severe, and longer duration pain

A

women

29
Q

(Women/men) are more prone to acute pain

A

men- women are more prone to chronic pain

30
Q

Myofascial pain patterns in females are modulated by what factors

A
  • Oral contraceptives
  • Reproductive hormones
  • Exogenous hormones
31
Q

Describe how estrogen affects the levels of TMD pain

A

low estrogen levels (and at times of rapid estrogen change) –> peak pain

32
Q

Describe times in the body when estrogen levels in women are high and low

A

High
-Pregnancy

Low
-post-partum

33
Q

Describe the pain in women with TMD with hormonal fluctuations

A

symptomatic TMD without impairing mastication

34
Q

Why might estrogen play a role in TMD pain

A

Increased estrogen –> increased inflammaiton –> increased TMD pain

35
Q

What are the genes that influence the presence of TMD and assoicated pain

A

ESR1 and ESRRB

36
Q

What is the most common Dx in TMD patient and community populations

A

Patient=myofascial pain with or without mouth opening limitation

Community=disc displacement with reduction

37
Q

Rank the following in order of least to most common

Disc derangement, muscle disorders, joint disorders

A

Joint, disc, muscle

38
Q

Rank the races in order of highest to lowest incidence of TMD

  • Asian
  • African american
  • White
A
  • AA
  • White
  • Asian
39
Q

What genetic markers predict TMD onset

A

none

40
Q

What genes are associated with the clinical, psychological, and sensory phenotypes assoc. with TMD onset

A

SCN1A

ACE2

41
Q

What is the role of the SCN1A gene

A

encodes the alpha subunit of the voltage gated Na channel involved in propagation of action potentials

42
Q

Role of ACE2

A

angiotensin I converting enzyme (increase risk of HTN)

43
Q

What are the different theories about the etiologies of TMD

A
  • Dental and occlusal etiologies
  • Skeletal abnormalities
  • Psychophysiological
  • Bruxism and other parafunctions
44
Q

T/F People with TMD also commonly have premature occlusal contacts

A

t

45
Q

T/F Occlusal trauma can lead to TMD development

A

F (correlation doesn’t equal causation)

46
Q

T/F loss of posterior support could be linked to a higher incidence and severity of arthritis in the TMJ

A

t

47
Q

Limitations for the theory that occlusal forces attribute to TMD

A
  • Based on clinical observations of reduction of symptoms after occlusal intervention
  • Distribution of occlusal characteristics in non-symptomatic patients
  • Placement of experimental occlusal/placebo are not associated to the development of symptoms
48
Q

Evidence for occlusal disharmony as a primary etiology for TMD (does/doesn’t) exist

A

doesnt

49
Q

A major limitation in the studies that looked at occlusion as an etiology for TMD was

A

Terms such as “disharmony” are used without an adequate definition leading to research that is not reproducible

50
Q

What type of interferences are associated with TMD in multiple studies

A

mediotrusive

51
Q

TMD caused by skeletal abnormalities theory- describe it

A

Pain is caused when our anatomy deviates from some theoretic idea

52
Q

Deviations in our skeletal anatomy that attributes to TMD (according to the theory) includes what abnormalities

A
  • Poor body alignment
  • Head posture
  • Concentricity of the condyle in the fossa
  • Misalignment of the cranial bones
53
Q

Limitations of the skeletal abnormality theory includes

A
  • Bias
  • Lack of longitudinal studies
  • Lack of clinical trials
54
Q

Describe the psycho-physiological model of etiology for TMD

A

People with stress/poor coping skills and parafunction have the most pain

55
Q

Define parafunction

A

any non-functional use of the motor system including…

  • Grinding
  • Clenching
  • Posturing
  • Holding
  • Using objects excessively
  • Musical instruments
56
Q

Describe the correlation between parafunction and TMD

A

high prevalence of bruxism in TMD patients

57
Q

What is the etiology of the most common TMDs

A

unknown

58
Q

Describe the difference between Axis I and II

A

Axis I
-Clinical TMD conditions

Axis II
-Pain related disabilities and psychological status

59
Q

What are the condiitons that fall under asix I

A
  • Myalgia
  • Arthralgia
  • Myofascial pain with referral
  • Heache attributed to TMD
  • Disc displacement with reduction
  • DDw/R with intermittent locking
  • DDw/oR with limited opening
  • DDw/oR W/o limited opening
  • Degenerative joint disease
  • Subluxation
60
Q

Look at the pictures on slide 65 describing the location of the disc with DDw/reduction, DD w/oR and osteoarthritis

A

ok

61
Q

T/F TMDs rarely progress into something worse

A

T (often remitting, self-limiting or fluctuating

62
Q

Independent risk factors for first-onset TMD are

A
  • Pre-existing pain conditions
  • Sleep disturbance
  • Cigarette smoking
63
Q

Strong predictor of TMD includes evoked pain from

A

Jaw opening

Muscle and TMJ palpation

64
Q

The strongest predictor of TMD incidence is

A

oral parafunction

65
Q

Women with positive disc displacement have (higher/lower) energy densities

A

higher

TMD (13 decks)

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