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Prostho 3 > 11. Diagnosis in FPD > Flashcards

11. Diagnosis in FPD Flashcards

1
Q

How do you modify treatment for an epileptic? (2)

A
  • Metal occlusal surfaces

- Short appointment

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2
Q

What happens for patients with Xerostomy?

A

Higher caries incidence

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3
Q

What happens with patients with diabetes?

A

Higher incidence of periodontal disease

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4
Q

What happens with patients with HIV?

A

Higher incidence of periodontal disease

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5
Q

What happens to patients with hyadantoin treatment?

A

Gingival hyperplasia

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6
Q

What are the pathologies that might make us modify treatment?

A
  • Epilepsy
  • allergies
  • xerostomy
  • diabetes
  • HIV
  • hydantoin
  • sjogren syndrome
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7
Q

What is the helkimo test? (4)

A

Sum of points evaluating:

  • movement limitation
  • pain during movement
  • muscular pain
  • TMJ pain and the function
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8
Q

What is does a 0 helkimo test mean?

A

No TMDs

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9
Q

What is does a 1 helkimo test mean?

A
  • Mild TMD

- 1-4 points

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10
Q

What is does a 2 helkimo test mean?

A
  • moderate TMD

- 5-9 points

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11
Q

What is does a 3 helkimo test mean?

A
  • severe TMD

- 10-25 points

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12
Q

Where is muscular palpation done? (3)

A
  • into the bulk of the muscle
  • against a hard plane (some bone nearby)
  • at the insertion of the ligament
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13
Q

How do you check the pain threshold of the patient? (2)

A
  • palpate mastoid process

- or vertex

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14
Q

How do you palpate the temporal muscle? (2)

A
  • along muscular fibers

- from front to back

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15
Q

How to you palpate the tendon of the temporal muscle ? (2)

A
  • with index finger over the ramus of the mandible

- towards coronoid process

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16
Q

How do you palpate the deep part of the masseter muscle?

A

15mm in front of the tragus, below the zygomatic arch

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17
Q

How do you palpate the superficial part of the masseter muscle? (3)

A
  • Over the ramus ofthe mandible.
  • From back to front.
  • Craniocaudally.
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18
Q

How do you palpate the masseter intraorally?

A

one finger intraorally and another extraorally

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19
Q

What does bilateral pain of the masseter muscle mean?

A

Indicates clenching

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20
Q

What does unilateral pain of the masseter muscle mean?

A

May be due to an interference

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21
Q

What is the first muscle to usually be affected my TMDs? (2)

A

Lateral pterygoid

- can sometimes pull from the disc displacing it

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22
Q

How do you palpate the lateral pterygoid?

A

Little finger at the bottom of the upper vestibule behind retromolar process

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23
Q

How do you palpate the medial pterygoid?

A
  • difficult

- only lower insertion, below the lower border of the angle of the mandible

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24
Q

How do you palpate the SCM?

A

Along the muscle

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25
Q

How do you palpate the posterior belly of digastric muscle?

A
  • Palpation with little finger ebtween posterior corder of the ramus of the mandible and the SCM
  • Head of patient to the front and downwards
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26
Q

Muscular pain occurs either at: (2)

A
  • maximal stretching of the muscle

- maximal contraction

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27
Q

Apart from painful muscular points, you should assess these in a functional examination:

A
  • Muscle hypertrophy.
  • Face asymmetries.
  • Muscle hypertonicity.
  • Spasm.
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28
Q

Functional limitation of muscular movement: Soft end feel? (3)

A
  • Muscles allow 2 mm stretching.
  • The opening can be increased when applying some force
    over the jaw.
  • Painful.
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29
Q

Functional limitation of muscular movement: Hard end feel? (3)

A
  • Articular problem, not muscular.
  • The mandible can’t be opened more, even when a gentle
    force is applied.
  • The opening can not be forced.
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30
Q

Functional limitation of muscular movement: Maximum mouth opening? (5)

A
  • Less than 40 mm interincisal opening.
  • Due to pain and spasm of elevatormuscles.
  • Protrusion and lateralities.
    ◦ Usually not limited (8mm) due to muscles.
    ◦ Unless lower lateral pterygoid is highly affected.
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31
Q

Functional examination: opening-closing path? (3)

A
  • more than 22mm defelction

- muscular or articular problem

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32
Q

Functional examination: opening-closing path muscular problem?

A

Variable deviated path

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33
Q

Functional examination: opening-closing path articulation problem?

A

always the same path

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34
Q

What is the more frequent pathology in joint examination?

A
  • Muscular pathology (more frequent)

- articular pathology

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35
Q

What is the most frequent articular pathology when doing joint examination?

A

Intracapsular pathology

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36
Q

Where does articular pain come from?

A

Usually not the articular surface, but from the surrounding tissues

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37
Q

How do you externally palpate articular pain

A
  • palpation of the lateral part of the condyle

- index and middle fingers in front of the tragus

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38
Q

What are the two kinds of articular pain palpation? (2)

A
  • External (laterally)

- Internal (posteriorly)

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39
Q

When externally palpatating articularly, what does pain indicate?

A

Capsulitis or synovitis

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40
Q

How do you internally palpate for articular pain?

A

Little finger into external auditory canal pushing forward

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41
Q

If there is pain when internally palpating for articular pain, this indicates… (2)

A
  • retrodiscitis (very common)

- posteriot capsulitis or synovitis

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42
Q

Articular sounds: what is a click?

A

Single explosive sound

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43
Q

Articular sounds: what is a crepitus??

A

Continous grating noise

44
Q

How can you hear articular sounds?

A
  • With the bell of the phonendoscope
  • while preforming opening-closing or eccentric movements
  • lateral palpation
45
Q

What can cause click articular sounds?

A
  • disc-condyle incoordination

- during disc recapturing

46
Q

What does it mean if there is a click articularly during opening? (2)

A

◦ Indicate anterior functional displacement of the
disc.
◦ Milder stage the nearer the MI point.

47
Q

What does it mean if there is a click articularly during opening-closing? (4)

A

◦ Reciprocal click (or clicking)
◦ Indicate disc dislocation with reduction
◦ Early on opening, late on closing usually
◦ More advanced stage

48
Q

A click sound during mediotrusion indicates…

A

medial disc dislocation

49
Q

What are the causes of crepitus sounds? (3)

A
  • Due to wear of the articular surfaces.
  • TMJ Osteoarthrosis.
  • Rx to see this: Schüller’s transcranial radiography.
50
Q

What is the problem when there is a maximum mouth opening of less than 40mm with hard end feel ? (2)

A
  • articular problem

- probably an anterior disc dislocation without reduction

51
Q

What is the problem when there is a mediotrusion of less than 8mm?

A

Probably an anterior disc dislocation without reduction

52
Q

What is the problem when there is lateral deflection of the mandible during protrusion?

A

deflection towards the affeted side (DDwoR)

53
Q

What is considered a pathological deflection during opening-closing ?

A

more than 2mm

54
Q

If there is a reduction during opening-closing: (2)

A
  • The deflection ends again at the midline.

- Deflection during the opening path

55
Q

If there isn’t a reduction during opening-closing:

A
  • The deflection doesn’t get back to the midline

- disc displacement without reduction -> affected condyle only rotates-> deflection to the affected side

56
Q

What is considered urgent in preprosthetic treatments?

A

Pain or infection

57
Q

What pathologies require urgent treatment? (4)

A
  • Acute pulp diseases (pulpitis).
  • Periodontal abscesses.
  • Tooth fractures.
  • Acute TMDs (trismus).
58
Q

What malocclusions require immediate treatment: (2)

A
  • Fremitus.

- Any occlusal contact clearly harmful to the patient.

59
Q

What do we do if an anterior tooth needs to be extracted?

A
  • Provisional immediate denture (Fixed or removable) prepared in advance

Then:

  • removable denture
  • maryland bridge
  • provisional bridge
60
Q

Third molars and attached gingiva?

A
  • Hardly ever have attached gingiva at buccal and lingual surfaces
61
Q

Should we extract third molars for bridges? (3)

A

Yes unless:

  • They’re in perfect condition
  • risk to inferior alveolar nerve
62
Q

When extracting third molars, possible extrusion of the antagonist can cause: (2)

A
  • prematurities
  • inadequate contact point: food impactation

*therefore extract antagonist too

63
Q

How long should you wait after extraction?

A

6m-1year

64
Q

What happens if you dont wait the recommended time after extraction for prosthetic treatment? (3)

A
  • bone resorption can still happen
  • gingival level migration
  • separation between pontic and gingiva
65
Q

What happens if you wait more than a year after extraction for prosthetic treatment?

A

Tooth migrations

66
Q

What are the stages of periodontal treatment? (3)

A
  1. initial treatment
  2. surgical treatment (if needed)
  3. maintenance
67
Q

What occurs in the initial periodontal treatment? (3)

A
  • prophylaxis
  • scaling and root planning
  • correction of overcontoured margins of restorations and other iatrogenic irritants
68
Q

What happens 2 months after scaling and root planning?

A

Reevaluation and decision:

  • surgical treatment
  • more SRP
  • prosthetic treatment
69
Q

What happens during the 2 months after scaling and root planning? (3)

A
  • Evaluation of the commitment of the patient with it’s oral health.
  • Stabilization of the gingival tissues
  • Very important for any prosthetic treatment to
    succeed.
70
Q

How should you check occlusal equilibration?

A
  • mount cast in CR

- eliminate contacts on the casts

71
Q

When should we not do occlusal equilibration? (2)

A
  • more than 4 contacts

- eliminating one contact can lead to another appearing

72
Q

When should you do occlusal equilibration? (5)

A
  • Only for occlusal contacts clearly harmful to
    the patient.
  • Fremitus.
  • Extrusions that might interfere with the
    denture.
  • Unevenness of the occlusal plane.
  • Lack of occlusal stability
73
Q

How long after a fistula/abscess treatment should you wait for prothetic treatment?

A

6 months

*be sure of the remission of the pathology

74
Q

When should you do an endo therapy of vital teeth? (4)

A
  • When cast post-and-core is needed (retention).
  • Extrusions.
  • Great tooth inclinations.
75
Q

How long after an endo therapy of a vital tooth should you wait before prothetic treatment?

A

1 month

76
Q

How long after an apicectomy should you wait before prothetic treatment?

A

6 months for full healing

77
Q

What is the disadvantage of an apicectomy? (3)

A

◦ Low crown-to-root ratio.
◦ Unaesthetic scar.
◦ Sometimes increases tooth
mobility.

78
Q

Should you extrude or intrude teeth to increase the ferrule effect?

A

extrude

79
Q

How long after periodontal surgery can you do prothetic treatment?

A

• Only gingiva has been
touched: 1 to 3 month
• Gingiva and bone: 6month

80
Q

How long should you wait after any surgery to do prosthetic treatment?

A

2-3 months

81
Q

How do you treat TMDs? (4)

A
  • physiotherapy
  • pharmacotherapy
  • psychological support
  • Occlusal splint
82
Q

What physiotherapy should be done to treat TMDs?

A
  • massage
  • therapeutic exercises
  • TENs
  • infrared light
83
Q

How do massages help TMDs?

A

Increases the heat and helps

eliminating toxins during the contraction

84
Q

How do therapeutic exercise help TMDs?

A

To help recover the
function; limiting the movements, opening
and closing

85
Q

How do TENs help TMDs?

A

Transcutaneous electrical nerve stimulation, to reduce the pain and stimulate
the tone of the muscles

86
Q

How do infrared light help TMDs?

A

Creates a heat that improves
the blood-flow, the oxygenation and relaxes
the muscles.

87
Q

Whats the purpose of pharmacotherapy in treatment of TMDs (3)

A
  • To reduce the psychological tension.
  • To relax the muscles.
  • Allow maneuvers needed during the treatment.
88
Q

Types of pharamcotherapy for TMD?

A

Cold/heat

• Muscle relaxant, robaxisal®, myolastan ®.
• Sedative and tranquilizer, can help the doctor reduce
the pain, benzodiazepines.
• Analgesic, not very useful to relieve acute pain,
paracetamol.
• Anti-inflammatories
• Vasoactive drugs: for vascular migrains
• Infiltrations in the affected areas

89
Q

How does heat impact TMDs? (3)

A
  • can creates changes over the neuromuscular
    system
  • increase of the blood-flow and the capillary permeability.
  • When muscular tension, pain and rigidity of the joints
90
Q

How does cold impact TMDs? (5)

A
  • anaesthetic effect, reduces spasms and the bloodflow
  • reducing the local inflammatory response
  • oedema,
  • haemorrhage.
  • When jaw movements are limited associated to active
    therapy
91
Q

Psychological support for TMD (3)

A

• Stress and Anxiety are a cause and consequence of
TMDs.
• Psychologist.
• Psychiatrist.

92
Q

What does occlusal splinting for TMD achieve?

A

Alters mandibular position and contact pattern of teeth

93
Q

How occlusal splinting for TMD work? (3)

A

• It hasn’t been proved what makes them work.
• It has been stated that it’s because it resets
neuromuscular patterns.
• Synonymous of occlusal device.

94
Q

What are the indications of occlusal splinting for TMD? (7)

A
  • Relaxes the muscles.
  • Helps reducing the pain.
  • Allow to handle the patient
    during the treatment.
  • Treatment for TMD`s.
  • Occlusal stabilization.
  • To prevent the occlusal
    trauma.
  • Reduce tooth wear.
95
Q

What is occlusal splinting for TMD effective at and not effective at?

A
  • Very effective at reducing muscular pain.

* Poorly effective to reduce joint sounds.

96
Q

Whats the objective of occlusal splinting for TMD? (5)

A
  • Relax muscles of the stomatognathic system.
  • Provide orthopedic stability to TMJs.
  • Lower grinding/parafunctional activity.
  • Protect periodontium from occlusal trauma.
  • Prevent wear of the dentition.
97
Q

What is the procedure of occlsal splinting for TMD? (2)

A
  • Occlusal record at final VD in CR position
  • The purpose is to take the condyle-disc-fossa to
    an optimum position
98
Q

What is needed before occlusal splinting for TMD

A

Physiotherapy and pharmacology to be able to treat the patient

99
Q

How do you occlusally splint when its impossible to record CR? (2)

A
  • Approximate CR.

- Posterior adjustments to the splint or new splint.

100
Q

Hwo do you manufacture occlusal splints? (3)

A

Heat curing acrylic resin

  • good mechanical properties
  • allows adjustments
101
Q

What splint do you need for night-time bruxism for TMD?

A

Upper splint

102
Q

What splint do you use for day-time bruxism for TMD?

A

Lower splint

103
Q

Design of the occlusal splint for TMD? (3)

A
  • Retention: survey line.
  • Avoid contact with periodontium (plaque
    gathering) .
  • Flat occlusal surface
104
Q

What occlusal scheme do you use for occlusal splint TMD?

A
  • Mutually protected articulation

- soft canine and anterior guidance

105
Q

How should the contacts be in a TMD occlusal splint? (3)

A
  • even contacts
  • no tooth without occlusal contact (prevents extrusions)
  • minimum possible VD (not making the splint weak) - to prevent myotatic reflex
106
Q

What is the time of use for an occlusal splint for TMDs? (2)

A
  • depends on the patient

- bruxist patients: forever

107
Q

Do occlusal splints have MI at CR? (2)

A
  • Rarely achieved the first time:

- Adjustments to the splint.

Prostho 3 (11 decks)

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