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305 > 15. Orofacial Pain and TMD > Flashcards

15. Orofacial Pain and TMD Flashcards

1
Q

What is pain?

A

It is an unpleasant sensory & emotional experience associated with actual or potential tissue damage or described in terms of such damage

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2
Q

What are the layers of pain?

A

1.) Pain behaviour
2.) Suffering
3.) Emotions
4.) Thoughts
5.) Nociception
6.) Tissue damage

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3
Q

What cranial nerve is involved with the pain in the orofacial complex?

A

Cranial nerve V (Trigeminal nerve)

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4
Q

What are the different types of pain?

A

1.) Musculoskeletal pain (MSK): muscular & TMJ pain
2.) Neurovascular pain: migraine headaches
3.) Neuropathic pain: Trigeminal neuralgia (from lesion or dysfunction in the nervous system)
4.) Psychogenic pain: Factitious disorder

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5
Q

Why are TMJ & TMD not the same thing?

A

TMJ = temporomandibular joint while the TMD = temporomandibular joint disorder/dysfunction

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6
Q

What are the ginglymoid in the anatomy of the TMJ?

A

They are the joint hinges which rotates

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7
Q

What are the arthroidal in the anatomy of the TMJ?

A

They are the joint that glides to translate & move forward

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8
Q

What are compound joints?

A

They are 3 or more articulation surfaces

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9
Q

What are all the muscles that exist in the TMJ?

A

1.) Temporalis
2.) Masseter
3.) Medial pterygoid
4.) Lateral pterygoid
5.) Sternocleidomastoid
6.) Posterior digastric
7.) Cervical musculature
8.) Trapezius

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10
Q

What are the bones that exist in the TMJ?

A

1.) Condylar head (part of the mandible)
2.) Glenoid fossa (part of the temporal bone)
3.) Articular eminence

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11
Q

What is found between two bones that allow the mouth to open & close in the TMJ?

A

The articular disc (a.k.a) is the cartilage disc which is made of fibrocartilage (good repair properties)

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12
Q

What is the component known to connect bone to bone?

A

A ligament

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13
Q

What is the component known to connect bone to ligament?

A

A tendon

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14
Q

What are the different types of ligaments in the anatomy of the TMJ?

A

1.) Collateral ligament - hinging movements
2.) Capsular ligament - resisting forces that separate or dislocate the articular surfaces
3.) TM ligament - limits rotational movements
4.) Sphenomandibular ligament
5.) Stylomandibular ligament

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15
Q

What role does the disc have in the TMJ joints?

A

It separates the upper & lower joint spaces.

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16
Q

What role does the endothelial cells have in the TMJ joints?

A

They release synovial fluid which acts as a lubricant & helps metabolic processes in the joint.

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17
Q

What are the symptoms of tight muscles in the TMJ?

A

Can cause spasms in the TMJ + pain.

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18
Q

What are the symptoms of inflamed joints in the TMJ?

A

They may cause pain, redness, heat, swelling, or loss of function.

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19
Q

What are the symptoms of damaged joints in the TMJ?

A

Pain in the jaw when their jaw moves along with the noise.

20
Q

What is local myalgia?

A

It is a musculoskeletal pain that is found in a localized/specific area

21
Q

What is myofascial pain?

A

It is a musculoskeletal pain that is found in a general area

22
Q

What is myofascial pain with referral?

A

It is a musculoskeletal pain that travels to a different area

23
Q

What are the 2 types of joint pain?

A

1.) Arthralgia
2.) Internal derangement

24
Q

What are examples of TMJ internal derangement?

A

1.) Disc displacement with reduction: out of place + pops in & out
2.) Disc displacement with reduction with intermittent locking: jaw is locked
3.) Disc displacement without reduction with limited opening: acute closed locks
4.) Disc displacement without reduction without limited opening

25
Q

How do we treat TMD?

A

Depends entirely on the diagnosis: if its muscle, joint or both.
Need to take conservative measures before suggesting surgery (very rare)

26
Q

What is burning mouth syndrome?

A

Aka oral dysaesthesia, is a common type of neuropathic pain seen in our patients (somatosensory pain)

27
Q

What is neuropathic pain?

A

It is pain caused by damage or disease affecting the somatosensory nervous system

28
Q

In whom are burning mouth syndromes more commonly found?

A

Commonly found in women, primarily occurs in peri or post-menopausal women & may occur abruptly or gradually

29
Q

What are the signs & symptoms of burning mouth syndrome?

A

They affect the tongue:
- dorum (anterior part) or anywhere
- reported “burning” or a raw feeling
- tongue looks normal
- If tongue looks abnormal, consider other entities: anemia, candida infection.
- Xerostomia
- abnormal taste sensations accompany the burning

30
Q

What are the local factors to rule out in burning mouth syndrome?

A

Anywhere in & around the mouth.

31
Q

What are the systemic factors of burning mouth syndrome?

A

1.) Vitamin B1 or B2 deficiency
2.) Pernicous anemia (B12)
3.) Pellagra (niacin deficiency)
4.) Folic acid deficiency
5.) Iron deficiency anemia
6.) Diabetes mellitus
7.) Chronic gastritis or regurgitation

32
Q

What are the treatments for burning mouth syndrome?

A
  • First line: clonazepam (a lozenge which works topically)
  • cognitive behavioral therapy
  • systemic medications
33
Q

What is trigeminal neuralgia?

A

It is a very serious facial neuralgia with intense, shooting pain involving a nerve.

34
Q

What is the most common affected branch of the trigeminal nerve when a trigeminal neuralgia is experienced?

A

The V2 branch.

35
Q

What are the differential diagnoses of the trigeminal neuraglia?

A

1.) Multiple sclerosis
2.) TMD/Myofascial pain
3.) Trigeminal autonomic cephalgias (headaches)
4.) Odontogenic source

36
Q

What are the diagnostic criteria for trigeminal neuralgia?

A

For pain:
1.) It lasts from a fraction of a second to 2 minutes.
2.) It has a severe intensity
3.) Electric shock-like, shooting, stabbing or sharp in quality

*Precipitated by innocuous stimuli within the affected trigeminal distribution

37
Q

How do we treat trigeminal neuralgia with medications?

A

1.) Carbamazepine: main tx
2.) Phenytoin
3.) Gabapentin

38
Q

How do we treat trigeminal neuralgia with surgery?

A

1.) Microvascular decompression
2.) Rhizotomy
3.) Gamma knife

39
Q

What is cephalgia?

A

Another word for headache + common disorder in humans.

40
Q

What are the types of headaches?

A

1.) Tension type: common headache
2.) Migraine: second most common

41
Q

What are the headache warning signs?

A

SNOOPS
S - systemic features
N - neurologic symptoms (confusion, altered consciousness)
O - onset (sudden, sharp, abrupt)
O - older patients
P - previous history of headaches (1st headache? altered headaches? change in frequency, severity)
S - secondary risk factors (HIV, cancer)

42
Q

What are primary headaches?

A

1.) Tension type headaches
2.) Migraine headaches
3.) Trigeminal autonomic cephalgias (cluster headaches)

43
Q

What are secondary headaches?

A

1.) Headaches attributed to trauma
2.) Headache attributed to cranial or cervical vascular disorder
3.) Headache attributed to a substance or its withdrawal
4.) Headache attributed to infection

44
Q

What are the characteristics of tension-type headaches?

A

1.) They are found bilaterally
2.) Pressing or tightening (non-pulsating) quality
3.) Mild or moderate intensity
4.) Not aggravated by routine physical activity such as walking or climbing stairs

  • not prone to nausea or vomiting
    no more than one of photophobia or phonophobia
45
Q

What are the characteristics of migraine headaches?

A

1.) They are found unilaterally
2.) They are pulsating
3.) Moderate/severe pain
4.) Aggravation by or causing avoidance of routine physical activity (eg: walking, or climbing stairs)

*can cause nausea and/or vomiting
photophobia and phonophobia

46
Q

What is a good way to remember migraine headaches?

A

remember: 5472 PUMA PPNV

5 headaches lasting 4 to 72 hours
PUMA: pulsating, unilateral ,moderate to severe, aggravated by exercise

PPNV: Photophobia & phonophobia, nausea & vomiting

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