15. Orofacial Pain and TMD Flashcards
What is pain?
It is an unpleasant sensory & emotional experience associated with actual or potential tissue damage or described in terms of such damage
What are the layers of pain?
1.) Pain behaviour
2.) Suffering
3.) Emotions
4.) Thoughts
5.) Nociception
6.) Tissue damage
What cranial nerve is involved with the pain in the orofacial complex?
Cranial nerve V (Trigeminal nerve)
What are the different types of pain?
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
Why are TMJ & TMD not the same thing?
TMJ = temporomandibular joint while the TMD = temporomandibular joint disorder/dysfunction
What are the ginglymoid in the anatomy of the TMJ?
They are the joint hinges which rotates
What are the arthroidal in the anatomy of the TMJ?
They are the joint that glides to translate & move forward
What are compound joints?
They are 3 or more articulation surfaces
What are all the muscles that exist in the TMJ?
1.) Temporalis
2.) Masseter
3.) Medial pterygoid
4.) Lateral pterygoid
5.) Sternocleidomastoid
6.) Posterior digastric
7.) Cervical musculature
8.) Trapezius
What are the bones that exist in the TMJ?
1.) Condylar head (part of the mandible)
2.) Glenoid fossa (part of the temporal bone)
3.) Articular eminence
What is found between two bones that allow the mouth to open & close in the TMJ?
The articular disc (a.k.a) is the cartilage disc which is made of fibrocartilage (good repair properties)
What is the component known to connect bone to bone?
A ligament
What is the component known to connect bone to ligament?
A tendon
What are the different types of ligaments in the anatomy of the TMJ?
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
What role does the disc have in the TMJ joints?
It separates the upper & lower joint spaces.
What role does the endothelial cells have in the TMJ joints?
They release synovial fluid which acts as a lubricant & helps metabolic processes in the joint.
What are the symptoms of tight muscles in the TMJ?
Can cause spasms in the TMJ + pain.
What are the symptoms of inflamed joints in the TMJ?
They may cause pain, redness, heat, swelling, or loss of function.
What are the symptoms of damaged joints in the TMJ?
Pain in the jaw when their jaw moves along with the noise.
What is local myalgia?
It is a musculoskeletal pain that is found in a localized/specific area
What is myofascial pain?
It is a musculoskeletal pain that is found in a general area
What is myofascial pain with referral?
It is a musculoskeletal pain that travels to a different area
What are the 2 types of joint pain?
1.) Arthralgia
2.) Internal derangement
What are examples of TMJ internal derangement?
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
How do we treat TMD?
Depends entirely on the diagnosis: if its muscle, joint or both.
Need to take conservative measures before suggesting surgery (very rare)
What is burning mouth syndrome?
Aka oral dysaesthesia, is a common type of neuropathic pain seen in our patients (somatosensory pain)
What is neuropathic pain?
It is pain caused by damage or disease affecting the somatosensory nervous system
In whom are burning mouth syndromes more commonly found?
Commonly found in women, primarily occurs in peri or post-menopausal women & may occur abruptly or gradually
What are the signs & symptoms of burning mouth syndrome?
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
What are the local factors to rule out in burning mouth syndrome?
Anywhere in & around the mouth.
What are the systemic factors of burning mouth syndrome?
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
What are the treatments for burning mouth syndrome?
- First line: clonazepam (a lozenge which works topically)
- cognitive behavioral therapy
- systemic medications
What is trigeminal neuralgia?
It is a very serious facial neuralgia with intense, shooting pain involving a nerve.
What is the most common affected branch of the trigeminal nerve when a trigeminal neuralgia is experienced?
The V2 branch.
What are the differential diagnoses of the trigeminal neuraglia?
1.) Multiple sclerosis
2.) TMD/Myofascial pain
3.) Trigeminal autonomic cephalgias (headaches)
4.) Odontogenic source
What are the diagnostic criteria for trigeminal neuralgia?
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
How do we treat trigeminal neuralgia with medications?
1.) Carbamazepine: main tx
2.) Phenytoin
3.) Gabapentin
How do we treat trigeminal neuralgia with surgery?
1.) Microvascular decompression
2.) Rhizotomy
3.) Gamma knife
What is cephalgia?
Another word for headache + common disorder in humans.
What are the types of headaches?
1.) Tension type: common headache
2.) Migraine: second most common
What are the headache warning signs?
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)
What are primary headaches?
1.) Tension type headaches
2.) Migraine headaches
3.) Trigeminal autonomic cephalgias (cluster headaches)
What are secondary headaches?
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
What are the characteristics of tension-type headaches?
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
What are the characteristics of migraine headaches?
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
What is a good way to remember migraine headaches?
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
