26 - Oral dysaesthesia and TMD Flashcards

1
Q

What is oral dysaesthesia?

A
  • abnormal sensory perception in absence of abnormal stimulus
  • can be somatoform or neuropathic
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2
Q

What is the difference between somatofrom and neuropathic dysaesthesia?

A
  • somatoform is the perception of a stimuli
  • neuropathic is when the nerve is damage
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3
Q

What feelings are associated with oral dysaesthesia?

A
  • burning
  • dysgeusia (bad taste)
  • paraesthesia
  • dry mouth feeling
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4
Q

What are predisposing factors for oral dysaesthesia?

A
  • deficiencies (haematinics, zinc, vit B)
  • fungal and viral infections
  • anxiety and stress (exacerbation)
  • women
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5
Q

Which oral dysaesthesia is most likely to be associated with a haematinic deficiency?

A

Burning mouth syndrome (NOT lips and tongue)

Now referred to as oral dysaesthesia

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6
Q

What presents with similar features to burning mouth syndrome on the lips and tongue?

A

Parafunction (tongue thrust)

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7
Q

Define dysgeusia.

A
  • bad taste/smell perceived by patient
  • no smell detected by practitioner and nothing on examination
  • can be caused by chronic sinusitis, infection or GORD
  • can be isolating condition
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8
Q

What is touch dysaesthesia?

A
  • pins and needles/tingling
  • described by patients as the feeling of anaesthesia wearing off
  • tests normally
  • MRI and cranial nerve testing essential
  • local causes must be excluded (infection or tumour)
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9
Q

What is dry mouth dysaesthesia?

A
  • pt CO dry mouth or Sjogren’s symptoms
  • can eat normally
  • worse when pt wakes at night
  • commonly associated with anxiety disorders
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10
Q

How do you manage dry mouth dysaesthesia therapeutically?

A
  • treated with antidepressant or anxiolytic drugs
  • must explain to patient that these drugs will make the mouth MORE dry but to continue with treatment
  • the root cause of their mouth dryness is the anxiety so once this is managed the dryness will go away
  • may still have some dryness but less debilitating than previously
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11
Q

How can you explain dysaesthesia to the patient?

A
  • similar to pins and needles sensation
  • assess level of anxiety and degree of involvement
  • empower the patient to be in control
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12
Q

What anxiolytic medication is available for management of dysaesthesia?

A
  • nortriptyline
  • mirtazepine
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13
Q

What neuropathic medication is available for management of dysaesthesia?

A
  • gabapentin/pregabalin
  • clonazepam (topical)
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14
Q

How can TMD be classified?

A
  • joint degeneration
  • internal derangement
  • no joint pathology
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15
Q

How do patients with joint degeneration present?

A
  • pain on use
  • crepitus
    +/- pain on rest
  • demonstrated with one finger
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16
Q

How do patients with internal derangement present?

A
  • locking open or closed
  • demonstrated with one finger
17
Q

How do patients with TMD with no pathology present?

A

Demonstrated with multiple fingers/open palm

18
Q

What are the common features of a patient with TMD?

A
  • systemic disorder (“pain vulnerable people”)
  • high anxiety with low depression (no diagnosis)
  • parafunction very common
19
Q

What are the physical signs of TMD?

A
  • clicking joint
  • locking with reduction
  • trismus
  • tenderness of MOM
  • tenderness of cervico-cranial muscles
20
Q

What are IO signs of parafunction?

A
  • tongue scalloping (tongue at rest)
  • linea alba
  • loss of incisal edge
21
Q

What history is relevant for TMD diagnosis?

A
  • acute pain in face and neck
  • any chronic face, head and neck pain
  • symptoms shows periodicity
  • parafunctional clenching
22
Q

What muscles are commonly tender in TMD?

A
  • MOM
  • SCM
  • trapezius
23
Q

What are common clinical findings associated with muscle dysfunction?

A
  • joint click
  • deviation on opening
24
Q

When is US indicated for TMD?

A

If functional visualisation of disc movement required

25
When is CBCT indicated for TMD?
If bony problem suspected
26
Which type of imaging gets the best view of the disc?
MRI
27
What causes the click of the TMJ?
- disc slips forward anteriorly - when the disc reduces back into the fossa the click is heard - this is encouraging that there is reduction
28
What are the management options of TMD?
- information about self help - physical therapy (soft diet, bite splint) - anxiolytic medication - physiotherapy - acupuncture - clinical psychology
29
What are the considerations when children have TMD?
- "anxious parents have anxious children" - maladaptive response to normal change - can be reaction to abuse or ACEs - psychology is more important in the treatment in children