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BDS4 Oral Medicine > 26 - Oral dysaesthesia and TMD > Flashcards

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
Q

When is CBCT indicated for TMD?

A

If bony problem suspected

26
Q

Which type of imaging gets the best view of the disc?

A

MRI

27
Q

What causes the click of the TMJ?

A
  • disc slips forward anteriorly
  • when the disc reduces back into the fossa the click is heard
  • this is encouraging that there is reduction
28
Q

What are the management options of TMD?

A
  • information about self help
  • physical therapy (soft diet, bite splint)
  • anxiolytic medication
  • physiotherapy
  • acupuncture
  • clinical psychology
29
Q

What are the considerations when children have TMD?

A
  • “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

BDS4 Oral Medicine (31 decks)

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