26 - Oral dysaesthesia and TMD Flashcards
What is oral dysaesthesia?
- abnormal sensory perception in absence of abnormal stimulus
- can be somatoform or neuropathic
What is the difference between somatofrom and neuropathic dysaesthesia?
- somatoform is the perception of a stimuli
- neuropathic is when the nerve is damage
What feelings are associated with oral dysaesthesia?
- burning
- dysgeusia (bad taste)
- paraesthesia
- dry mouth feeling
What are predisposing factors for oral dysaesthesia?
- deficiencies (haematinics, zinc, vit B)
- fungal and viral infections
- anxiety and stress (exacerbation)
- women
Which oral dysaesthesia is most likely to be associated with a haematinic deficiency?
Burning mouth syndrome (NOT lips and tongue)
Now referred to as oral dysaesthesia
What presents with similar features to burning mouth syndrome on the lips and tongue?
Parafunction (tongue thrust)
Define dysgeusia.
- 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
What is touch dysaesthesia?
- 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)
What is dry mouth dysaesthesia?
- pt CO dry mouth or Sjogren’s symptoms
- can eat normally
- worse when pt wakes at night
- commonly associated with anxiety disorders
How do you manage dry mouth dysaesthesia therapeutically?
- 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
How can you explain dysaesthesia to the patient?
- similar to pins and needles sensation
- assess level of anxiety and degree of involvement
- empower the patient to be in control
What anxiolytic medication is available for management of dysaesthesia?
- nortriptyline
- mirtazepine
What neuropathic medication is available for management of dysaesthesia?
- gabapentin/pregabalin
- clonazepam (topical)
How can TMD be classified?
- joint degeneration
- internal derangement
- no joint pathology
How do patients with joint degeneration present?
- pain on use
- crepitus
+/- pain on rest - demonstrated with one finger
How do patients with internal derangement present?
- locking open or closed
- demonstrated with one finger
How do patients with TMD with no pathology present?
Demonstrated with multiple fingers/open palm
What are the common features of a patient with TMD?
- systemic disorder (“pain vulnerable people”)
- high anxiety with low depression (no diagnosis)
- parafunction very common
What are the physical signs of TMD?
- clicking joint
- locking with reduction
- trismus
- tenderness of MOM
- tenderness of cervico-cranial muscles
What are IO signs of parafunction?
- tongue scalloping (tongue at rest)
- linea alba
- loss of incisal edge
What history is relevant for TMD diagnosis?
- acute pain in face and neck
- any chronic face, head and neck pain
- symptoms shows periodicity
- parafunctional clenching
What muscles are commonly tender in TMD?
- MOM
- SCM
- trapezius
What are common clinical findings associated with muscle dysfunction?
- joint click
- deviation on opening
When is US indicated for TMD?
If functional visualisation of disc movement required
When is CBCT indicated for TMD?
If bony problem suspected
Which type of imaging gets the best view of the disc?
MRI
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
What are the management options of TMD?
- information about self help
- physical therapy (soft diet, bite splint)
- anxiolytic medication
- physiotherapy
- acupuncture
- clinical psychology
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
