Describe the quality of pain for each of the three origins below - Muscle - Joint - Nerve

- Muscle= Dull, aching, pressure, tight, stiff - Joint= sharp - Nerve= shock

describe the duration of pain for each of the three origins listed - muscular - joint - nerve

- Muscular= can hurt for long durations (hours) - Joint ~3 hr intervals (intermediate time) - Nerve= seconds

3. Clinical Exam Flashcards by Janae Garofalo

Relevant dental history in the Dx of TMD is

trauma

parafunction

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Relevant medical history in dx of TMD is

osteoarthritis

fibromyalgia

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Relevant cheif complaints in Dx of TMD are

Joint sounds
Limited function
Sounds

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What things should you ask the patient about their pain

Location
Intensity
Referral patterns
Quality
Duration
Frequency
Temporal pattern
Modifiers
Assoc. signs and symptoms

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Why is location important?

Because the pain can be due to TMD or another systemic disease

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As the number of bodily sites with pain increases what else increase

the risk of developing another pain disorder

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What is required for pain location in fibromyalgia

-opposite quadrants and spinal area

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T/F Most patients with TMD pain have localized pain

f- most have widespread pain

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Compared to those suffering from localized pain, those with widespread pain have (higher/lower) general health (more/less) sleep dysfunction, (increased/decreased) ability to control pain and (greater/less) health care needs

lower
more
decreased
greater (higher depression)

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How should the intensity of a patient’s pain be assessed

Baseline (before treatemnt
Followups after tx (with the same scale)
*Helps determine if the Dx was correct or not

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How does the intensity of someones pain help you decide methods of treatment

the greater the pain the more aggressive the treatment

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How does the quality of pain assist with Dx

can help you determine if the origin of the pain is muscular, joint or nerve

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Describe the quality of pain for each of the three origins below

Muscle
Joint
Nerve

Muscle= Dull, aching, pressure, tight, stiff
Joint= sharp
Nerve= shock

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Does the location, intensity, quality, etc of the pain have dx validity

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Describe referral

when you palpate an area and the pain is in a different region

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What can duration of pain tell you

similar to the quality of pain it can help you determine the origin

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describe the duration of pain for each of the three origins listed

muscular
joint
nerve

Muscular= can hurt for long durations (hours)
Joint ~3 hr intervals (intermediate time)
Nerve= seconds

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If the pain is alleviated by drugs like tylenol what may be the origin

musculoskeletal

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If the pain is not alleviated with drugs and pain persists for 24hrs what may be the diagnossi

intracranial condition

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Define temporal pattern

When you start with pain and the pain improves (even without treatment)

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What are modifiers of pain

things that either make the pain feel better or worse

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Associated signs and symptoms of TMD are

Fever
Blurred vision
Neusea

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Patients with migraines and arthritis will also have blurred vision describe the difference between the two

migraine the blurred vision will improve as the migraine improves.

Arthritis the blurred vision doesn’t improve.

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What is the difference between closed and open lock

Closed= the mouth will not open 
Open= the mouth will not close

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DX criteria for TMD are

- Pain (jaw temple, ear, front of ear etc.) | - Headache (includes temple areas) in last 30 days

What activities may worsen a patients TMD associated pain and headache

- Chewing hard or tough foods - Opening your mouth or moving your jaw forward or to the side - Other jaw activities (talking, kissing, or yawning) - Jaw habits such as holding teeth together, clenching/grinding or chewing gum

The clinical assessment consists of

- Opening pattern - Vertical range of motion - Horizontal range of motion - Assessment of joint sounds (clicking and crepitus) - Muscles palpation - TMJs palpation

When asking patients to describe their past pain what time window should you give them and why

30 days because beyond that recall is unreliable

What reference lines are drawn where and for what reasons

-Horizontal line on lover incisor= Vertical overlap

What is HO used for

add to protrusive movement to determine the total horizontal movement of the patient

What are the different types of opening patterns

- Straight - Corrected deviation - Deviation

What are the different ranges of motion test in the clinical exam

Vertical - PFO - MUO - MAO Horizontal - Lateral - Protrusive

If the PFO is much less than the MAO what may be the origin of the pain and why

muscles because they can be stretched

What needs to be considered when measuring lateral movements

midline deviation

How should you clinically examin for joint sounds

place your fingers in front of the patient's ears

Why would you want to have the patient tap their teeth together before checking for joint sounds

reference noise that is not a click

How much pressure is used for muscle and TMJ palpation

Lateral pole= 0.5 kilo | Everything else= 1 kilo

How long should you hold your palpation for and why

5 sec... this is the minimal amount of time needed to elicit referral

What should you ask the patient if they have pain on palpation

ask them if it is familiar to their headaches and if it is referred

If you are palpating the anterior band of the temporalis and the patient is experiencing pain also in the posterior band of the temporalis is this referral

Describe the 3 locations of palpation at the temporalis and masseter

Temporalis- posterior, middle, and anterior Massetter= Origin (near the zygoma) - Body (middle) - Insertion (near mandibular body)

What is the difference between palpating the lateral pole and around the TMJ are

-Lateral pole= static and around the TMJ you move your finger

Where do you place your fingers to palpate the lateral pole and around the TMJ

Slightly open your mouth and protrude. Place finger in the depression

When should TMJ imaging be done to supplement a clinical exam

- Osseous abnormality - Mechanical abnormality - History of trauma - Sensory/motor abnormality - Significan change in occlusion

Purpose of TMJ imaging is

- Evaluate the integrity and relationships of the hard and soft tissues - Confirm extent or stage of progression in know disease - Evaluate the effects of treatment

T/F Condylar eccentricity is a reliable indicator of the soft tissue status of the joint (why or why not)

F- it is NOT because the condylar head is not concentric to the shape of the fossa

Do the left and right condyles need to be mirror images of each other to be considered "normal"

What TMJ structures/pathology can be seen on a pan

- Gross osseous changes (erosion, osteophytes, or fractures) - Other pathology that can be affecting the TMJ (i.e a tumor)

what can't you see on a pan of the TMJ tissues

- No info about condylar position because the jaw is slightly open and protruded - Pan view doesn't provide adequate examination of the hard tissues of the joints

What is the Dx validity of pan X-ray in Dx of hard tissue abnormalities in Pan

-If you see it it is there if you don't see it it doesn't mean it isn't there (high spec. low sens)

Which helps you evaluate hard/soft tissue - MRI - CT

MRI= soft | CT (or CBCT)= Hard

What are the different planes of view you get with CT and MRI

MRI= sagital and coronal | CT=axial and coronal (these can be manipulated to sagittal view also)

In an MRI (sagital view) the normal position of the posterior band and intermediate zone of the disc is

posterior band= 11:30 -12:30 | Intermediate zone= over the head of the condyle

What is the gold standard for imaging fo soft and hard tissues

MRI (Soft)/CT (hard)

MRI can be used to detect what abnormalities with the TMJ

- Internal derangements - Effusion - Osseous changes - Rule out intracranial causes of pain in patients with neuropathic pain or headaches

Dx accuracy and efficency of MRIs are (consistent/inconsistent)

inconsistent

Look at the slides and article for the pictures of the disc and MRI

What is the difference between T1 and T2

T1= Proton weighted -Good for osseous and discal tissue T2=weighted pulse sequence -Good for Inflammation and joint effusion

Is there a relationship between inflammation and joint effusion

What cuts are the easiest to see on MRI of the disc

the most central

What two images are needed for TMJ Dx

opened and closed position

How can you rule out if a patient has TMD or MS

take an MRI

When the disc is anteriorly displaced the posterior band is (greater than/less than) 11:30

less than

Will the intermediate zone of the disc be in contact with the head of the condyle in anteriorly displaced disc

What view is needed to determine if the disc is medially/laterally displaced

coronal MRI

In a CT scan what demonstrates a normal condyle

Round condyle head | well defined cortical margin

T/F reliability of Dx of hard tissue status with CT is good

What four parameters are being observed when performing jaw tracking

Looking at jaw movement parameters such as.... - Amplitude of movement - Reproducibility of jaw movement - Velocity - Smoothness of jaw trajectories

T/F Some jaw movements have dx validity

f- no differences between normal and TMD patients

What is the JT-3D

- Records incisor-point movements | - No dx validity

What is electromyography

Standard method of recording muscle specific activity in skeletal muscles -No evidence to support EMG use in evaluation or Dx of TMD (failed to discriminate between case and controls)

Uses of joint vibration analysis

listen the the joint of the bones colliding upon vibration

Uses of sonography and vibratography

-Recording and listening to jaw joint noises

T/F Normal jaw doesn't mean absence of sound

Use of a T-scan

analyzes occlusal forces

T/F unblanaced occlusion cause TMD

Risks of using the following devices are

- improper treatment | - Misdiagnosis