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D1 Spring - Occlusion & Fixed Pros. > 4/24: General Considerations in the Treatment of Temporomandibular Disorders > Flashcards

4/24: General Considerations in the Treatment of Temporomandibular Disorders Flashcards

1
Q

What needs to be considered in the evaluation and treatment of patients?

A

The interrelationship of various TMJ disorders

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2
Q

What can trauma to any structure of the masticatory system cause or contribute to?

A

Most TMDs

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3
Q

Where is support for the appropriate treatment modalities found in?

A

Evidence based literature

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4
Q

Some etiologic factors that contribute to TMDs are difficult to __________ or _________ (e.g., emotional stress)

A

eliminate; control

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5
Q

What kind of therapies seem to report similar success rates on a long term bases?

A

Conservative and non conservative therapies

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6
Q

What two groups do treatment methods for TMDs be categorized into?

A

Definitive treatments
Supportive therapy

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7
Q

What are definitive treatments?

A

Directed to controlling or eliminating the etiologic factors that created the disorder

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8
Q

What is supportive therapy?

A

Treatment methods directed toward altering patient symptoms but often do not affect the etiology

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9
Q

When do TMDs result when?

A

Normal activity is interrupted by an event

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10
Q

What are common events that can cause TMD?

A

Local trauma or increase in emotional stress

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11
Q

What is the second influencing effect of occlusion?

A

Through orthopedic instability

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12
Q

What is another common etiology of TMD?

A

Increased emotional stress

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13
Q

What is any source of deep pain responsible of?

A

Creating the TMD

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14
Q

What is the last etioloy?

A

Parafunctional activity, diurnal or nocturnal, bruxing or clenching

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15
Q

All initial treatment should be _________, ________, and ___________

A

Conservative, reversible, and noninvasive

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16
Q

What is occlusal therapy considered to be?

A

Any treatment that is directed towards altering the mandibular position and/or occlusal contact pattern of the teeth

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17
Q

What does reversible occlusal therapy alter?

A

The patient’s occlusal condition only temporarily and is best accomplished with an occlusal appliance

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18
Q

What happens when the occlusal appliance is worn?

A

An occlusal contact pattern is established that is in harmony with optimum condyle-disc fossa relationship

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19
Q

What does an occlusal contact pattern is established that is in harmony with optimum condyle-disc fossa relationship provide?

A

Orthopedic stability

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20
Q

What does irreversible occlusal therapy permanently alter?

A

The occlusal condition and/or mandibular position

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21
Q

What are examples of irreversible occlusal therapy?

A

Selective grinding or restorative procedures

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22
Q

What are indications if a patient responds successfully to reversible occlusal therapy?

A

Irreversible occlusal therapy may be helpful

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23
Q

What can increased levels of emotional stress affect?

A

Muscle function by increasing the resting activity, increasing bruxism, or both

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24
Q

What are other disorders that may activate the autonomic nervous system?

A
  • irritable bowel syndrome
  • premenstrual syndrome
  • intestinal cystitis
  • fibromyalgia
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25
Q

What does evidence suggest about greater levels of emotional stress and what it can create?

A

Increased parafunctional activity in the masticatory system

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26
Q

What is a correlation drawn between?

A

Increased levels of anxiety, fear, frustration, and anger and muscle hyperactiviy

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27
Q

What do more challenging patients suffer from?

A

OCD, PTSD, patients that suffered from physical or sexual abuse, depression

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28
Q

What happens when psychologic therapy is indicated?

A

The patient should be referred to a properly trained therapist

29
Q

What should the first treatment be when a patient comes to the dentist with symptoms closely related to muscle hyperactivity?

A

Educate the patient regarding the relationship between emotional stress, muscle hyperactivity and the problem

30
Q

What happens once the emotional stress problem is understood?

A

Anxiety will be reduced, which often reduces pain

31
Q

What is a general rule?

A

“if it hurts, don’t do it”

32
Q

What does “if it hurts, don’t do it” mean?

A

The diet should be altered
The patient is encouraged to eat softer foods, take smaller bites, and generally chew slowly

33
Q

What should a patient do if they find their teeth contacting, other than swallowing, chewing or speaking?

A

Immediately disengage them

34
Q

What are other habits that can aggravate TMD symptoms?

A

Biting on objects, chewing on ice, or heavy gum chewing

35
Q

What are the two types of relaxation therapy?

A

Substitutive
Active relaxation

36
Q

What is substitutive therapy?

A

A substitution for stressful events or an interposition between them (activities that they enjoy, regular exercise)

37
Q

What is active relaxation therapy?

A

Therapy that directly reduces muscle activity (pt is trained to relax the symptomatic muscles, biofeedback, negative biofeedback)

38
Q

The evaluation of levels of emotional stress in a patient’s life is extremely __________

A

Difficult

39
Q

When high levels of emotional stress are suspected as an etiologic factor contributing to a disorder, _____________ should be initiated

A

Stress reduction therapy

40
Q

What is a very effective way of starting a stress reduction therapy?

A

Establishing a positive doctor patient relatinoship

41
Q

When should a stress reduction therapy approach be presented?

A

Early in the tx plan so the patient can appreciate the relationship between pain, emotional stress, and the dental procedures that may be offered

42
Q

What therapy is of little use in the case of macrotraums?

A

Definitive therapy since the trauma is no longer present

43
Q

What therapy is of necessary in the case of microtraums?

A

Definitive therapy that consists on developing orthopedic stability

44
Q

There is no correlation between the amount of __________ and _________

A

Bruxing activity; pain

45
Q

What should patient education begin by?

A

Informing the patient that the teeth should only contact during chewing, speaking, and swallowing

46
Q

What is nocturnal bruxism influences by?

A

Factors such as emotional stress levels and sleep paterns

47
Q

What can nocturnal bruxism be reduced with?

A

Occlusal appliance therapy

48
Q

What is supportive therapy directed toward?

A

Altering the patients symptoms, often has no effect on the etiology of the disorder

49
Q

What is supportive therapy extremely helpful in?

A

Providing immediate relief on the symptoms

50
Q

Supportive therapy is only ____ and not replacement for _____ therapy

A

Symptomatic; definitive

51
Q

What are the two types of supportive therapy?

A
  1. Pharmacological therapy
  2. Physical therapy
52
Q

What are the most common classes of pharmacologic agents for the management of TMDs?

A
  • analgesics
  • antiinflammatories
  • muscle relaxants
  • anxyolitics
  • antidepressants
  • anticonvulsives
53
Q

What is physical therapy?

A

Group of supported activities that is instituted in conjunction with definitive treatment

54
Q

What are modalities of physical therapy?

A

Thermotherapy
Coolant therapy

55
Q

What is thermotherapy?

A

Heat is the prime mechanism,
Based on the premise that it increases the circulation to the applied area

56
Q

What is coolant therapy?

A

Cold encourages the relaxation of muscles that are in spasm, and thus relieves pain
**ice should not be left on the tissues for longer than 5-7 min

57
Q

What is ultrasound therapy?

A

Method of producing an increase in temperature at the interface of the tissues and therefore affects deeper tissues than does surface heat

58
Q

What is ultrasound therapy used in conjunction with?

A

Surface heat, especially when treating a post trauma patient

59
Q

What principle does electrogalvanic therapy use?

A

Electric current will cause a muscle to contract

60
Q

How does electrogalvanic therapy work?

A

Rhythmic electrical impulse is applied to the muscle, creating repeated involuntary contractions and relaxations

61
Q

What is transcutaneous electrical nerve stimulation?

A

Continuous stimulation of cutaneous nerve fibers at a subpainful levels

62
Q

What does transcutaneous electrical nerve stimulation use?

A

A low voltage, low amperage current of varies frequency

63
Q

What are manual techniques?

A

Soft tissue mobilization
Joint mobilization

64
Q

What is soft tissue mobilization?

A

Superficial and deep massage

65
Q

What is joint mobilization technique?

A

Gentle distraction of the joint

66
Q

What is muscle conditioning?

A

Exercises that can help restore normal function and range of movement

67
Q

When is assisted muscle stretching used?

A

When there is a need to regain muscle length
Should never be sudden or forceful

68
Q

What is accupuncture?

A

Stimulation of certain areas that causes the release of endogenous opioids which reduces painful sensations

D1 Spring - Occlusion & Fixed Pros. (17 decks)

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