4/24: General Considerations in the Treatment of Temporomandibular Disorders Flashcards
What needs to be considered in the evaluation and treatment of patients?
The interrelationship of various TMJ disorders
What can trauma to any structure of the masticatory system cause or contribute to?
Most TMDs
Where is support for the appropriate treatment modalities found in?
Evidence based literature
Some etiologic factors that contribute to TMDs are difficult to __________ or _________ (e.g., emotional stress)
eliminate; control
What kind of therapies seem to report similar success rates on a long term bases?
Conservative and non conservative therapies
What two groups do treatment methods for TMDs be categorized into?
Definitive treatments
Supportive therapy
What are definitive treatments?
Directed to controlling or eliminating the etiologic factors that created the disorder
What is supportive therapy?
Treatment methods directed toward altering patient symptoms but often do not affect the etiology
When do TMDs result when?
Normal activity is interrupted by an event
What are common events that can cause TMD?
Local trauma or increase in emotional stress
What is the second influencing effect of occlusion?
Through orthopedic instability
What is another common etiology of TMD?
Increased emotional stress
What is any source of deep pain responsible of?
Creating the TMD
What is the last etioloy?
Parafunctional activity, diurnal or nocturnal, bruxing or clenching
All initial treatment should be _________, ________, and ___________
Conservative, reversible, and noninvasive
What is occlusal therapy considered to be?
Any treatment that is directed towards altering the mandibular position and/or occlusal contact pattern of the teeth
What does reversible occlusal therapy alter?
The patient’s occlusal condition only temporarily and is best accomplished with an occlusal appliance
What happens when the occlusal appliance is worn?
An occlusal contact pattern is established that is in harmony with optimum condyle-disc fossa relationship
What does an occlusal contact pattern is established that is in harmony with optimum condyle-disc fossa relationship provide?
Orthopedic stability
What does irreversible occlusal therapy permanently alter?
The occlusal condition and/or mandibular position
What are examples of irreversible occlusal therapy?
Selective grinding or restorative procedures
What are indications if a patient responds successfully to reversible occlusal therapy?
Irreversible occlusal therapy may be helpful
What can increased levels of emotional stress affect?
Muscle function by increasing the resting activity, increasing bruxism, or both
What are other disorders that may activate the autonomic nervous system?
- irritable bowel syndrome
- premenstrual syndrome
- intestinal cystitis
- fibromyalgia
What does evidence suggest about greater levels of emotional stress and what it can create?
Increased parafunctional activity in the masticatory system
What is a correlation drawn between?
Increased levels of anxiety, fear, frustration, and anger and muscle hyperactiviy
What do more challenging patients suffer from?
OCD, PTSD, patients that suffered from physical or sexual abuse, depression
What happens when psychologic therapy is indicated?
The patient should be referred to a properly trained therapist
What should the first treatment be when a patient comes to the dentist with symptoms closely related to muscle hyperactivity?
Educate the patient regarding the relationship between emotional stress, muscle hyperactivity and the problem
What happens once the emotional stress problem is understood?
Anxiety will be reduced, which often reduces pain
What is a general rule?
“if it hurts, don’t do it”
What does “if it hurts, don’t do it” mean?
The diet should be altered
The patient is encouraged to eat softer foods, take smaller bites, and generally chew slowly
What should a patient do if they find their teeth contacting, other than swallowing, chewing or speaking?
Immediately disengage them
What are other habits that can aggravate TMD symptoms?
Biting on objects, chewing on ice, or heavy gum chewing
What are the two types of relaxation therapy?
Substitutive
Active relaxation
What is substitutive therapy?
A substitution for stressful events or an interposition between them (activities that they enjoy, regular exercise)
What is active relaxation therapy?
Therapy that directly reduces muscle activity (pt is trained to relax the symptomatic muscles, biofeedback, negative biofeedback)
The evaluation of levels of emotional stress in a patient’s life is extremely __________
Difficult
When high levels of emotional stress are suspected as an etiologic factor contributing to a disorder, _____________ should be initiated
Stress reduction therapy
What is a very effective way of starting a stress reduction therapy?
Establishing a positive doctor patient relatinoship
When should a stress reduction therapy approach be presented?
Early in the tx plan so the patient can appreciate the relationship between pain, emotional stress, and the dental procedures that may be offered
What therapy is of little use in the case of macrotraums?
Definitive therapy since the trauma is no longer present
What therapy is of necessary in the case of microtraums?
Definitive therapy that consists on developing orthopedic stability
There is no correlation between the amount of __________ and _________
Bruxing activity; pain
What should patient education begin by?
Informing the patient that the teeth should only contact during chewing, speaking, and swallowing
What is nocturnal bruxism influences by?
Factors such as emotional stress levels and sleep paterns
What can nocturnal bruxism be reduced with?
Occlusal appliance therapy
What is supportive therapy directed toward?
Altering the patients symptoms, often has no effect on the etiology of the disorder
What is supportive therapy extremely helpful in?
Providing immediate relief on the symptoms
Supportive therapy is only ____ and not replacement for _____ therapy
Symptomatic; definitive
What are the two types of supportive therapy?
- Pharmacological therapy
- Physical therapy
What are the most common classes of pharmacologic agents for the management of TMDs?
- analgesics
- antiinflammatories
- muscle relaxants
- anxyolitics
- antidepressants
- anticonvulsives
What is physical therapy?
Group of supported activities that is instituted in conjunction with definitive treatment
What are modalities of physical therapy?
Thermotherapy
Coolant therapy
What is thermotherapy?
Heat is the prime mechanism,
Based on the premise that it increases the circulation to the applied area
What is coolant therapy?
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
What is ultrasound therapy?
Method of producing an increase in temperature at the interface of the tissues and therefore affects deeper tissues than does surface heat
What is ultrasound therapy used in conjunction with?
Surface heat, especially when treating a post trauma patient
What principle does electrogalvanic therapy use?
Electric current will cause a muscle to contract
How does electrogalvanic therapy work?
Rhythmic electrical impulse is applied to the muscle, creating repeated involuntary contractions and relaxations
What is transcutaneous electrical nerve stimulation?
Continuous stimulation of cutaneous nerve fibers at a subpainful levels
What does transcutaneous electrical nerve stimulation use?
A low voltage, low amperage current of varies frequency
What are manual techniques?
Soft tissue mobilization
Joint mobilization
What is soft tissue mobilization?
Superficial and deep massage
What is joint mobilization technique?
Gentle distraction of the joint
What is muscle conditioning?
Exercises that can help restore normal function and range of movement
When is assisted muscle stretching used?
When there is a need to regain muscle length
Should never be sudden or forceful
What is accupuncture?
Stimulation of certain areas that causes the release of endogenous opioids which reduces painful sensations
