5 - TMD Flashcards
What is TMD also known as?
- temporomandibular dysfunction
- myofascial pain dysfunction
- pain dysfunction syndrome
- facial arthromyalgia
What are the causes of TMD pain?
- myofascial pain
- disc displacement
- degenerative disease
- chronic recurrent dislocation
- ankylosis
- hyperplasia
- neoplasia
- infection
What are the different types of disc displacement?
- anterior with reduction
- anterior without reduction
What degenerative diseases can affect the TMJ?
- localised osteoarthritis
- rheumatoid arthritis
What neoplasia can affect the TMJ?
- osteochondroma
- osteoma (benign)
- sarcoma (malignant)
What is osteochondroma?
- an overgrowth of cartilage and bone that happens at the end of the bone near the growth plate
- most common non-cancerous bone growth
What is the pathogenesis of TMD?
- inflammation of MOM or TMJ secondary to parafunction
- trauma
- stress
- psychogenic
What should be assessed in IO exam for TMD?
- interincisal mouth opening
- signs of parafunction
- MOM
What are signs of parafunction IO?
- cheek biting
- linea alba
- tongue scalloping
- occlusal NCTSL
What is arthrography?
Fluid injected into joint and imaged
What different imaging techniques can be used to assess TMD?
- OPT
- CBCT
- MRI
- nuclear imaging (shows areas of increased cellular activity)
- US
What are the common clinical features of TMD?
- more common in females, 18-30 years
- intermittent pain over several months or years
- muscle/joint/ear pain
- increased on wakening
- trismus or locking
- clicking or popping
- headaches
What does crepitus indicate with TMD?
Late degenerative changes
What differential diagnoses must be separated from TMD?
- dental pain
- sinusitis
- salivary gland and ear pathology
- referred neck pain
- headache
- atypical facial pain and trigeminal neuralgia
- angina
- condylar fracture
- temporal arteritis
What are the reversible treatment options for TMD?
- patient education and counselling
- physical therapy
- medication
- splints
What medication can be used to treat TMD?
- NSAIDs
- muscle relaxants
- tricyclic antidepressants
- botox (MOM)
- steroids (intra-joint)
What advice can be offered to patients for TMD?
- reassurance
- soft diet, masticate bilaterally
- no wide opening, no chewing gum
- don’t incise foods, cut food into small pieces
- stop parafunctional habits
- support mouth on opening (ie yawning)
What physical therapy can be offered to patients for TMD?
- physiotherapy
- massage and heat
- acupuncture
- relaxation and mindfulness
- ultrasound therapy
- TENS
- hypnotherapy
What splints can be offered to patients for TMD?
- bite raising appliances
- anterior repositioning splint
How does ultrasound therapy treat TMD?
- creates heat
- uncommon
What is important when providing a splint for TMD?
- all occlusal surfaces must be covered
- if not all surfaces covered, when used long term can cause over eruption of uncovered teeth
How do bite raising appliances treat TMD?
- make wearers aware of habits
- should be worn at time of parafunction, they stabilise the occlusion and improve function of MOM
- protect teeth in cases of grinding
What are the irreversible treatment options for TMD?
- occlusal adjustment
- TMJ surgery
What are the surgery options for TMD?
- arthrocentesis
- arthroscopy
- disc-repositioning
- disc repair/removal
- high condylar shave
- total joint replacement
What causes clicking in the TMJ?
- disc displacement where the disc has slipped anteriorly
- the condyle has to overcome the obstruction of the anteriorly placed disc
- click occurs due to the uncoordinated movement of the disc and condyle
What are the treatment options for disc displacement with reduction?
- counselling
- limit opening
- bite raising appliance
- if painless, no treatment required
What are causes of trismus from trauma?
- IDB (haemotoma within medial pterygoid)
- prolonged dental treatment
- infection
What are the treatment options for trismus from trauma (after acute phase)?
- physiotherapy
- therabite / stacked tongue depressors
- jaw screw
