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BDS4 Oral Surgery > 5 - TMD > Flashcards

5 - TMD Flashcards

1
Q

What is TMD also known as?

A
  • temporomandibular dysfunction
  • myofascial pain dysfunction
  • pain dysfunction syndrome
  • facial arthromyalgia
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2
Q

What are the causes of TMD pain?

A
  • myofascial pain
  • disc displacement
  • degenerative disease
  • chronic recurrent dislocation
  • ankylosis
  • hyperplasia
  • neoplasia
  • infection
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3
Q

What are the different types of disc displacement?

A
  • anterior with reduction
  • anterior without reduction
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4
Q

What degenerative diseases can affect the TMJ?

A
  • localised osteoarthritis
  • rheumatoid arthritis
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5
Q

What neoplasia can affect the TMJ?

A
  • osteochondroma
  • osteoma (benign)
  • sarcoma (malignant)
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6
Q

What is osteochondroma?

A
  • an overgrowth of cartilage and bone that happens at the end of the bone near the growth plate
  • most common non-cancerous bone growth
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7
Q

What is the pathogenesis of TMD pain?

A
  • inflammation of MOM or TMJ secondary to parafunction
  • trauma
  • stress
  • psychogenic
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8
Q

What should be assess in IO exam for TMD?

A
  • interincisal mouth opening- willis bite gauge
  • signs of parafunction
  • MOM
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9
Q

What are signs of parafunction IO?

A
  • cheek biting /buccal keratosis
  • linea alba
  • tongue scalloping
  • occlusal NCTSL
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10
Q

What is arthrography?

A

Fluid injected into joint and imaged

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11
Q

What different imaging techniques can be used to assess TMD?

A
  • OPT
  • CBCT
  • MRI
  • nuclear imaging (shows areas of increased cellular activity)
  • Ultrasound
  • Arthrography
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12
Q

What are the common clinical features of TMD?

A
  • 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 /crepitus
  • headaches
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13
Q

What does crepitus indicate with TMD?

A

Late degenerative changes

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14
Q

What differential diagnoses must be separated from TMD?

A
  • dental pain (8s)
  • sinusitis
  • ear pathology
  • salivary gland pathology
  • referred neck pain
  • headache
  • atypical facial pain
  • trigeminal neuralgia
  • angina
  • condylar fracture
  • temporal arteritis
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15
Q

What are the reversible treatment options for TMD?

A
  • patient education and counselling
  • physical therapy
  • medication
  • splints
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16
Q

What medication can be used to treat TMD?

A
  • NSAIDs
  • muscle relaxants
  • tricyclic antidepressants
  • botox (MOM)
  • steroids (intra-joint)
17
Q

What counselling can be offered to patients for TMD?

A
  • 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)
18
Q

What physical therapy can be offered to patients for TMD?

A
  • physiotherapy
  • massage and heat
  • acupuncture
  • relaxation and mindfulness
  • ultrasound therapy
  • TENS
  • hypnotherapy
19
Q

What splints can be offered to patients for TMD?

A
  • bite raising appliances
  • anterior repositioning splint
20
Q

How does ultrasound therapy treat TMD?

A
  • creates heat
  • uncommon
21
Q

What is important when providing a splint for TMD?

A
  • all occlusal surfaces must be covered
  • if not all surfaces covered, when used long term can cause over eruption of uncovered teeth
22
Q

example of BRA

A
  • Essix retainer
  • Michigan splint (hard acrylic)
23
Q

How do bite raising appliances BRA treat TMD?

A
  • stabilize occlusion
  • improve fx of MOM
  • decreasing abnormal activity
  • protect teeth in cases of grinding
24
Q

What are the irreversible treatment options for TMD?

A
  • occlusal adjustment
  • TMJ surgery
25
Q

What are the surgery options for TMD?

A
  • arthrocentesis
  • arthroscopy
  • disc-repositioning
  • disc repair/removal
  • high condylar shave
  • total joint replacement
26
Q

What causes clicking in the TMJ?

A
  • disc displacement 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
27
Q

what is disc displacement also called

A

internal derangement

28
Q

S + S of internal derangement

or disc displacment

A
  • jaw tightness/ locking - for short until disc reduces
  • mandible initially deviate to affected side before returning to midline
29
Q

what can disc displacment lead to if untreated

or internal derangement

A

osteoarthritis

30
Q

What are the treatment options for disc displacement with reduction?

A
  • counselling
  • limit opening
  • bite raising appliance
  • if painless, no treatment required
31
Q

What are possible causes of trismus from trauma?

A
  • IDB (haemotoma within medial pterygoid)
  • prolonged dental treatment
  • infection
32
Q

What are the treatment options for trismus from trauma (after acute phase)?

A
  • physiotherapy
  • therabite / stacked tongue depressors
  • jaw screw

BDS4 Oral Surgery (23 decks)

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