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 pain?
- inflammation of MOM or TMJ secondary to parafunction
- trauma
- stress
- psychogenic
What should be assess in IO exam for TMD?
- interincisal mouth opening- willis bite gauge
- signs of parafunction
- MOM
What are signs of parafunction IO?
- cheek biting /buccal keratosis
- 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)
- Ultrasound
- Arthrography
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 /crepitus
- headaches
What does crepitus indicate with TMD?
Late degenerative changes
What differential diagnoses must be separated from TMD?
- dental pain (8s)
- sinusitis
- ear pathology
- salivary gland pathology
- referred neck pain
- headache
- atypical facial pain
- 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 counselling 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
example of BRA
- Essix retainer
- Michigan splint (hard acrylic)
How do bite raising appliances BRA treat TMD?
- stabilize occlusion
- improve fx of MOM
- decreasing abnormal activity
- 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 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 is disc displacement also called
internal derangement
S + S of internal derangement
or disc displacment
- jaw tightness/ locking - for short until disc reduces
- mandible initially deviate to affected side before returning to midline
what can disc displacment lead to if untreated
or internal derangement
osteoarthritis
What are the treatment options for disc displacement with reduction?
- counselling
- limit opening
- bite raising appliance
- if painless, no treatment required
What are possible 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
