9. Temporomandibular Dysfunction Flashcards
What is the main blood supply to TMJ ?
Deep auricular artery.
Branch of maxillary artery.
What is the 3 main nerve supplies to TMJ ?
Auriculotemporal.
Masseteric.
Deep temporal nerve.
Does the posterior band of the articular disc have nerve innervation - yes or no ?
No
Does bilaminar zone of articular disc have nerve innervation - yes or no ?
Yes
What are the main causes of TMD ?
Myofascial pain.
Disc displacement.
Degenerative disease.
Chronic recurrent dislocation.
Ankylosis.
Hyperplasia.
Neoplasia.
Infection.
Trauma.
Stress.
Inflammation secondary to parafunctional habits.
Occlusal abnormalities.
Define anterior disc displacement with reduction.
Disc slips forward out of place (past the condyle) but can resolve itself and slip back into position.
What is localised degenerative disease associated with TMD ?
Osteoarthritis
What is generalised (systemic) degenerative disease associated with TMD ?
Rheumatoid arthritis
What is crepitus associated with ?
Arthritic change in the TMJ
What should be examined extra-orally in patient reporting TMD ?
MoM.
Joints - clicks or crepitus.
Jaw movements.
Facial asymmetry.
What should be examined intra-orally in patient reporting TMD ?
Interincisal mouth opening.
Signs of parafunctional habit - cheek biting, linea alba, tongue scalloping, occlusal non-carious tooth surface loss (attrition).
Common clinical features - what gender is TMD most associated with ?
Females
Common clinical features - what age is TMD most associated with ?
18-30
Common clinical features - what might a patient with TMD report ?
Intermittent pain for several months.
Muscle, joint, ear pain.
Trismus.
Clicking.
Headaches.
Worse in the morning.
What might TMD be confused with in differential diagnosis ?
Third molar dental pain.
Sinusitis.
Ear pathology.
Referred neck pain.
Headaches.
Atypical facial pain.
Trigeminal neuralgia.
Angina.
Condylar fracture.
Temporal arteritis.
What medications can be prescribed for TMD ?
NSAIDs.
Muscle relaxants.
Tricyclic antidepressants.
Botox.
Steroid injections.
What advice should be given to patients experiencing TMD ?
Soft diet.
Masticate bilaterally.
No wide opening.
No chewing gum.
Cut food into small pieces.
Avoid parafunctional habits.
Support mouth on opening.
What are the potential physical therapy options for TMD ?
Massage/heat - 10/15 min compress.
Acupuncture.
Relaxation.
US therapy.
TENS.
Hypnotherapy.
Give 3 examples of bite raising appliances which can be prescribed for patients with TMD.
Anterior repositioning splint.
Wenvac splint.
Michigan splint.
Essex retainer.
How do bite raising appliances help TMD ?
Stabilise occlusion and improve function of masticatory muscles, decreasing abnormal activity.
What are two irreversible treatment options for TMD ?
Occlusal adjustment.
TMJ surgery.
Why does an IDB cause trismus ?
Haematoma in medial pterygoid, causing muscle spasm.
What are the three treatment options for trismus if no resolution after acute phase ?
Physiotherapy.
Therabite.
Jaw screw.
Name three TMJ surgeries.
- Athrocentesis.
- Arthroscopy.
- Disc repositioning.
- Disc repair/removal.
- Total joint replacement.
NICE guidelines - what are the criteria for TMD (patient should have one or more of the following clinical features) ?
Pain in TMJ or MoM provoked by palpation or jaw movement.
Reproducible joint noise on any jaw movement (with/without restricted opening).
Headache limited to temporal region.
Otalgia and/or tinnitus in absence of ear disease.
NICE guidelines - define chronic TMD.
Lasting more than 3 months.
NICE guidelines - list some differential diagnoses which should be eliminated when diagnosing TMD.
Dental cause.
Salivary gland disease.
Maxillary sinusitis.
Headache disorders.
Neuralgias.
Ear condition - otitis media/externa.
MRONJ.
What is the mechanism of action of diazepam ?
Benzodiazepine which increases effect of neurotransmitter GABA.
What are some side effects of diazepam ?
Confusion, drowsiness, ataxia, fatigue, withdrawal.
What are some medical contraindications to diazepam ?
Psychosis, acute pulmonary insufficiency, sleep apnoea, severe hepatic impairment, pregnancy, very elderly, history of addition.
What are some medication related contraindications to diazepam ?
Alcohol, antihypertensives, diuretics, vasodilators, antifungals, HIV medication.
List some conservative management techniques for treatment of TMD.
Soft diet.
Reassurance.
Local heat therapy.
Elimination of parafunctional habits.
Jaw joint and muscle exercises.
Bite raising appliance.
Replacement of dentures or missing teeth.
Anti-inflammatory medication (NSAIDs).
Anti-depressant medication.
SECONDARY CARE - why are anti-depressants beneficial in the management of TMD ?
Help with stress, improve sleep, anti-inflammatory and analgesic properties.
PRIMARY CARE - what can a GDP prescribe ?
Opioids, diazepam, NSAIDs - with advice from OS or OM.
SECONDARY CARE - what can OS or OM specialist prescribe ?
Tricyclic antidepressants, opioids, diazepam, botox therapy.
PRIMARY CARE - what is the review period ?
3 weeks.
No improvement or worsening symptoms ? Onward referral.
PRIMARY CARE - what are the benefits/problems of soft splint vs. hard splint ?
Will need to be replaced more often.
Less time consuming - does not require facebow transfer.
ANTERIOR DISC DISPLACEMENT WITHOUT REDUCTION - define luxation of TMJ.
Patient cannot manipulate back into position and requires clinical professional to manoeuvre.
ANTERIOR DISC DISPLACEMENT WITHOUT REDUCTION - define subluxation of TMJ.
Patient can manipulate into place.
What are three radiographic investigations which can be carried out for TMD ?
OPT including condyles.
Arthrogram.
MRI.
