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BDS4 CDS Oral Surgery > 9. Temporomandibular Dysfunction > Flashcards

9. Temporomandibular Dysfunction Flashcards

1
Q

What is the main blood supply to TMJ ?

A

Deep auricular artery.

Branch of maxillary artery.

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2
Q

What is the 3 main nerve supplies to TMJ ?

A

Auriculotemporal.
Masseteric.
Deep temporal nerve.

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3
Q

Does the posterior band of the articular disc have nerve innervation - yes or no ?

A

No

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4
Q

Does bilaminar zone of articular disc have nerve innervation - yes or no ?

A

Yes

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5
Q

What are the main causes of TMD ?

A

Myofascial pain.
Disc displacement.
Degenerative disease.
Chronic recurrent dislocation.
Ankylosis.
Hyperplasia.
Neoplasia.
Infection.
Trauma.
Stress.
Inflammation secondary to parafunctional habits.
Occlusal abnormalities.

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6
Q

Define anterior disc displacement with reduction.

A

Disc slips forward out of place (past the condyle) but can resolve itself and slip back into position.

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7
Q

What is localised degenerative disease associated with TMD ?

A

Osteoarthritis

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8
Q

What is generalised (systemic) degenerative disease associated with TMD ?

A

Rheumatoid arthritis

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9
Q

What is crepitus associated with ?

A

Arthritic change in the TMJ

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10
Q

What should be examined extra-orally in patient reporting TMD ?

A

MoM.
Joints - clicks or crepitus.
Jaw movements.
Facial asymmetry.

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11
Q

What should be examined intra-orally in patient reporting TMD ?

A

Interincisal mouth opening.
Signs of parafunctional habit - cheek biting, linea alba, tongue scalloping, occlusal non-carious tooth surface loss (attrition).

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12
Q

Common clinical features - what gender is TMD most associated with ?

A

Females

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13
Q

Common clinical features - what age is TMD most associated with ?

A

18-30

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14
Q

Common clinical features - what might a patient with TMD report ?

A

Intermittent pain for several months.
Muscle, joint, ear pain.
Trismus.
Clicking.
Headaches.
Worse in the morning.

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15
Q

What might TMD be confused with in differential diagnosis ?

A

Third molar dental pain.
Sinusitis.
Ear pathology.
Referred neck pain.
Headaches.
Atypical facial pain.
Trigeminal neuralgia.
Angina.
Condylar fracture.
Temporal arteritis.

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16
Q

What medications can be prescribed for TMD ?

A

NSAIDs.
Muscle relaxants.
Tricyclic antidepressants.
Botox.
Steroid injections.

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17
Q

What advice should be given to patients experiencing TMD ?

A

Soft diet.
Masticate bilaterally.
No wide opening.
No chewing gum.
Cut food into small pieces.
Avoid parafunctional habits.
Support mouth on opening.

18
Q

What are the potential physical therapy options for TMD ?

A

Massage/heat - 10/15 min compress.
Acupuncture.
Relaxation.
US therapy.
TENS.
Hypnotherapy.

19
Q

Give 3 examples of bite raising appliances which can be prescribed for patients with TMD.

A

Anterior repositioning splint.
Wenvac splint.
Michigan splint.
Essex retainer.

20
Q

How do bite raising appliances help TMD ?

A

Stabilise occlusion and improve function of masticatory muscles, decreasing abnormal activity.

21
Q

What are two irreversible treatment options for TMD ?

A

Occlusal adjustment.
TMJ surgery.

22
Q

Why does an IDB cause trismus ?

A

Haematoma in medial pterygoid, causing muscle spasm.

23
Q

What are the three treatment options for trismus if no resolution after acute phase ?

A

Physiotherapy.
Therabite.
Jaw screw.

24
Q

Name three TMJ surgeries.

A
  • Athrocentesis.
  • Arthroscopy.
  • Disc repositioning.
  • Disc repair/removal.
  • Total joint replacement.
25
Q

NICE guidelines - what are the criteria for TMD (patient should have one or more of the following clinical features) ?

A

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.

26
Q

NICE guidelines - define chronic TMD.

A

Lasting more than 3 months.

27
Q

NICE guidelines - list some differential diagnoses which should be eliminated when diagnosing TMD.

A

Dental cause.
Salivary gland disease.
Maxillary sinusitis.
Headache disorders.
Neuralgias.
Ear condition - otitis media/externa.
MRONJ.

28
Q

What is the mechanism of action of diazepam ?

A

Benzodiazepine which increases effect of neurotransmitter GABA.

29
Q

What are some side effects of diazepam ?

A

Confusion, drowsiness, ataxia, fatigue, withdrawal.

30
Q

What are some medical contraindications to diazepam ?

A

Psychosis, acute pulmonary insufficiency, sleep apnoea, severe hepatic impairment, pregnancy, very elderly, history of addition.

31
Q

What are some medication related contraindications to diazepam ?

A

Alcohol, antihypertensives, diuretics, vasodilators, antifungals, HIV medication.

32
Q

List some conservative management techniques for treatment of TMD.

A

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.

33
Q

SECONDARY CARE - why are anti-depressants beneficial in the management of TMD ?

A

Help with stress, improve sleep, anti-inflammatory and analgesic properties.

34
Q

PRIMARY CARE - what can a GDP prescribe ?

A

Opioids, diazepam, NSAIDs - with advice from OS or OM.

35
Q

SECONDARY CARE - what can OS or OM specialist prescribe ?

A

Tricyclic antidepressants, opioids, diazepam, botox therapy.

36
Q

PRIMARY CARE - what is the review period ?

A

3 weeks.
No improvement or worsening symptoms ? Onward referral.

37
Q

PRIMARY CARE - what are the benefits/problems of soft splint vs. hard splint ?

A

Will need to be replaced more often.
Less time consuming - does not require facebow transfer.

38
Q

ANTERIOR DISC DISPLACEMENT WITHOUT REDUCTION - define luxation of TMJ.

A

Patient cannot manipulate back into position and requires clinical professional to manoeuvre.

39
Q

ANTERIOR DISC DISPLACEMENT WITHOUT REDUCTION - define subluxation of TMJ.

A

Patient can manipulate into place.

40
Q

What are three radiographic investigations which can be carried out for TMD ?

A

OPT including condyles.
Arthrogram.
MRI.

BDS4 CDS Oral Surgery (18 decks)

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