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Prosthesis > Chapter 8: Aetiology, pathology and exploration of the TMJ > Flashcards

Chapter 8: Aetiology, pathology and exploration of the TMJ Flashcards

1
Q

TMJ pain-dysfunction syndrome concept:

A

Pain in the masticatory muscles with functional limitations of mandibular mobility

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2
Q

Aetiology of TMD

A
  • Emotional stress
  • Bruxism
  • Prematurity and interferences in normal occlusion with failure of muscle adaptation
  • Difficulty in mastication in patients with malocclusion
  • Ill lifting prosthesis
  • Rheumatoid arthritis
  • Trauma
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3
Q

What is bruxism?

A

Non-functional jaw movements of voluntary or involuntary character with grinding or clenching teeth

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4
Q

Chatacteristics of bruxism

A
  • Bad habits
  • The magnitude of the forces is 5 times higher
  • Overloaded muscles
  • The predominance of the horizontal forces
  • Isometric contraction
  • Protection reflexes disappear
  • Prematurity and interferences
  • Arthrosis due to cell proliferation causing shape alterations
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5
Q

How do prematurities and interferences affect muscular activity?

A

They cause muscular hyperactivity and inhibitory effect on functional activity

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6
Q

What is occlusal trauma?

A

3 different diagnoses:
1. Occlusal trauma is one of the terms used to describe the pathological changes or adaptations occurring in the periodontium because of excessive forces produces by muscles of mastication

  1. Occlusal trauma is an injury that occurs anywhere in the masticatory system because of an abnormal occlusal contact manifesting in the neuromuscular system
  2. Occlusal trauma is an injury on the insertion apparatus which is the result of excessive occlusal forces exceeding its tolerance limit, thus characterising a traumatic occlusion
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7
Q

What do emotional stress and malocclusion lead to?

A

They lead to muscle hyperactivity and pathology (surpassing capacity of adaptation

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8
Q

Clinical consequences on teeth:

A
  • Mobility
  • Recession
  • Tooth wear
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9
Q

Clinical consequences on muscles:

A
  • Spitting
  • Spasms
  • Myositis
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10
Q

What is spitting?

A

Increased muscle tone with pain and weakness when it is working but without functional limitation

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11
Q

What is a spasm?

A

Increased tone with episodic pain due to nonfunctional continuous contraction-relaxation and functional limitation by shortening

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12
Q

What is myositis?

A

Inflammation of the muscle which might be due to the prolonged spasm or infection with continuous pain irrespective of the muscle use and significant functional limitation

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13
Q

Clinical consequences on the TMJ

A
  • Muscular hyperactivity is pulling the disc forward (pterygoid contraction) and stretches the ligaments and the retro discal lamina
  • The disc moves forward, and the condyle is positioned in the posterior part of the disc instead of being in the centre which causes a click
  • If the situation persists, it may lead to luxation with elongated ligaments causing limitations and locking
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14
Q

Opening click without disc luxation:

A

Incoordination

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15
Q

Double-click on opening and closing or reciprocal:

A

Luxation

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16
Q

TMJ clicking can be (according to the period of clicks):

A
  • At the beginning of opening and end of closing: 20% (young patients)
  • In the middle of the opening and closing: 80%
  • At the end of the opening and the beginning of the closing
  • With reduction
  • Without reduction or locking
17
Q

Predisposing factors of joint:

A
  • Joint anatomy (articular eminence is inclined and requires a higher degree of rotation)
  • Condyles are flattened and small
  • Angled fossa
  • Laxity of the ligaments
  • Lateral pterygoid insertion
18
Q

What kind of TMJ clicking is treatable?

A

At the beginning of opening and at the end of closing

19
Q

Diagnosis of TMD

A
  • Clinical history
  • Examination
  • Complementary tests: X-ray, CT, CAT, NMR
20
Q

Clinical history of TMD

A
  • Pain (where it starts, location etc)
  • Dysfunction or functional limitation
  • Emotional stress
  • Tinnitus
  • Cervical pain
  • Headaches
  • Muscular pain: masseter, external pterygoid (behind the upper vestibular retromolar tuberosity), internal pterygoid and temporal
21
Q

Examination of TMD

A
  • Dental inspection
  • Analysis of mobility and amplitude
  • Palpation
22
Q

Palpation tests:

A
  • Static tests: impede movement against strong pressure. Painful, it comes from the muscle
  • Dynamic tests: mobility against light pressure. Painful, it comes from the joint of the muscle
23
Q

Analysis of mobility and amplitude:

A
  • Opening: degree of opening 45 mm and deviations. Assessment of elastic forces opening without pain
  • Laterality: 15 mm elastic end
  • Protrusion: 15 mm without deviation
  • Soft: indicates muscle problem
  • Hard: indicated TMJ disorder
24
Q

Radiological signs

A
  1. In the periodontium:
    - Widening of the periodontal space
    - Vertical bone resorption in wedge
    - Pulp stones
  2. In the teeth:
    - Hypercementosis
  3. In the TMJ:
    - Flattening of the articular surface
    - Subchondral sclerosis
    - The disappearance of joint space
25
Q

Treatment of TMD

A
  • Orthodontic treatment of malocclusions
  • Dental equilibration by selective grinding or occlusal adjustment
  • Mouthguard (night guard) or bite splint
  • Prosthetic rehabilitation treatment
  • Surgical treatment of TMJ
26
Q

What is an anterior disc displacement with reduction?

A

A clicking or popping sound occurs as the disc returns to its normal position in relation to the condyle. During the closure, the disc becomes anteriorly displaced again, sometimes accompanied by a second sound (reciprocal click).

27
Q

What is an anterior disc displacement without redcurrant¡acting (locking)?

A

It is a progression of anterior disc displacement with reduction. The displaced disc acts as a barrier and prevents full translation of the condyle. Only rotation occurs.

28
Q

What are the 3 main causes of internal derangement of the intra-articular disc?

A
  • Trauma
  • Abnormal functional loading joint
  • Degenerative joint disease
29
Q

What is the most common cause of internal derangement?

A

Acute trauma

Prosthesis (9 decks)

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