dysaesthesia + tmd

Question 1

What is oral dysaesthesia?

Answer 1

An abnormal sensory perception in the absence of abnormal stimuli

Question 2

What are the 2 types of oral dysaesthesia?

Answer 2

Somatoform - perception and understanding of information is wrong
Neuropathic - abnormal sensory stimulus and nerves function incorrectly

Question 3

Give 4 examples of common dysaesthesias

Answer 3

Burning or nipping feeling
Dysgeusia - foul, salty or metallic taste
Paraesthetic feeling
Dry mouth feeling

Question 4

Give 4 predisposing factors for oral dysaesthesia

Answer 4

Deficiencies - haematinics, zinc, vitamin B1 and B6
Fungal and viral infections - ensure pt doesn’t have a treatable medical condition
Anxiety and stress
Gender - woman more likely to present than men

Question 5

What is burning mouth syndrome most associated with?

Answer 5

Haematinic deficiency

Question 6

Why is the site of burning mouth important?

Answer 6

Lips and tongue most likely to be parafunction
Multiple other sited most likely to be dysaesthesia

Question 7

What is dysgeusia?

Answer 7

Bad taste, bad smell
Nothing detected by practitioner
Nothing found on examination

Question 8

What is touch dysaesthesia and what should be done?

Answer 8

Pins and needles feeling
Normal sensation to objective testing despite pins and needles feeling
Cranial nerves must be tested
MRI is essential to check for demyelination or tumour

Question 9

Describe a dry mouth dysaesthesia and what should be done

Answer 9

Most common oral dysaesthesia
Patient complains of debilitating dry mouth
Patient eats okay
Worse when waken at night
Usually associated with anxiety disorders
Investigate as if patient has Sjögren’s - salivary flow, autoantibodies - should get no positive findings

Question 10

How are dysaesthesias managed?

Answer 10

Explain condition to patient - mouth may be normal, but the way you’re feeling isn’t normal
Assess degree of anxiety
Patient must have control and understand the condition
Anxiolytic medication eg - nortriptyline, mirtazepine, vortioxetine
Neuropathic medication eg - Gabapentin, pregabalin, clonazepam

Question 11

How are patients with TMD classed?

Answer 11

Joint degeneration - pain on use and crepitus
Locking open or close
No joint pathology

Question 12

How can you guess if a patient has TMJ joint pathology or not?

Answer 12

If joint pathology, patient will often put a single finger directly on the TMJ
If no pathology, patient will use many fingers or open palm to show where pain is

Question 13

Give 4 possible causes of TMD

Answer 13

Occlusion
Grinding
Clenching
Stress

Question 14

Give 4 physical signs of TMD

Answer 14

Any fromL
- clicking joint
- locking with reduction
- limiting of opening mouth
- tenderness of masticatory muscles
- tenderness of cervical-cranial muscles
- scalloped tongue
- linea alba

Question 15

Give 4 common examination findings in TMD

Answer 15

Any from:
- joint noise
- deviation on opening
- dental occlusion upset
- focal muscle tenderness - masticatory, SCM and trapezius
- tenderness of TMJ
- limited opening

Question 16

What investigations are used for TMD?

Answer 16

Usually none indicated
Ultrasound scan - if visualisation of disc movement is needed
OPT or CBCT - if bony problem suspected
MRI - best image of disc
Arthroscopy to directly visualise the disc

Question 17

How is TMD managed?

Answer 17

Patient info - how they can self help
Physical therapy - CBT, exercise, diet and analgesics
Bite splint
Tricyclics
Other anxiolytics such as diazepam
Physiotherapy
Acupuncture
Clinical psychology

Question 18

How do children often present with TMD?

Answer 18

Tendency to anxiety neurosis
May be a maladaptive response to a normal change