Etiologic Factors Underlying TMJD

Question 1

it is very important that the clinician treating TMDs have an appreciation of the relationship between sleep and ___

Answer 1

muscle pain

Question 2

approximately ___% of the sleep period of an adult is made up on non-REM sleep

Answer 2

80% (so, 20% is REM sleep)

Question 3

non-REM sleep is thought to be important in restoring the function of ___. during this phase, there is an increase in synthesis of ___.

Answer 3

• body systems

- vital macromolecules (proteins, RNA)

Question 4

REM sleep is important in restoring the function of ___, where ___ are dealt with and smoothed out.

Answer 4

• cerebral cortex and brainstem

- emotions

Question 5

when an individual is deprived of ___ sleep, certain emotional states become predominant, including greater anxiety and irritability, and difficultly concentrating

Answer 5

REM

Question 6

REM sleep is important for ___ rest, while non-REM sleep is important for ___ rest.

Answer 6

• psychic

- physical

Question 7

when a patient is experimentally deprived of ___ sleep for several nights, he or she will often begin to complain of musculoskeletal tenderness, aching, and stiffness, which may result from their inability to restore metabolic requirements

Answer 7

non-REM

Question 8

studies have shown that bruxing may be closely associated with the ___ phases of sleep

Answer 8

arousal

Question 9

describe the number and duration of bruxing events

Answer 9

• variable between individuals
• average of 5-6 seconds per event
• voluntary clenching of 20-60 seconds elicits pain in jaw muscles

Question 10

nocturnal bruxing can reach ___% of voluntary maximum clench

Answer 10

60%

Question 11

one factor that seems to influence bruxing activity is ___

Answer 11

emotional stress

Question 12

what are 5 signs and symptoms of bruxing and clenching?

Answer 12

muscle hypertrophy, attrition of occlusal surfaces, fracture of teeth/restorations, tooth mobility, pain (muscle, skeletal, dentition)

Question 13

what are some important history and exam findings for patients with TMD?

Answer 13

headaches upon wakening, localized tooth pain, localized muscle pain

Question 14

if symptoms become prolonged, the pain condition can move from ___ to ___

Answer 14

acute to chronic

Question 15

if symptoms are prolonged and the pain condition moves from acute to chronic, the ___ can be altered, making management more complicated

Answer 15

CNS

Question 16

as pain moves from acute to chronic and the CNS is altered, what 3 areas might be altered? what happens when this occurs?

Answer 16

• hypothalamus-pituitary-adrenal axis, central sensitization, and reduction in descending inhibitory control
• more chronic pain conditions may develop which cannot be managed by addressing the five etiologic factors (occlusal factors, trauma, emotional stress, deep pain input, parafunction)

Question 17

what are 4 examples of chronic pain conditions?

Answer 17

chronic TMD, myofascial pain, fibromyalgia, sleep disturbances

Question 18

orthopedic stability exists when the stable ___ of teeth is in harmony with the ___

Answer 18

intercuspal position of the teeth is in harmony with the musculoskeletally stable position of the condyles in the fossae

Question 19

describe CR vs CO discrepancies as they relate to orthopedic stability

Answer 19

• stable muscles and joint in CR
• stable tooth to tooth contact in CO
• disharmony can lead to symptoms (adaptability, degree of instability and amount of loading)

Question 20

___ is an inclusive term referring to any increased level of muscle activity that is not associated with a functional activity

Answer 20

muscle hyperactivity

Question 21

muscle hyperactivity includes what 3 things?

Answer 21

bruxing, clenching, and increase in muscle tonicity related to habits, posture, or increased emotional stress

Question 22

describe what can happen if the occlusal condition is altered in an attempt to manage muscle hyperactivity

Answer 22

the introduction of an experimental interference can lead to painful symptoms, and acute changes in occlusal conditions can precipitate a protective response of the muscle (protective co-contraction)