Final Exam Flashcards
2 Types of TMD
Myogenous TMD
Arthrogenous TMD
Mygoenous TMD
Muscle and ligament related
Arthrogenous TMD
Joint and bone related
TMD are
A common subgroup of orofacial pain disorders
There are 2 basic types of TMD
Joint Disc
The disc is vascular innervated and elastic
Lateral ptergyogid muscle is
Located in front of the disk and attached to the front of the disc
Reasons you cant open your mouth
If you cannot open your mouth might be because the disc is locked in front and then you’re hitting on the retrodiscal tissues causing pain
Retrodiscal tissue
Are innervated so if there is a load in the back it will be painful
Can apply loads to front because
Cartilage at the front of the disc is a vascular so there wont be any pain
Disc reduction
Bring the disc back into place
A good history taking is the
Basis of accurate diagnosis
Cardinal criteria to diangose TMD
Pain Limitation of function Limitation of movement Physical change Alternated jaw relationship Tempromandibular sounds that have increased in intensity and frequency
TMD: Limitation of function
Cannot bite
TMD: Limitation of movemnt
Cannot open or close mouth
TMD: Altered jaw relationship
Deviation instead of biting in a straight line
TMD: Sounds
CLicking can be normal what is very important is that the sounds are increasing in intensity and frequency
Articulator eminence angle defines
Condylar Guidance
Around 30-40 degrees
When trying to replicated TMD
You cannot Control Articulator eminence angles can only simulate in articulator
Cannot replicate joint only the teeth
Mandible works in what plane
Circular plane so it drops more in the back than in the front
Articulator is only one plane so anterior teeth must be set a lower angle (20 degrees) Posterior teeth (30 degrees)
Articulator is only one plane so anterior teeth vs posterior
Anterior teethmust be set a lower angle (20 degrees) Posterior teeth (30 degrees)
Etiology TMD
Issues with Pulp Occlusal Perio Muscles of mastication Joint Ear infections Neck muscles
Tolerance
The body will tolerate the problem for a narrow period of time. If you keep ignoring it then you end up with a problem
TMJ innervated
CN V
CN VII
Can cause referred pain
TMD is a disease that has
A multifactorial etiology
TMD etiologic factors may be classified into
Predisposing factors
Initiating factors
Perpetuating factors
TMD: Predisposing factors
Increase the risk of TMD
Systemic, occlusal, loss of posterior teeth
TMD: Initiating Factors
Cause TMD
Trauma, parafunctional habits
TMD: Perpetuating factors
Enhance progression of TMD
Behavioral, social, or emotional stress
Factors associated with TMD
Occlusal condition Trauma Emotional stress Deep Pain input Parafunctional activities
Problems in bringing teeth together into MI are reflected in the
Muscles
Once the teeth are in occlusion problems in loading the mastication structures are reflected in
The joints
Introduction of an acute condition——>
Presence of orthopedic instability
Orthopedic stability occurs when
The stable MI position of teeth is in harmony with the musculoskelatlyl stable position of the condyles in their fossa
Activities of the mastication system
Functional
Parafunctional
Functional activities of masticatory system
Chewing eating and swallowing
Parafunctional activities of masticatory
Diurnal parafunctilal activity
Nocturnal parafunctional
Diurnal Parafunctional activity
Clenching eating swallowing
Cheek and tongue biting
Finger and thumb sucking
Nocturnal Parafunctional activity
Bruxing-clenching and grinding result in the same consequence as clenching and grinding
Prosthetic treatment in TMD should only be carried out
After reversible therapy (night guard) has resulted in relief of pain and function
Dentist must refrain from providing dental therapies if
Occlusal interferences are not related to symptoms
TMD Treatment Modalities
Conservative
No conservative
Conservative modalities
Reversible non invasive
Nonconservative modalities
Irreviesrible
Surgery
Definitive treatment
Intended to directly eliminate or alter the cause o the disorder and its consequences
Supportive therapy
Not treating the problem but helping ease the pain/discomfort
Supportive therapy is directed toward
Altering the patients symptoms and reducing pain and dysfunction
Supportive therapy has _____ on the cause of disorder
No effect
Pharmacological
Physical therapy
Analgesics
Aspirin
Anti-inflammatory
Ibuprofen
Muscle relaxants
Soma
Anxiolytics agents
Valium
Antidepressant
Prozac
Anticonvulsant
Lyrics
Occlusal appliance material
Hard acrylic
Positive Occlusal contact
With teeth in opposing arch
Teeth do not touch anymore
Uses of occlusal appliances
Temporarily provides a more ortho-pedically stable joint position
To introduce an optimum functional occlusion that reorganizes the neuromuscular reflex activity
To protect teeth and supportive structures from abnormal forces that may create breakdown or occlusal wear
Occlusal appliances reduce what activity
They reduce parafunctional muscle activity, hence reduce myogenous pain
Occlusal appliances also reduce forced placed on
The TMJs and other structures within the masticatory system
When these structures are unloaded the associated symptoms decrease
Common features to all occlusal appliances
Temporary alteration of occlusal condition
Alteration of the condylar position
Increase in vertical dimension
Cognitive awareness
Placebo effect
Types of occlusal appliances
Stabilization appliance
Anterior positioning appliance
Anterior bite plane
Posterior bite plane
Pivoting appliance
Soft appliance
Most common appliance
Stabilization appliance
Easiest
Soft appliances are not
Therapeutic but might relieve pain
Not manufactured by dentist
Stabilization appliance is generally fabricated for
The maxillary arch and provides optimum functional occlusion
When stabilization appliance is in place the condyles are
In there most musculoskelatly stable position at the time when the teeth are contacting evenly
Primary goal of stabilization appliance
Elimante any orthopedic instability
Static
Don’t move
Dynamic
Do move
Goal of prosthodontic treatment
PRESERVE what remain
Support reaming teeth and provide a substitute for missing teeth
Relationship between elements
Dental compositions (micro)
Dentofacial composition (mini)
Facial composition (macro)
Esthetic harmony
Harmony depends on equilibrium between distractive elements
Frame of Reference
Bridge of nose
Philtrum
Face midline
Dental midline
Philtrum
BEST reference to find midline of the face
Not nose
Face midline
Should match the midline of the maxillary and mandibular teeth midline
Dental Midline
Studies have shown that the mean threshold for acceptable dental midline deviations is 2.2+/-1.5 mm
Esthetics depends largely on
Proportion
Unattractive if
Top heavy
Squat
Out of proportion
Golden proportion
How much smaller each tooth is compared to the one adjacent to it
Pythagoras
1/1/618
Plato
1/1.733
Increased embrasure is seen in
Young dentition and a restoration with unnaturally reduced embrasures
Incisor angulation slight______ is acceptable but ______ should be avoided
Mesial
Distal
Lip Line
Upper Lip
High: Enitre length of the tooth
Moderate
Low: hides margins and defects
Smile Line
Has to do with the teeth
Imaginary line that curves with the lower lip
More pronounced in women
Hypoethical curved line drawn along the edges of maxillary anterior teeth that has to coincide or run parallel to the curve a true of the lower lip
Buccal Corridor
Dark triangle on the side of the lips-are a singe of beauty
No corridor —>
Mouth full of teeth
Dominance
Primarily refers to the two central incisors
largest tooth that shows the highest in value
Brightest and stands out more
Embrasures
Form
Symmetry
Progression
Dental morphology
Contact areas
Embrasures
Texture
Gingival Morphology
Gingival tissue and racial factor
Gingival health and contour
Gingival zenith