General Considerations in Treatment of TMD Flashcards
the interrelationship of various tmj disordered always needs to be considered un the
evaluation and tx of patients
— to any structure of the masticatory system can either cause or contribute to most tmds
trauma
treatment of tmds
the tx that have been suggested vary over a great spectrum of modalities
the support for the appropriate tx modalities should be found in
evidence based lit
some — factors that contribute to tmds are difficult to eliminate or control
etiological
ex. stress
(2) therapies seem to report similar success rates on a long term basis (70-85%)
conservative and nonconservative
• DEFINITIVE TREATMENTS:
directed to controlling or eliminating the etiological factors that created the disorder
• SUPPORTIVE THERAPY:
treatment methods directed toward altering patient symptoms but often do not affect the etiology
tmds result when
normal activity is interrupted by an event
common events may be
• LOCAL TRAUMA OR INCREASE IN EMOTIONAL STRESS
• SECOND INFLUENCING EFFECT OF OCCLUSION is through
ORTHOPEDIC INSTABILITY
another common etiology of tmds is
• INCREASED EMOTIONAL STRESS
any source of — may also be responsible for creating tmd
deep pain
the last etiology is (3)
PARAFUNCTIONAL ACTIVITY, DIURNAL OR
NOCTURNAL, BRUXING OR CLENCHING
ALL INITIAL TREATMENT SHOULD BE (3)
CONSERVATIVE, REVERSIBLE AND
NONINVASIVE.
OCCLUSAL THERAPY
considered to be any treatment that is directed towards altering the mandibular position and/or occlusal contact pattern of the teeth
REVERSIBLE OCCLUSAL THERAPY
alters the patients occlusal condition only temporarily, and is best accomplished with an occlusal appliance
when the occlusal appliance is worn an occlusal contact pattern is established that is in harmony with the optimum condyle-disc fossa relationship, therefore it provides
orthopedic stability
IRREVERSIBLE OCCLUSAL THERAPY
permanently alters the occlusal condition and or mandibular position
ex. selective grinding or restorative procedures
When a patient responds successfully to reversible occlusal therapy, these appear
to be indications that
irreversible occlusal therapy may also be helpful.
DEFINITIVE THERAPIES FOR EMOTIONAL STRESS
— is one of several psychological factors that should be considered
• EMOTIONAL STRESS
increased levels of emotional stress can affect muscle function by
increasing the resting activity, increasing bruxism or both
other disordered that may activate the aNS: (4)
IBS
premenstrual syndrome
intestinal cystitis
fibromyalgia
some evidence demonstrates that greater levels of emotional stress can created
increased parafunctional activity in the masticatory system
a correlation can be drawn between
increased levels of anxiety, fear, frustration, and anger and muscle hyperactivity
some more challenging patients are those who suffer from (4)
OCD
PTSD
physical/sexual abuse
depression
when psychologic therapy is indicated the patient should be referred to a
properly trained therapist
when a patient comes to the dentist with symptoms closely related to muscle hyperactivity, the first tx is to educate the patient regarding the relationship between (3)
emotional stress, muscle hyperactivity and the problem
once they understand the problem,
anxiety will be reduced, which often reduces the pain
a general rule is
• IF IT HURTS, DON’T DO IT
• IF IT HURTS, DON’T DO IT
this usually means that the — should be altered
diet
the patient is encouraged to eat softer foods, take smaller bites, and chew slowly
the patient should be instructed that any time they find their teeth contacting. other than swalling, shewing or speaking, they should
immediately disengage them
other symptom such as (3) can aggravate tmd symptoms
BITING ON OBJECTS, CHEWING ON ICE, OR HEAVY
GUM CHEWING
RELAXATION THERAPY: (2 types)
SUBSTITUTIVE
• ACTIVE RELAXATION:
SUBSTITUTIVE
a sub for stressful events or an interposition between them (activities that they enjoy, regular exercise)
ACTIVE RELAXATION
therapy that directly reduces muscle activity
pt is trained to relax the symptomatic muscles, biofeedback, negative biofeedback
the evaluation of levels of – stress in a patients life is extremely difficult
emotional
when high levels of emotional stress are suspected as an etiological factor contributing to a disorder,
stress reduction therapy should be initiated
a very effective way of staring a stress reduction therapy is establishing a
positive doctor-patient relationship
THE APPROACH SHOULD BE TO PRESENT STRESS AS A FACTOR EARLY IN THE TREATMENT
PLAN SO THE PATIENT CAN APPRECIATE THE RELATIONSHIP BETWEEN (3)
PAIN, EMOTIONAL
STRESS, AND THE DENTAL PROCEDURES THAT MAY BE OFFERED.
it is very helpful to provide — that the patient can take home and read and more fully appreciate
written info and instruction
macrotrauma
— therapy is of little use since the trauma is no longer present
definitive
microtrauma
— is necessary to curtail the trauma.
definitive therapy
consist on developing orthopedic stability
there is no correlation between the amount of bruxing activity and
pain
• PATIENT EDUCATION should begin by
informing the patient that the teeth should only contact during chewing, speaking, and swalling
• NOCTURNAL BRUXISM is usually influenced by factors such as (3)
emotional stress levels and sleep patterns
in some cases is can be reduced with occlusal appliance therapy
SUPPORTIVE THERAPY
directed toward altering the patients symptoms, often has no effect on the etiology of the disorder
SUPPORTIVE THERAPY is extremely helpful is providing
immediate relief to symptoms
SUPPORTIVE THERAPY
it is only symptomatic and not a replacement for
definitive therapy
• PHARMACOLOGICAL THERAPY:
the most common classes of pharmacological agents used for the management of tmds are (6)
analgesics antiinflammatories muscle relaxants anyolitics antidepressents anticonvulsives
• PHYSICAL THERAPY:
group of supported activities that is instituted in conjunction with definitive treatment
modalities of physical therapy
thermotherapy
thermotherapy
heat is the prime mechanism
based on the premise that it increases the circulation to the applied area
• COOLANT THERAPY:
cold encourages the relaxation of muscles that are in spasm. and thus relives pain
the ice should not be left on the tissues for longer than 5-7 min
ULTRASOUND THERAPY
a method of producing an increase in temp at the interface of the tissues and therefore affects deeper tissues than does surface heat
it has been suggested that it be used in conjunction with surface heat, especially when treating a
post trauma patient
ELECTROGALVANIC THERAPY
utilizes the principle that an electric current will cause a muscle to contract
a rhythmic electrical impulse is applied to the muscle, creating repeated involuntary contractions and relazations
TRANSCUTANEOUS ELECTRICAL NERVE
STIMULATION
continuous stimulation of cutaneous nerve fibers at a subpainful level
TRANSCUTANEOUS ELECTRICAL NERVE
STIMULATION
uses a
low voltage, low amerage current of varied frequency
• SOFT TISSUE MOBILIZATION:
superficial and deep massage
• JOINT MOBILIZATION:
gentle distraction of the joint
MUSCLE CONDITIONING
exercises that can help restore normal function and range of movement
ASSISTED MUSCLE STRETCHING
used when there is a need to regain muscle length
should never be sudden or forceful
ACUPUNCTURE
stimulation of certain areas that causes the release of endogenous opioids which reduces painful sensations
