General Considerations in Treatment of TMD

Question 1

the interrelationship of various tmj disordered always needs to be considered un the

Answer 1

evaluation and tx of patients

Question 2

— to any structure of the masticatory system can either cause or contribute to most tmds

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trauma

Question 3

treatment of tmds

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the tx that have been suggested vary over a great spectrum of modalities

Question 4

the support for the appropriate tx modalities should be found in

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evidence based lit

Question 5

some — factors that contribute to tmds are difficult to eliminate or control

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etiological

ex. stress

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(2) therapies seem to report similar success rates on a long term basis (70-85%)

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conservative and nonconservative

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• DEFINITIVE TREATMENTS:

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directed to controlling or eliminating the etiological factors that created the disorder

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• SUPPORTIVE THERAPY:

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treatment methods directed toward altering patient symptoms but often do not affect the etiology

Question 9

tmds result when

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normal activity is interrupted by an event

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common events may be

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• LOCAL TRAUMA OR INCREASE IN EMOTIONAL STRESS

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• SECOND INFLUENCING EFFECT OF OCCLUSION is through

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ORTHOPEDIC INSTABILITY

Question 12

another common etiology of tmds is

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• INCREASED EMOTIONAL STRESS

Question 13

any source of — may also be responsible for creating tmd

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deep pain

Question 14

the last etiology is (3)

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PARAFUNCTIONAL ACTIVITY, DIURNAL OR

NOCTURNAL, BRUXING OR CLENCHING

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ALL INITIAL TREATMENT SHOULD BE (3)

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CONSERVATIVE, REVERSIBLE AND

NONINVASIVE.

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OCCLUSAL THERAPY

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considered to be any treatment that is directed towards altering the mandibular position and/or occlusal contact pattern of the teeth

Question 17

REVERSIBLE OCCLUSAL THERAPY

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alters the patients occlusal condition only temporarily, and is best accomplished with an occlusal appliance

Question 18

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

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orthopedic stability

Question 19

IRREVERSIBLE OCCLUSAL THERAPY

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permanently alters the occlusal condition and or mandibular position
ex. selective grinding or restorative procedures

Question 20

When a patient responds successfully to reversible occlusal therapy, these appear
to be indications that

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irreversible occlusal therapy may also be helpful.

Question 21

DEFINITIVE THERAPIES FOR EMOTIONAL STRESS

— is one of several psychological factors that should be considered

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• EMOTIONAL STRESS

Question 22

increased levels of emotional stress can affect muscle function by

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increasing the resting activity, increasing bruxism or both

Question 23

other disordered that may activate the aNS: (4)

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IBS
premenstrual syndrome
intestinal cystitis
fibromyalgia

Question 24

some evidence demonstrates that greater levels of emotional stress can created

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increased parafunctional activity in the masticatory system

Question 25

a correlation can be drawn between

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increased levels of anxiety, fear, frustration, and anger and muscle hyperactivity

Question 26

some more challenging patients are those who suffer from (4)

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OCD PTSD physical/sexual abuse depression

Question 27

when psychologic therapy is indicated the patient should be referred to a

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properly trained therapist

Question 28

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)

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emotional stress, muscle hyperactivity and the problem

Question 29

once they understand the problem,

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anxiety will be reduced, which often reduces the pain

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a general rule is

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• IF IT HURTS, DON’T DO IT

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• IF IT HURTS, DON’T DO IT | this usually means that the --- should be altered

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diet the patient is encouraged to eat softer foods, take smaller bites, and chew slowly

Question 32

the patient should be instructed that any time they find their teeth contacting. other than swalling, shewing or speaking, they should

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immediately disengage them

Question 33

other symptom such as (3) can aggravate tmd symptoms

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BITING ON OBJECTS, CHEWING ON ICE, OR HEAVY | GUM CHEWING

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RELAXATION THERAPY: (2 types)

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SUBSTITUTIVE | • ACTIVE RELAXATION:

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SUBSTITUTIVE

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a sub for stressful events or an interposition between them (activities that they enjoy, regular exercise)

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ACTIVE RELAXATION

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therapy that directly reduces muscle activity | pt is trained to relax the symptomatic muscles, biofeedback, negative biofeedback

Question 37

the evaluation of levels of -- stress in a patients life is extremely difficult

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emotional

Question 38

when high levels of emotional stress are suspected as an etiological factor contributing to a disorder,

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stress reduction therapy should be initiated

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a very effective way of staring a stress reduction therapy is establishing a

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positive doctor-patient relationship

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THE APPROACH SHOULD BE TO PRESENT STRESS AS A FACTOR EARLY IN THE TREATMENT PLAN SO THE PATIENT CAN APPRECIATE THE RELATIONSHIP BETWEEN (3)

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PAIN, EMOTIONAL | STRESS, AND THE DENTAL PROCEDURES THAT MAY BE OFFERED.

Question 41

it is very helpful to provide --- that the patient can take home and read and more fully appreciate

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written info and instruction

Question 42

macrotrauma | --- therapy is of little use since the trauma is no longer present

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definitive

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microtrauma | --- is necessary to curtail the trauma.

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definitive therapy consist on developing orthopedic stability

Question 44

there is no correlation between the amount of bruxing activity and

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pain

Question 45

• PATIENT EDUCATION should begin by

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informing the patient that the teeth should only contact during chewing, speaking, and swalling

Question 46

• NOCTURNAL BRUXISM is usually influenced by factors such as (3)

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emotional stress levels and sleep patterns | in some cases is can be reduced with occlusal appliance therapy

Question 47

SUPPORTIVE THERAPY

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directed toward altering the patients symptoms, often has no effect on the etiology of the disorder

Question 48

SUPPORTIVE THERAPY is extremely helpful is providing

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immediate relief to symptoms

Question 49

SUPPORTIVE THERAPY | it is only symptomatic and not a replacement for

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definitive therapy

Question 50

• PHARMACOLOGICAL THERAPY: | the most common classes of pharmacological agents used for the management of tmds are (6)

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``` analgesics antiinflammatories muscle relaxants anyolitics antidepressents anticonvulsives ```

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• PHYSICAL THERAPY:

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group of supported activities that is instituted in conjunction with definitive treatment

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modalities of physical therapy

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thermotherapy

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thermotherapy

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heat is the prime mechanism | based on the premise that it increases the circulation to the applied area

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• COOLANT THERAPY:

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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

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ULTRASOUND THERAPY

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a method of producing an increase in temp at the interface of the tissues and therefore affects deeper tissues than does surface heat

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it has been suggested that it be used in conjunction with surface heat, especially when treating a

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post trauma patient

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ELECTROGALVANIC THERAPY

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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

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TRANSCUTANEOUS ELECTRICAL NERVE | STIMULATION

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continuous stimulation of cutaneous nerve fibers at a subpainful level

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TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION uses a

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low voltage, low amerage current of varied frequency

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• SOFT TISSUE MOBILIZATION:

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superficial and deep massage

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• JOINT MOBILIZATION:

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gentle distraction of the joint

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MUSCLE CONDITIONING

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exercises that can help restore normal function and range of movement

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ASSISTED MUSCLE STRETCHING

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used when there is a need to regain muscle length | should never be sudden or forceful

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ACUPUNCTURE

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stimulation of certain areas that causes the release of endogenous opioids which reduces painful sensations