Intro to TMD's Flashcards
What are TMD’s
Group of unreleated disease states with a common set of symptosm
what are the common set of symptoms form TMD
Pain and jaw dysfunction
why do dentist care about TMD
Patients may have a TMD
used to be treated by dentist in past
Dental health related to jaw
TMJ surgery remains under ORal maxofilogical surgery
2 types of TMD’s
Extracapsular (non-joint related, usually muscaular)
Joint related
what is true TMJ disease
Joint related TMD
is all jaw pain/dysfunction TMD
No
other sources of jaw pain/dysfunction
Neuralgias
Headache
Neurological/neuromuscular disease
Coronary artery disease
what do we tend to mix symptoms with
mix symptoms such as muscle pain with diagnosis such as myofascial pain
what do we confer causation on
structural appearance (i.e disc is the center of the TMJ universe)
what are some misconceptions about TMS
assumption about causes
association with craizness
Mystery
How does one deal with TMD’s
manageing the problem
are TMD patients male or female
Most are female
what often comes along with TMD
most have concomitant depression, anxiety, firbomyalgia, irritable bowel syndrom…
treatment succes of TMD
some have very difficult problems and a few wont ever get well
what is pain
An unpleasant sensory and emotion experience associated with actual or potential tissue damage, or described in terms of such damage
what does pain include
an experience and knowing that it was bad
How to define pain clinicaly
Location of symptom intensity of symptom (1-10) qualitiy of symptom (burning...) Onset of symptom + precipitat.ing factors Radiationof symptoms (show me where) associated symtpoms (sound...) Alleviating factors (avoid jaw function) Aggravating factors (singing.... which pain do you mean when you \_\_\_\_\_ [ what pain happens does it hurt before getting out of bed...
how will a patient show well localized pain
one finger pointing
how will a patient show ill-defined pain
moves fingers/palm across cheek and temple
well localized pain is a symptom of what type of TMD
Joint pain
Ill definied pain is a symptom of what type of TMD
Muscle pain
masticatory muscle disorders from most common to least common
Local myalgia Myofascial pain Centrally mediated myalgia myospasm Myositis Myofibrotic contracture masticatory muscle neoplasia
symptoms of local myalgia
stiff
sore
achy
cramp with chewing, opening wide, or awakening
Causes of local myalgia
Ischemia Bruxism Fatigue Splinting delayed-onset muscle soreness
Diagnostic findings for local myalgia
Regional dull ache with function
No or minimal pain at rest
Local tenderness to palpation
absence of trigger points and pain referal patterns
Symptoms of Myofascial pain
Region dull, aching pain
Trigger points
OVerlap with tension-type headache
causes of myofascial pain
Not well understood
Diagnostic findings of myofascial pain
regional pain aggravated by function
trigger point palpation causes wider area pain with predictable referral
reduction of pain with trigger point treatment
soft end feel with stretch
what is splinting
when pain in a joint, muscles stiffen up to hold the joint
what is soft end feel
at end of stretch, can keep going but with pain
what is a trigger point
a sensitive palpable nodule within the body of muscle
what may associate with trigger points
A taut band strand of contracted muscle
do we all agree trigger points exist
contraversial due to histo not showing anything
- may have high local levels of pain mediators
what can pressure to trigger points do
Cause pain referral in predictable patterns
how to treat trigger points
Injection (local anesthetic, corticosteroid, saline)
Dry needling
spray and stretch (Capocoolant spray)
symptoms of centrally mediated myalgia
Chronic, cont muscle pain
no clinical inflammation
Causes of central mediated myalgia
Prolonged nociceptive input
chronic autonomic upregulation
stress
other deep pain input
Diagnostic finds of Centrally mediated myalgia
Prolonged, Cont. pain by history`
Dull ache at rest
Aggravated by function and palpation
may have trigger points
symptoms of myospas
Sudden involuntary tonic contracture
fasciculation
Cramping/tight feel
Causes of myospasm
Ischemia
Neuromuscular disease
Hypokalemia
Diagnostic findings fro myospsm
Acute onset of pain in function and rest
MArkedly reduced ROMO
increases EMG activiety
what is Spasticity
cramp up of muscle to feel tightness and pain
symptoms of myositis
Clinical inflammation over entire muscle
CAuses of myositis
Direct trauma
Spreading infection
Diagnostic findings of myositis
PAin is continous Diffuse tenderness warmth Edema Moderate to severely limited ROM
Symptoms of myofibrotic contracture
Shortened muscle
Painless unless stretch
Causes of myofibrotic contracture
Long immobilization
infection or trauma causing fibrosis
Diagnostic findings of myofirotic contracture
Limited ROM
Unyielding stop (hard end feel)
little or no pain
symptoms of masticatory muscle neoplasia
Intramuscular swelling with or without pain
limited movement
Causes of masticatory muscle neoplasia
intramuscular neoplasm
Benign or malignant
Primary of metastatic
Diagnostic findings of masticatory muscle neoplasia
Swelling
trismus
Paresthesia
Variable pain
what makes up the TMJ
Temporal bone Mandible Fibrous capsul Lateral pterygoid msucle attachments Interpositional fibrocarilage disk
what parts of the temporal bone are invovled in the TMJ
tympanic plate posterior
Glenoid (articular) fossa
Articular eminence
what part of the mandible is invovled in the TMJ
mandibular condyle
what binds the articular disk lateral and medialy
tightly bound to condyle laterally and medially
how does the Disk attach to the posterior wall
Loose retrodiscall attachment
what attaches the disk anterior and posteior
Loose conenctive tissue
what lines the anterior and posterior recesses of the TMJ
synovium lining
can the disk heal itself
Yes
is the articular disk a meniscus
No
roll of the retrodiscal zone
All the condyle to move forward by preventing a suction effect
How far can the TMJ rotate
20mm
how far can the TMJ translate
40-50mm
how far can the TMJ move laterally
Contralateral 7-10mm
what does protrusion do to the TMJ
translates both joints
where is the disk when the mouth is closed
On the back surface of the articular emienence on top of the condyl
where is the disk when the mouth is open
On top the condyl and underthe articular eminence
how common is anterior disc displacement
Very common (12-45% of people)
symptoms of anterior disc displacement
Frequenctly asymptomatic
pathology for Anterior disc displacment
Most agree not a pathological condition
some say class II malocclusion may be caused by ADD
all agree that ADD can become patholgy in some individuals
what id the noticiable differnec with an anterior displaced sidk
MAkes an audible pop with condyl snapping below it
possible problem with ADD
disc may obstrucut movement
pop does no occur and joint becomes locked
are all displaced disc the same
No
how can displaced disks be classified
Based on clinical and radiographic findings
what happens to most people with Displaced discs
few jionts progress to the next stage
Most adapt and heal
what happens if ADD doesn’t heal
Degenerative changes in articular surface and bone
what is the degernation of articular surfaces and bone
Osteoarthrosis
is TMJ Disease mechanical
Not always, incomplete and inaccurate, must also include inflammatory preocesses
what are the pathways to osteoarthrosis
Inflmmation endocrine MEtabolic Development Biomech
how well do we undertsand arthralgia
Etiology is not well understood
what we know for why arthralgia happens
systemic factors influence disease cource in several, with little clincial predcitve value
What articular tissues can change
aritulcar fibrocartialge surfaces
Disc
Bone
how can mobility be impaired
Adhesions Adhesive hypomobility (suction cup effect)
what are some of the things that can be patholgoical affected tissue
Articualr tissues
Synovium
How does the articular surface degrade under pathology
softening
Vascularization
Fibrillation
bone exposure
Synovial pathology steps
Hypertrophy Hyperemia Capillary dilation Microbleeding GRanulation, fibrosis
adhesion types for pathogy
Light, filmy
Fibrous bands
Pseudowall
Disk patholgy
Neovascularization
Fibrillation
Perforation
Consequences of Hypomobility
Reduced disc movement
Reduced mandibular movement
Poor synovial fluid circulation
Declining joint health and function
what does poor synovial fluid circulation lead to
Focal hypoxia
Impaired nutrition
Increased friction
what does declining joint health and functino lead to
Inflammation
degeneration becomes self-sustaining
treating pathology should have what characteristics
based on scientific validated diagnositic eval
Non-invasive
Reverse
Common initial tratment to TMD
couseling
Anti-inflammtion
Occclusal orthootic (not jaw position and occlusion altering
Physical therapy
what is done when non-surgical treatment fails fro intracapsular disease
do the least invasive surgical option likely to succeed
