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physiology > Intro to TMD's > Flashcards

Intro to TMD's Flashcards

1
Q

What are TMD’s

A

Group of unreleated disease states with a common set of symptosm

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2
Q

what are the common set of symptoms form TMD

A

Pain and jaw dysfunction

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3
Q

why do dentist care about TMD

A

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

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4
Q

2 types of TMD’s

A

Extracapsular (non-joint related, usually muscaular)

Joint related

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5
Q

what is true TMJ disease

A

Joint related TMD

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6
Q

is all jaw pain/dysfunction TMD

A

No

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7
Q

other sources of jaw pain/dysfunction

A

Neuralgias
Headache
Neurological/neuromuscular disease
Coronary artery disease

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8
Q

what do we tend to mix symptoms with

A

mix symptoms such as muscle pain with diagnosis such as myofascial pain

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9
Q

what do we confer causation on

A

structural appearance (i.e disc is the center of the TMJ universe)

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10
Q

what are some misconceptions about TMS

A

assumption about causes
association with craizness
Mystery

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11
Q

How does one deal with TMD’s

A

manageing the problem

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12
Q

are TMD patients male or female

A

Most are female

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13
Q

what often comes along with TMD

A

most have concomitant depression, anxiety, firbomyalgia, irritable bowel syndrom…

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14
Q

treatment succes of TMD

A

some have very difficult problems and a few wont ever get well

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15
Q

what is pain

A

An unpleasant sensory and emotion experience associated with actual or potential tissue damage, or described in terms of such damage

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16
Q

what does pain include

A

an experience and knowing that it was bad

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17
Q

How to define pain clinicaly

A 
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...
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18
Q

how will a patient show well localized pain

A

one finger pointing

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19
Q

how will a patient show ill-defined pain

A

moves fingers/palm across cheek and temple

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20
Q

well localized pain is a symptom of what type of TMD

A

Joint pain

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21
Q

Ill definied pain is a symptom of what type of TMD

A

Muscle pain

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22
Q

masticatory muscle disorders from most common to least common

A 
Local myalgia
Myofascial pain
Centrally mediated myalgia
myospasm
Myositis
Myofibrotic contracture
masticatory muscle neoplasia
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23
Q

symptoms of local myalgia

A

stiff
sore
achy
cramp with chewing, opening wide, or awakening

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24
Q

Causes of local myalgia

A 
Ischemia
Bruxism
Fatigue
Splinting
delayed-onset muscle soreness
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25
Q

Diagnostic findings for local myalgia

A

Regional dull ache with function
No or minimal pain at rest
Local tenderness to palpation
absence of trigger points and pain referal patterns

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26
Q

Symptoms of Myofascial pain

A

Region dull, aching pain
Trigger points
OVerlap with tension-type headache

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27
Q

causes of myofascial pain

A

Not well understood

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28
Q

Diagnostic findings of myofascial pain

A

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

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29
Q

what is splinting

A

when pain in a joint, muscles stiffen up to hold the joint

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30
Q

what is soft end feel

A

at end of stretch, can keep going but with pain

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31
Q

what is a trigger point

A

a sensitive palpable nodule within the body of muscle

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32
Q

what may associate with trigger points

A

A taut band strand of contracted muscle

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33
Q

do we all agree trigger points exist

A

contraversial due to histo not showing anything

- may have high local levels of pain mediators

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34
Q

what can pressure to trigger points do

A

Cause pain referral in predictable patterns

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35
Q

how to treat trigger points

A

Injection (local anesthetic, corticosteroid, saline)
Dry needling
spray and stretch (Capocoolant spray)

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36
Q

symptoms of centrally mediated myalgia

A

Chronic, cont muscle pain

no clinical inflammation

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37
Q

Causes of central mediated myalgia

A

Prolonged nociceptive input
chronic autonomic upregulation
stress
other deep pain input

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38
Q

Diagnostic finds of Centrally mediated myalgia

A

Prolonged, Cont. pain by history`
Dull ache at rest
Aggravated by function and palpation
may have trigger points

39
Q

symptoms of myospas

A

Sudden involuntary tonic contracture
fasciculation
Cramping/tight feel

40
Q

Causes of myospasm

A

Ischemia
Neuromuscular disease
Hypokalemia

41
Q

Diagnostic findings fro myospsm

A

Acute onset of pain in function and rest
MArkedly reduced ROMO
increases EMG activiety

42
Q

what is Spasticity

A

cramp up of muscle to feel tightness and pain

43
Q

symptoms of myositis

A

Clinical inflammation over entire muscle

44
Q

CAuses of myositis

A

Direct trauma

Spreading infection

45
Q

Diagnostic findings of myositis

A 
PAin is continous
Diffuse tenderness
warmth
Edema
Moderate to severely limited ROM
46
Q

Symptoms of myofibrotic contracture

A

Shortened muscle

Painless unless stretch

47
Q

Causes of myofibrotic contracture

A

Long immobilization

infection or trauma causing fibrosis

48
Q

Diagnostic findings of myofirotic contracture

A

Limited ROM
Unyielding stop (hard end feel)
little or no pain

49
Q

symptoms of masticatory muscle neoplasia

A

Intramuscular swelling with or without pain

limited movement

50
Q

Causes of masticatory muscle neoplasia

A

intramuscular neoplasm
Benign or malignant
Primary of metastatic

51
Q

Diagnostic findings of masticatory muscle neoplasia

A

Swelling
trismus
Paresthesia
Variable pain

52
Q

what makes up the TMJ

A 
Temporal bone
Mandible
Fibrous capsul
Lateral pterygoid msucle attachments
Interpositional fibrocarilage disk
53
Q

what parts of the temporal bone are invovled in the TMJ

A

tympanic plate posterior
Glenoid (articular) fossa
Articular eminence

54
Q

what part of the mandible is invovled in the TMJ

A

mandibular condyle

55
Q

what binds the articular disk lateral and medialy

A

tightly bound to condyle laterally and medially

56
Q

how does the Disk attach to the posterior wall

A

Loose retrodiscall attachment

57
Q

what attaches the disk anterior and posteior

A

Loose conenctive tissue

58
Q

what lines the anterior and posterior recesses of the TMJ

A

synovium lining

59
Q

can the disk heal itself

A

Yes

60
Q

is the articular disk a meniscus

A

No

61
Q

roll of the retrodiscal zone

A

All the condyle to move forward by preventing a suction effect

62
Q

How far can the TMJ rotate

A

20mm

63
Q

how far can the TMJ translate

A

40-50mm

64
Q

how far can the TMJ move laterally

A

Contralateral 7-10mm

65
Q

what does protrusion do to the TMJ

A

translates both joints

66
Q

where is the disk when the mouth is closed

A

On the back surface of the articular emienence on top of the condyl

67
Q

where is the disk when the mouth is open

A

On top the condyl and underthe articular eminence

68
Q

how common is anterior disc displacement

A

Very common (12-45% of people)

69
Q

symptoms of anterior disc displacement

A

Frequenctly asymptomatic

70
Q

pathology for Anterior disc displacment

A

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

71
Q

what id the noticiable differnec with an anterior displaced sidk

A

MAkes an audible pop with condyl snapping below it

72
Q

possible problem with ADD

A

disc may obstrucut movement

pop does no occur and joint becomes locked

73
Q

are all displaced disc the same

A

No

74
Q

how can displaced disks be classified

A

Based on clinical and radiographic findings

75
Q

what happens to most people with Displaced discs

A

few jionts progress to the next stage

Most adapt and heal

76
Q

what happens if ADD doesn’t heal

A

Degenerative changes in articular surface and bone

77
Q

what is the degernation of articular surfaces and bone

A

Osteoarthrosis

78
Q

is TMJ Disease mechanical

A

Not always, incomplete and inaccurate, must also include inflammatory preocesses

79
Q

what are the pathways to osteoarthrosis

A 
Inflmmation
endocrine
MEtabolic
Development
Biomech
80
Q

how well do we undertsand arthralgia

A

Etiology is not well understood

81
Q

what we know for why arthralgia happens

A

systemic factors influence disease cource in several, with little clincial predcitve value

82
Q

What articular tissues can change

A

aritulcar fibrocartialge surfaces
Disc
Bone

83
Q

how can mobility be impaired

A 
Adhesions
Adhesive hypomobility (suction cup effect)
84
Q

what are some of the things that can be patholgoical affected tissue

A

Articualr tissues

Synovium

85
Q

How does the articular surface degrade under pathology

A

softening
Vascularization
Fibrillation
bone exposure

86
Q

Synovial pathology steps

A 
Hypertrophy
Hyperemia
Capillary dilation
Microbleeding
GRanulation, fibrosis
87
Q

adhesion types for pathogy

A

Light, filmy
Fibrous bands
Pseudowall

88
Q

Disk patholgy

A

Neovascularization
Fibrillation
Perforation

89
Q

Consequences of Hypomobility

A

Reduced disc movement
Reduced mandibular movement
Poor synovial fluid circulation
Declining joint health and function

90
Q

what does poor synovial fluid circulation lead to

A

Focal hypoxia
Impaired nutrition
Increased friction

91
Q

what does declining joint health and functino lead to

A

Inflammation

degeneration becomes self-sustaining

92
Q

treating pathology should have what characteristics

A

based on scientific validated diagnositic eval
Non-invasive
Reverse

93
Q

Common initial tratment to TMD

A

couseling
Anti-inflammtion
Occclusal orthootic (not jaw position and occlusion altering
Physical therapy

94
Q

what is done when non-surgical treatment fails fro intracapsular disease

A

do the least invasive surgical option likely to succeed

physiology (32 decks)

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