Lecture 14- TMJ Disorders Flashcards
what is the main reason for TMDs
trauma
describe the success rates of conservative and non conservative therapies
similar success rates on a long term basis 70-85%
what are the 2 groups of tx methods for TMDs and define each
-definitive treatments: directed to controlling or eliminating the etiologic factors that created the disorder
- supportive therapy: treatment methods directed towards altering patient symptoms but do not affect the etiology
what are the common events causing TMDs
local trauma or increase in emotional stress
what is the second influencing effect of occlusion and TMDs
orthopedic instability
what is the last etiology of TMDs
parafunctional activity, diurnal or nocturnal, bruxing or clenching
all initial treatment of TMDs should be____
conservative, reversible and noninvasive
what is occlusal therapy
any tx that is directed towards altering the mandibular position and/or occlusal contact pattern of the teeth
what is reversible occlusal therapy
-alters patient occlusion temporarily using an occlusal appliance like a night guard
how does reversible occlusal therapy provide orthopedic stability
when the occlusal appliance is worn an occlusal contact pattern is established that is in harmony with the optimum condyle disc fossa relationship
what is the purpose of an occlusal guard
orthopedic stability
what are examples of irreversible occlusal therapy
selective grinding or restorative procedures
how can increased levels of emotional stress affect muscle function
by increasing resting activity, increasing bruxism or both
what are other disorders that may activate the autonomic nervous ssystem
- IBS
- PMS
- intestinal cystisis
- fibromyalgia
what are the correlations between emotional stress and TMD
increased levels of anxiety, fear and frustration and anger and muscle hyperactivity
more challenging emotional stress patients suffer from
- OCD
-PTSD
-sufferers of physical or sexual abuse - depression
what should you do if a patient comes to the dentist with symptoms closely related to muscle hyperactivity
-educate the patient regarding the relationship between emotional stress, muscle hyperactivity and the problem
- refer to therapist
-once they understand problem, anxiety will be reduced which often reduces pain
what does “if it hurts dont do it” mean with food
encourage pt to eat softer foods, take smaller bites, and chew slowly
what other habits can aggrevate TMD symptoms
biting on objects
chewing on ice
heavy gum chewing
what are the two types of relaxation therapy and define them
- substitutive: a substitution for stressful events or an interposition between them (exercise, activities they enjoy)
- active relaxation: therapy that directly reduces muscle activity (train sympomatic muscles to relax, biofeedback, negative feedback)
what is an effective way to start stress reduction therapy
positive doctor patient relationship
how should stress reduction therapy be approached
present stress as a factor early in tx so the patient can appreciate the relationship between pain, emotional stress and the dental procedure
in the case of macrotrauma, definitive therapy is ____
of little use because the trauma is no longer present
in the case of microtrauma, definitive therapy is ____
necessary to curtail the trauma
definitive therapy would consist of ____
developing orthopedic stability
there is _____ between the amount of bruxing activity and pain
no correlation
how should patient education begin
by informing the patient that the teeth should only contact during chewing, speaking and swallowing
what is nocturnal bruxism influenced by
factors such as emotional stress levels and sleep patterns
what type of therapy is useful in providing immediate relief of the symptoms
supportive therapy
what are the 2 types of supportive therapy
pharmacological therapy and physical therapy
what are the common drugs used for pharmacological therapy
-analgesics
- antiinflammatories
- muscle relaxants
- anxyolitcs
-antidepressants
-anticonvulsives
what are the modalities of physical therapy
- thermotherapy: heat is prime mechanism because it increases circulation
- coolant therapy: cold relaxes the muscles and relieves the pain. should not be left on longer than 5 to 7 minutes
what is ultrasound therapy
method of producing an increase in temperature at the interface of the tissues and therefore affects deeper tissues than does surface heat
what should ultrasound therapy be used in conjunctio with
surface heat therapy
what is electrogalvanic therapy
utilizes the principle that an electric current will cause a muscle to contract
-rhythmic electrical impulse is applied to the muscle creating repeated involuntary contractions and relaxation
what is transcutaneous electrical nerve stimulation
- continuous stimualtion of cutaneous nerve fibers at a subpainful level
- uses low votlagge, low amperage current of varied frequency
what are manual techniques
-soft tissue mobilization: superficial and deep massage
- joint mobilization: gentle distraction of the joint
what is muscle conditioning
exercises that can help restore normal function and range of movement
when should assisted muscle stretching be done
when there is a need to regain muscle length
- but should never be sudden or forceful
what is acupuncture
-stimulation of certain areas that cause the release of endogenous opioids which reduces painful sensations
