LOL TMD Flashcards
Inflammation of the capsule ligaments with Joint soreness and inflammation
Capsulitis
What is the most common TMD diagnosis?
Capsulitis
Irritation to the Synovial Fluid, similar to Capsulitis
Synovitis
Bone inflammation, wear and tear arthritis
Ostoearthritis
Osteoarthritis is the most common due to…
overuse
Clicking and Popping are due to…
Internal Derangement
Every Arthritis can be in the _____
2 most common systemic arthritis found there…
jaw joint
osteoarthritis/rheumatoid
Joint inflamed b/c of injury, auto accident, etc…
Should be evaluated for?
Traumatic arthritis
TMD
Type of pain that refers from one place to another (tender point to a distant site).
Myofascial pain
Myofascial pain is ______ and treated with what?
Referred
Stretching, heat, cold, rest, Muscle Relaxants
Localized pain, same area
Myalgia
Type of pain that is referred:
Type of pain that stays local:
Myofascial
Myalgia
Most common muscle pain is ______ and responds to ______
Myalgia
Stretching
Muscle inflamed from injury (or infection)
Myositis
Most common cause of Myositis for Dentists:
Do not…
Use what 3 Tx?
Wisdom tooth extraction
stretch
NSAIDS, steroids, rest
A Charlie Horse, forceful painful contraction, very rare (tetanus like)
Spasm
Spasms may be caused due to low ______ or other minerals/homones
could also be caused by a ____
K+
virus
Muscle tightens to protect joints or other muscles
*must find cause/what trying to protect
Protective Splinting
If body is Protective Splinting, what do?
Tx cause, use Muscle Relaxants
*also rest/stretching
Muscle that has undergone degenerative change that causes the contracted state to persist:
Usually due to _____
Calcified Contracture is _____
Can be ______
Stuck in a certain position _______
Myofibrotic Contracture
injury/infection
rare
hereditary
permanently
Anterior Temporalis refers to:
Middle Temporalis:
Posterior Temporalis:
Mx anteriors
Mx PM’s
Mx Molars
Masseter refers to what 3 areas:
Ear
Lower molars
Above right eye
SCE refers to what 4 areas?
Ear
above eye (may be contralateral)
occiput
eye
Trapezius/Posterior Cervicalis refers to what 3 areas?
Temple
Ear
Eye
Lateral Pterygoid refers to what 3 areas?
TMJ
Eye
Zygoma
Differential Diagnosis important so Tx can be focused on joint or muscle
True
Jaw pain is usually _____
Joint or Muscle
Most TMD cases area a combo of both joint and muscle
True
Important to distinguish ADD w/o reduction early
True
When opening, if a jaw deflects to _______, required immediate attention
one side (locked)
What is the most common cause of TMD probs?
Multifactorial
List 6 contributing factors for TMD:
extrinsic trauma
hyper function of masticatory mm
hyperextension
occlusion
systemic disease
psychosocial
What is the most important thing when you screen a pt?
Hx
What treats Superior Capsulitis?
What does it use?
Unilateral Pivot
teeter/totter effect (pulls down one side of joint, lets heal)
What treats Posterior Capsulitis?
move Forward
*heals in anterior positioning device
What movement can aggravate lateral capsule?
Lateral
Mx Stabilization appliance stabilizes what?
eliminates:
reduces clenching force/joint loading by ___%
occlusion
fulcrums/interferences
70%
Mx Stabilization increases joint space
False
Mx Stabilization appliance should cover all teeth in what positions?
should have what kind of guidance?
CR, CO, MI
anterior/canine
Mn Stabilization has similar rules to Mx
True
(m, joint, both) Opening Pain:
Closing Pain:
Chewing Pain:
Moving the Head:
Sharp Pain:
Dull Pain:
Muscle or Joint
Joint
Muscle or Joint
Meck
Joint
Muscle
Pain associated with popping/clicking:
Side to side movement pain:
Limited opening w/o deviation
Limited opening with Deflection:
Joint
Joint
Muscle
Disc displaced/Joint
___% have at least 1 sign of joint dysfunction
___% has at least 1 symptom
____% of the population needs Tx
75%
33%
5-7%
Of the 5-7% of the population that need TMD Tx, % internal derangement?
arthritis:
masticatory muscle disorder?
31%
39%
30%
Females outnumber Males in TMD by what ratio?
4-5:1
___% of pts who come into your office have non-0tooth related pain, and we must identify these
40%
Rotation happens in what Joint Compartment?
Sliding/Displacement occurs where?
Inferior Joint compartment
Superior Joint compartment
The Jugular is in the TMJ
False
Lateral ROM:
Protrusion:
Opening:
10 - 12 mm
8 - 10 mm
over 40 mm
TMJ disc made of what?
Cartilage covering the condyle is what?
Why is this relevant?
Fibrous CT
Dense Fibrocartilage
healing
Primary Tx for TMD is what 3 things?
non-invasive
reversible
multidisciplinary
Tx for TMD includes dental specialist, primary care, neurologist, physical therapy, etc
True
Tx for TMD should never be what 2 interventions?
crowns/surgery
change bite location
Surgery/full mouth rehab is reserved for what in TMD?
second phase
*last option
Anterior reposition splint, aka
FARRAR
FARRAR (ant reposition splint) reduces load where?
temporarily recaptures what?
Use this device when?
Posterior attachment tissues
Anterior displaced disc
if disc too far forward
Anterior Reposition Splint should be used full time
False
*only at night
What is the goal of an Anterior Reposition Splint?
make a pseudo disc from healing
*never permanently reposition forward
TMD is always progressive
False
*heals better than other joints, most adaptable
Most common symptom of TMD is headache:
False
What is the most common symptom of TMD?
Jaw Pain
Most TMD cases are due to bad bite
False
Bad bite causes ___% of TMD
15%
Las Vegas Institute not evidence based
True
Use of x-rays are the only exception for machines/instruments to use to diagnose or Tx TMD
True
3 contraindications for TMD Tx
permanent bite changes
ortho appliance
full mouth rehab
TMD is usually not caused by malocclusion
True
6 symptoms of TMD
Jaw pain
Ear pain
Headaches
Ear stuffiness
Dizziness
Hearing loss
The Intracranial exam checks for function of what?
Cranial nerves
If you can’t find pain in the tooth, look where?
same tooth in opposing arch
You can Tx sleep apnea, neuralgia, myalgia, movement disorders, dyskeniseas, and TMD
True
An IntraOral nightguard will prevent _____ but do nothing for ______
wear
pain
Nightguards and intraoral appliances look the same butthey differ how?
intraoral appliance is NOT an occlusal guard
*it is an Orthopedic appliance
***stabilization appliance
Any pain in the head can refer to anywhere else, this includes the neck down to where?
C5
If the pain is right below the TMJ, this could indicate…
neck/C1 problem
It is well documented that a removable orthotic works for TMD
True
The most common symptom of TMD is not headache, it is toothache
true
*although think different elsewhere
___% of the population has popping
50%
Bone to bone contact is very rare
True
Most common problem we see in TMD
muscle pain
Most common nerve causing pain to the TMD
Trigem
Masseter origin:
insertion:
innervation:
action:
zygomatic arch
lateral surface ramus/coronoid
masseteric branch V3
closes jaw/elevates Mn
Temporalis origin:
insertion:
innervation
Action:
tomporal fossa
coronoid process/ant Mn
V3 - deep temporal branches
elevates Mn (post fibers retract)
Lateral Pterygoid Origin:
Insertion:
Innvervation:
Action:
greater wing sphenoid (upper) lateral surface lateral pterygoid plate (Lower)
neck of condyle of Mn/articular disc/capsule TMJ
Branches of V3
opens mouth/protrusion/grinding
Medial Pterygoid Origin:
Insertion:
Innervation:
Action:
medial surface lateral pterygoid plate (sphenoid)/pyramidal process palatine/tuberosity Mn
lower part medial surface Mn/angle of Mn
Pterygoid branches V3
Elevates Mn/protrusion
Depression (3 mm.):
elevation (3 mm.):
Protrusion (1 mm.):
Retrusion (2 mm.):
Lateral:
suprahyoid, infrahyoid, gravity
temporal, masseter, medial pterygoid
lateral pterygoid
middle/posterior temporal, deep masseter
retractors same side/protruders opposite
TMJ is a modified…
Synovial Joint
Lateral temporomandibular ligament
stylomandibular ligament
sphenomandibular ligament
visualize
Intrinsic TMJ ligament:
2 Extrinsics:
TM-lateral ligmanet
Stylomandibular/sphenomandibular
Sylomandibular runs from where to where?
Sphenomandibular?
styloid process - angle mandible
spine of sphenoid - lingula of Mn
Opening pain can be _____
Closing pain…
muscle or joint
usually joint
