Management of TMD and Occlusion Flashcards
at least ___% of the general population have at least one sign of functional disturbance of the masticatory system
50-60%
T or F:
many symptoms of functional disturbances of the masticatory system are “subclinical”, meaning the patient does not have a clinical awareness
true
these can end up representing more significant functional disturbances if left unattended, which is why it is important to identify any and all signs and symptoms of functional disturbances in every patient
the effectiveness and success of treatment lie in the ability of the clinician to establish ___
proper diagnosis
the purpose of a history and examination is to identify any area or structure of the masticatory system that shows ___
breakdown or pathologic change
breakdown in the masticatory system is generally signified by ___
pain and/or dysfunction
what are the 5 masticatory structures?
teeth, periodontium, supporting structures of the teeth, the TMJ, and the muscles that move the mandible
disorders of the head and neck can frequently lead to ___ pains that are felt in the masticatory structures but do not have their sources within the masticatory structures
heterotopic
a general rule in the effort to identify masticatory pain is that ___ usually aggravates or accentuates the problem
jaw function
with pain disorders, as much as ___% of the information needed to make the diagnosis will come from the ___
- 70-80%
- history (as opposed to examination)
an effective history centers on the patient’s ___
chief complaint
pain is evaluated according to the patient’s description of the chief complaint, which should include which factors?
- location, onset, and characteristics
- aggravating and alleviating factors
- past treatments
- relationship to other complaints as to location, behavior, quality, duration, and degree
the patient’s description of the location of his or her complaint identifies only the ___ of pain. it is the examiners responsibility to determine whether or not it is the true ___ of pain
- site
- source
why it is important that the patient present circumstances associated with the initial onset of pain in chronological order?
so that proper relationships may be evaluated
T or F:
it is not important to ask the patient what they feel has caused the pain condition
false
it provides good insight into the patient’s view of the pain, and many times the patient knows precisely what caused the condition
when a patient is judging the quality of their pain, it is important that this judgement be independent of ___
pain intensity, variability, temporal characteristics, or any accompanying lancinating exacerbations that may punctuate the basic underlying painful sensation
what are the terms used to evaluate quality of pain?
bright, dull, pricking, itching, stinging, burning, aching, or pulsating/throbbing
behavior of pain should be evaluated according to its ___ behavior as well as its ___ and ___
- frequency or temporal behavior
- duration and localizability
What terms are used to describe the temporal behavior of pain?
intermittent, continuous, variable, recurrent
what terms are used to describe duration of pain?
momentary, minutes/hours/days, or protracted
what terms are used to describe localization of pain?
localized, diffuse, radiating, lancinating, spreading, enlarging, and migrating
intensity of pain should be established by distinguishing between ___ and ___ pain
mild and severe
one of the best methods of assessing the intensity of pain is with a ___
visual analog scale (will vary from patient to patient)
what is the difference between steady and paroxysmal pain?
- steady = flowing type of pain, even though variable in intensity or distinctly intermittent
- paroxysmal = sudden volleys or jabs
what two types of commonly used medications may play a role in some pain conditions?
oral contraceptives and estrogen replacements
T or F:
there are no conclusive questionnaires that can be used to identify whether high levels of emotional stress relate to the patient’s problem, nor can any emotional stress test be used to help diagnose or determine an effective treatment
true
T or F:
secondary gains may have a direct effect on the success or failure of treatment
true
in cases where patients have more than 1 pain complaint, management of the primary pain condition may alleviate the secondary pain condition. however, sometimes the pain conditions are completely independent of one another. identifying the relationship between these complaints is essential and best determined by the ___
history
routine psychological evaluation may not be necessary with ___ pain; however, with ___ pain, it is essential
acute, chronic
chronic pain patients are best evaluated and managed by a ___ approach
multidisciplinary
the multidimensional pain inventory (MPI) scale classifies patients into one of which three pain profiles?
adaptive coping, interpersonal distress, and dysfunctional chronic pain
even before examining the masticatory structures, it is important to evaluate gross function of the ___, ___, ___, and ___
cranial nerves, eyes, ears, and neck
approximately ___% of patients reporting with TMJ pain also complain of ear discomfort
70%
what is the normal range of mouth opening?
53-58mm
what is considered “restricted” range of mouth opening, and what percent of young adults and the elderly experience this?
<40mm
1.2% of young adults
15% of the elderly
nonodontogenic toothaches can come from which 5 sources, and which one is the most common?
muscular (most common), vascular, sinus, and cardiac sources
T or F:
anesthetic solutions containing epinephrine cause greater muscle damage
true
myofascial pain arises from hypersensitive areas in muscles called ___
trigger points
there is good evidence that the ___ plays a significant role in the etiology of myofascial pain
CNS
the ___ nerve block has very significant diagnostic value in orofacial pain
auriculotemporal
