Management of TMD and Occlusion

Question 1

at least ___% of the general population have at least one sign of functional disturbance of the masticatory system

Answer 1

50-60%

Question 2

T or F:
many symptoms of functional disturbances of the masticatory system are “subclinical”, meaning the patient does not have a clinical awareness

Answer 2

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

Question 3

the effectiveness and success of treatment lie in the ability of the clinician to establish ___

Answer 3

proper diagnosis

Question 4

the purpose of a history and examination is to identify any area or structure of the masticatory system that shows ___

Answer 4

breakdown or pathologic change

Question 5

breakdown in the masticatory system is generally signified by ___

Answer 5

pain and/or dysfunction

Question 6

what are the 5 masticatory structures?

Answer 6

teeth, periodontium, supporting structures of the teeth, the TMJ, and the muscles that move the mandible

Question 7

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

Answer 7

heterotopic

Question 8

a general rule in the effort to identify masticatory pain is that ___ usually aggravates or accentuates the problem

Answer 8

jaw function

Question 9

with pain disorders, as much as ___% of the information needed to make the diagnosis will come from the ___

Answer 9

• 70-80%

- history (as opposed to examination)

Question 10

an effective history centers on the patient’s ___

Answer 10

chief complaint

Question 11

pain is evaluated according to the patient’s description of the chief complaint, which should include which factors?

Answer 11

• location, onset, and characteristics
• aggravating and alleviating factors
• past treatments
• relationship to other complaints as to location, behavior, quality, duration, and degree

Question 12

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

Answer 12

• site

- source

Question 13

why it is important that the patient present circumstances associated with the initial onset of pain in chronological order?

Answer 13

so that proper relationships may be evaluated

Question 14

T or F:

it is not important to ask the patient what they feel has caused the pain condition

Answer 14

false
it provides good insight into the patient’s view of the pain, and many times the patient knows precisely what caused the condition

Question 15

when a patient is judging the quality of their pain, it is important that this judgement be independent of ___

Answer 15

pain intensity, variability, temporal characteristics, or any accompanying lancinating exacerbations that may punctuate the basic underlying painful sensation

Question 16

what are the terms used to evaluate quality of pain?

Answer 16

bright, dull, pricking, itching, stinging, burning, aching, or pulsating/throbbing

Question 17

behavior of pain should be evaluated according to its ___ behavior as well as its ___ and ___

Answer 17

• frequency or temporal behavior

- duration and localizability

Question 18

What terms are used to describe the temporal behavior of pain?

Answer 18

intermittent, continuous, variable, recurrent

Question 19

what terms are used to describe duration of pain?

Answer 19

momentary, minutes/hours/days, or protracted

Question 20

what terms are used to describe localization of pain?

Answer 20

localized, diffuse, radiating, lancinating, spreading, enlarging, and migrating

Question 21

intensity of pain should be established by distinguishing between ___ and ___ pain

Answer 21

mild and severe

Question 22

one of the best methods of assessing the intensity of pain is with a ___

Answer 22

visual analog scale (will vary from patient to patient)

Question 23

what is the difference between steady and paroxysmal pain?

Answer 23

• steady = flowing type of pain, even though variable in intensity or distinctly intermittent
• paroxysmal = sudden volleys or jabs

Question 24

what two types of commonly used medications may play a role in some pain conditions?

Answer 24

oral contraceptives and estrogen replacements

Question 25

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

Answer 25

true

Question 26

T or F:

secondary gains may have a direct effect on the success or failure of treatment

Answer 26

true

Question 27

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 ___

Answer 27

history

Question 28

routine psychological evaluation may not be necessary with ___ pain; however, with ___ pain, it is essential

Answer 28

acute, chronic

Question 29

chronic pain patients are best evaluated and managed by a ___ approach

Answer 29

multidisciplinary

Question 30

the multidimensional pain inventory (MPI) scale classifies patients into one of which three pain profiles?

Answer 30

adaptive coping, interpersonal distress, and dysfunctional chronic pain

Question 31

even before examining the masticatory structures, it is important to evaluate gross function of the ___, ___, ___, and ___

Answer 31

cranial nerves, eyes, ears, and neck

Question 32

approximately ___% of patients reporting with TMJ pain also complain of ear discomfort

Answer 32

70%

Question 33

what is the normal range of mouth opening?

Answer 33

53-58mm

Question 34

what is considered “restricted” range of mouth opening, and what percent of young adults and the elderly experience this?

Answer 34

<40mm
1.2% of young adults
15% of the elderly

Question 35

nonodontogenic toothaches can come from which 5 sources, and which one is the most common?

Answer 35

muscular (most common), vascular, sinus, and cardiac sources

Question 36

T or F:

anesthetic solutions containing epinephrine cause greater muscle damage

Answer 36

true

Question 37

myofascial pain arises from hypersensitive areas in muscles called ___

Answer 37

trigger points

Question 38

there is good evidence that the ___ plays a significant role in the etiology of myofascial pain

Answer 38

CNS

Question 39

the ___ nerve block has very significant diagnostic value in orofacial pain

Answer 39

auriculotemporal