Oral med - TMD Flashcards
What are the 2 main systems to classify orofacial pain?
International classification of headache disorders edition 3 2018 (ICHD3)
International classification of orofacial pain 1st edition 2020 (ICOP)
List 6 groups of ICOP
- Orofacial pain attributed to disorders of dentoalveolar and anatomically related structures
- Myofascial orofacial pain
- Temporomandibular joint (TMJ) pain
- Orofacial pain attributed to lesion or disease of the cranial nerves
- Orofacial pains resembling presentations of primary headaches
- Idiopathic orofacial pain
Describe TMD?
group of conditions affecting the TMJ and/or muscles of mastication
4 sites of TMD?
jaw
ear
in front of ear
temple
3 things that can affect TMD?
jaw movement
function
parafunction
4 types of noises associated with TMD?
clicking
snapping
popping
crepitus (grinding, crunching)
4 types of movement associated with TMD?
restricted opening
interfering with eating
locking - intermittent/ persistent; closed; open; able to release with manoeuvre?
deviation
what habits are associated with TMD?
clenching
grinding
chewing/ biting
musical instruments
singing
3 co-morbidities of TMD?
fibromyalgia
chronic pain
psychological factors
where do you palpate when investigation TMJ?
lateral pole of TMJ
what do you ask the pt to do when you are palpating the lateral lob of TMJ?
3 repetitions of opening, closing, lateral, protrusive movements
what muscles should be palpated when investigating TMD?
temporalis
masseter
how do you palpate the temporalis when investigating TMD?
palpate with teeth clenched above ear and forwards above eye
how to you palpate the masseter when investigating TMD?
bimanual palpation - one finger inside and one outside mouth
what is the normal range of mouth opening?
40mm including incisal overlap
what are intraoral signs of TMD?
ridging buccal mucosa at level of occlusal plane
scalloping of borders of tongue
tooth wear
2 types of TMD diagnosis?
pain related TMDs
intra-articular TMDs
2 types of pain related TMD?
myalgia
- local myalgia
- myofascial pain
- myofascial pain with referral
arthralgia
- headache related to TMD
what are the types of intra-articular TMDs?
disc displacement with reduction
disc displacement with reduction with intermittent locking
disc displacement without reduction with limited opening
disc displacement without reduction without limited opening
degenerative joint disease
subluxation
describe myalgia
pain of muscle origin, affected by jaw movement, function or parafunction
and
repetition of this pain on provocation testing of the masticatory muscles
describe the history of a pt with myalgia
pain in jaw, temple, in front of the ear or in the ear
and
modified with jaw movement, function or parafunction
what is the result of examination of a pt with myalgia related TMD?
confirmation of pain location (s) in the temporalis or masseter
and
familiar pain in masseter or temporalis muscle with at least one of the following tests:
- palpation of temporalis or masseter
- maximum unassisted or assisted opening movements
what are the sub-types of myalgia?
local myalgia
myofascial pain
myofascial pain with referral
describe arthralgia
pain of the joint origin affected by jaw movement, function or parafunction and replicated by provocation testing of the TMJ
history of pt with arthralgia?
pain in jaw, temple, ear or in front of the ear in the past month
AND
pain modified with jaw movement, function and parafunction
on examination of a patient with arthralgia, what is the findings?
confirmation of pain location in area of TMJ (s)
AND
familiar pain:
on palpation of lateral pole
OR
on maximum unassisted or assisted opening, right or left lateral or protrusive movements
describe disc displacement with reduction
intracapsular biomechanical disorder involving the condyle-disc complex.
in the closed mouth position: disc is in the anterior position relative to the condylar head and the disc reduces on mouth opening
what noises are associated with disc reduction?
clicking
popping
snapping
describe the history that a pt with disc displacement with reduction will present with?
history of noise in past 30 days in movement/ function
or
patient report of any noise during examination
what will you find on examination of a pt with disc displacement with reduction?
clicking popping or snapping during opening and closing movements on palpation during at least one of the 3 repetitions of jaw opening and closing
or
during opening or closing
and
on left or right lateral or protrusive movements
describe disc displacement without reduction with limited opening
disc does not reduce with opening. persistent limited mandibular movement which does not reduce when the patient or clinician performs a manoeuvre. closed lock
describe the history of a pt with disc displacement without reduction with limited opening
jaw locked so mouth doesnt open all the way
limitation in jaw opening that interferes with eating
what will you find upon examination of a pt with disc displacement without reduction with limited opening?
maximum assisted opening (passive stretch) less than 40mm including vertical incisal overlap
describe degenerative joint disease
a degenerative disorder involving the joint characterised by deterioration of articular tissue with concomitant osseous changes in the condyle and/ or articular eminence.
describe the history of a pt with degenerative joint disease?
history of noise in the past 30 days on jaw movement or in function
or
patient report of any noise during exam
what will you find upon examination of a pt with degenerative joint disease?
crepitus detected with palpation during opening, closing, right or left lateral or protrusive movements
describe subluxation (open lock)
a hypermobility disorder involving the disc condyle complex and the articular eminence
open mouth disc condyle complex is anterior to the articular eminence and is unable to return to normal closed position without a manipulative manoeuvre
momentary or prolonged duration
difference between subluxation and luxation?
subluxation = if pt can manoeuvre the joint back into position
luxation = if assistance of clinician required
describe the history of a pt presenting with subluxation?
last 30 days jaw locking or catching in wide open mouth position
and
inability to close mouth without a manipulative manoeuvre
what will you find upon examination of pt with subluxation?
no examination findings required
conservative management of TMD?
rest and relax
modify diet
avoid wide mouth opening
regular application of gentle heat - chronic conditions
regular application of cold pack - acute onset and or restricted mouth opening
jaw exercises
NSAIDs - ibuprofen 14 days
paracetamol
what can be prescribed for muscle spasms or disc displacement without reduction with limited opening?
diazepam 5 day course
