Oral med - TMD

Question 1

What are the 2 main systems to classify orofacial pain?

Answer 1

International classification of headache disorders edition 3 2018 (ICHD3)

International classification of orofacial pain 1st edition 2020 (ICOP)

Question 2

List 6 groups of ICOP

Answer 2

1. Orofacial pain attributed to disorders of dentoalveolar and anatomically related structures
2. Myofascial orofacial pain
3. Temporomandibular joint (TMJ) pain
4. Orofacial pain attributed to lesion or disease of the cranial nerves
5. Orofacial pains resembling presentations of primary headaches
6. Idiopathic orofacial pain

Question 3

Describe TMD?

Answer 3

group of conditions affecting the TMJ and/or muscles of mastication

Question 4

4 sites of TMD?

Answer 4

jaw
ear
in front of ear
temple

Question 5

3 things that can affect TMD?

Answer 5

jaw movement
function
parafunction

Question 6

4 types of noises associated with TMD?

Answer 6

clicking
snapping
popping
crepitus (grinding, crunching)

Question 7

4 types of movement associated with TMD?

Answer 7

restricted opening
interfering with eating
locking - intermittent/ persistent; closed; open; able to release with manoeuvre?
deviation

Question 8

what habits are associated with TMD?

Answer 8

clenching
grinding
chewing/ biting
musical instruments
singing

Question 9

3 co-morbidities of TMD?

Answer 9

fibromyalgia
chronic pain
psychological factors

Question 10

where do you palpate when investigation TMJ?

Answer 10

lateral pole of TMJ

Question 11

what do you ask the pt to do when you are palpating the lateral lob of TMJ?

Answer 11

3 repetitions of opening, closing, lateral, protrusive movements

Question 12

what muscles should be palpated when investigating TMD?

Answer 12

temporalis
masseter

Question 13

how do you palpate the temporalis when investigating TMD?

Answer 13

palpate with teeth clenched above ear and forwards above eye

Question 14

how to you palpate the masseter when investigating TMD?

Answer 14

bimanual palpation - one finger inside and one outside mouth

Question 15

what is the normal range of mouth opening?

Answer 15

40mm including incisal overlap

Question 16

what are intraoral signs of TMD?

Answer 16

ridging buccal mucosa at level of occlusal plane
scalloping of borders of tongue
tooth wear

Question 17

2 types of TMD diagnosis?

Answer 17

pain related TMDs
intra-articular TMDs

Question 18

2 types of pain related TMD?

Answer 18

myalgia
- local myalgia
- myofascial pain
- myofascial pain with referral
arthralgia
- headache related to TMD

Question 19

what are the types of intra-articular TMDs?

Answer 19

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

Question 20

describe myalgia

Answer 20

pain of muscle origin, affected by jaw movement, function or parafunction
and
repetition of this pain on provocation testing of the masticatory muscles

Question 21

describe the history of a pt with myalgia

Answer 21

pain in jaw, temple, in front of the ear or in the ear
and
modified with jaw movement, function or parafunction

Question 22

what is the result of examination of a pt with myalgia related TMD?

Answer 22

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

Question 23

what are the sub-types of myalgia?

Answer 23

local myalgia
myofascial pain
myofascial pain with referral

Question 24

describe arthralgia

Answer 24

pain of the joint origin affected by jaw movement, function or parafunction and replicated by provocation testing of the TMJ

Question 25

history of pt with arthralgia?

Answer 25

pain in jaw, temple, ear or in front of the ear in the past month
AND
pain modified with jaw movement, function and parafunction

Question 26

on examination of a patient with arthralgia, what is the findings?

Answer 26

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

Question 27

describe disc displacement with reduction

Answer 27

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

Question 28

what noises are associated with disc reduction?

Answer 28

clicking
popping
snapping

Question 29

describe the history that a pt with disc displacement with reduction will present with?

Answer 29

history of noise in past 30 days in movement/ function
or
patient report of any noise during examination

Question 30

what will you find on examination of a pt with disc displacement with reduction?

Answer 30

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

Question 31

describe disc displacement without reduction with limited opening

Answer 31

disc does not reduce with opening. persistent limited mandibular movement which does not reduce when the patient or clinician performs a manoeuvre. closed lock

Question 32

describe the history of a pt with disc displacement without reduction with limited opening

Answer 32

jaw locked so mouth doesnt open all the way
limitation in jaw opening that interferes with eating

Question 33

what will you find upon examination of a pt with disc displacement without reduction with limited opening?

Answer 33

maximum assisted opening (passive stretch) less than 40mm including vertical incisal overlap

Question 34

describe degenerative joint disease

Answer 34

a degenerative disorder involving the joint characterised by deterioration of articular tissue with concomitant osseous changes in the condyle and/ or articular eminence.

Question 35

describe the history of a pt with degenerative joint disease?

Answer 35

history of noise in the past 30 days on jaw movement or in function
or
patient report of any noise during exam

Question 36

what will you find upon examination of a pt with degenerative joint disease?

Answer 36

crepitus detected with palpation during opening, closing, right or left lateral or protrusive movements

Question 37

describe subluxation (open lock)

Answer 37

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

Question 38

difference between subluxation and luxation?

Answer 38

subluxation = if pt can manoeuvre the joint back into position
luxation = if assistance of clinician required

Question 39

describe the history of a pt presenting with subluxation?

Answer 39

last 30 days jaw locking or catching in wide open mouth position
and
inability to close mouth without a manipulative manoeuvre

Question 40

what will you find upon examination of pt with subluxation?

Answer 40

no examination findings required

Question 41

conservative management of TMD?

Answer 41

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

Question 42

what can be prescribed for muscle spasms or disc displacement without reduction with limited opening?

Answer 42

diazepam 5 day course