Orofacial Pain Flashcards
List the 9 features of TM issues
- Females of a child bearing age
- Bilateral pain
- Poorly localised
- Throbbing, boring, dull cache
- Muscle tightness and tension
- Aggravated by jaw function
- Alleviated by rest, massage and NSAIDS
- Psychological impacts
- Referred pain
List the 6 risk factors for TM issues
- Jaw parafunction
- Somatic symptoms
- Poor sleep
- Stress
- Genotype
- Comorbid conditions/ poor health
List the 4 categories of temporomandibular disorders
- Temporomandibular joint disorders
- Masticatory muscle disorders
- Headache
- Associated structures
For arthralgia, state:
- Definition
Definition:
• Pain of joint origin that is affected by jaw movement, function, or parafunction, and replication of this pain occurs with provocation testing of the TMJ.
For arthralgia, state:
- How a diagnosis is formed
- Pain in the jaw, temple, in front of the ear, or in the ear AND Pain modified with jaw movement, function or parafunction.
- Confirmation of pain location in the area of the TMJ
1 of the following provocation tests causes pain
• Palpation of the lateral pole or around the lateral pole
• Maximum unassisted or assisted opening, right or left lateral movements, or protrusive movements
State what myalgia is
- Muscular pain associated with muscles of mastication. This pain is also felt upon provocation testing of the masticatory muscles
- Limitation of mandibular movement(s) secondary to pain may be present. There are three sub-classes of myalgia: local myalgia, myofascial pain, and myofascial pain with referral (see below).
Explain how myalgia is diagnosed
- Pain in the jaw, temple, in front of the ear, or in the ear AND Pain modified with jaw movement, function or parafunction.
- Pain modified with jaw movement, function or parafunction
1 of the following provocation tests causes pain:
• Confirmation of pain location in the temporalis or masseter muscle
• Report of familiar pain in the temporalis or masseter with at least 1 of the following provocation tests
• Palpation of the temporalis or masseter muscle
• Maximum unassisted or assisted opening
For disc disorders, explain how a diagnosis is made
- In the last 30 days any TMJ noise(s) present with jaw movement or function
- Patient report of any noise present during the exam
- Clicking, popping and/or snapping noise detected with palpation during at least 1 of 3 repetitions of opening or closing
- Clicking popping and/or snapping noise detected with palpation during at least 1 of 3 repetitions of right or left lateral movements, or protrusive movements
For disc disorders, explain how an imaging diagnosis is made
Imaging:
• In the natural occlusal position, the posterior band of the disc is located anterior to the 11:30 position and the intermediate zone of the disc is anterior to the condylar head
• On full opening, the intermediate zone of the disc is located between the condylar head and the articular eminence
For disc disorders with reduction, state:
- Define what it is
Disc disorders with reduction:
• The articular disc is displaced anteriorly (ahead of condyle) and it may return to its normal position with opening/ closing
For disc disorders with reduction, state:
- How a diagnosis is formed
Diagnosis:
• In the last 30 days any TMJ noise(s) present with jaw movement or function
- Patient report of any noise present during the exam
- Clicking, popping and/or snapping noise detected with palpation during at least 1 of 3 repetitions of opening or closing
- Clicking popping and/or snapping noise detected with palpation during at least 1 of 3 repetitions of right or left lateral movements, or protrusive movements
For disc disorders without reduction with limited opening, state:
- Define what it is
• The articular disc is displaced anteriorly (ahead of condyle) and it does not return to its normal position
For disc disorders without reduction with limited opening, state:
- How a diagnosis is formed
Diagnosis:
• Jaw lock, mouth cannot open fully
• Limited jaw opening
• Not a very wide opening (below 40 mm) and there is vertical incisal overlap
For disc disorders without reduction with limited opening, state:
- How an imaging diagnosis is made
Imaging:
• In the natural occlusal position, the posterior band of the disc is located anterior to the 11:30 position and the intermediate zone of the disc is anterior to the condylar head
• On full opening, the intermediate zone of the disc is located anterior to the condylar head
For hypermobility disorders such as subluxation state:
- Define what it is
Disc disorders with reduction:
• In the open mouth position, the disc-condyle complex is positioned anterior to the articular eminence and is unable to return to a normal closed mouth position without a specific manipulative maneuver.
For hypermobility disorders such as subluxation state:
- Diagnosis
Diagnosis:
• In last 30 days, jaw locking or catching in a wide open mouth position, even for a moment, so could not close from the wide open position
• Inability to close the mouth without a specific manipulative maneuver
• Inability to return to a normal closed mouth position without the clinician or patient performing a specific manipulative maneuver
For hypermobility disorders such as subluxation state:
- Luxation
Luxation:
• When the patient needs the assistance of the clinician to reduce the dislocation and normalize jaw movement; this is referred to as luxation
Discuss what types of things would be included when screening methods patients with jaw issues
- Ask about sleep quality and quantity, as well as about how the patient is responding to stress
- In addition, it is important to ask about how sleep/ stress affects oral behaviour - grinding, inappropriate sleep position puts pressure on jaw, pressing tongue against teeth, cheek chewing habits, tensing jaw, biting on hard things etc
List the 8 things you would include in a pain history
- Site
- Onset
- Character
- Radiation
- Associated factors
- Time
- Exacerbating/relieving factors
- Severity
Explain some clinical measurements that can be taken to assess jaw function
- Movement range of incisors - should be equal to or more than 40 mm
- Lateral and protrusive movements - should be equal to or more than 7 mm
List the first step of explanation and reassurance when attempting to address orofacial pain
- Explain the biopsychosocial model of pain in lay-terms
- Reassure patient by acknowledging her/his pain & that management is available
- Clinical psychologists are frequently utilized to help with this
List the things that would be used as a self care to help with TMD issues
- Education about the causes
- Self exercises
- Self massages
- Thermal therapies
- Dietary advice and nutrition
- Parafunctional behaviour identification, monitoring and avoidance
List 3 the types of pain killers
- NSAIDS: topical/ oral. Helps with acute, inflammatory pain. Do not uses in heart failure, uncontrolled hypertension and asthma
- Opioids: can be used with NSAIDS. Used for severe pain. Can cause dependence and vomiting
- Others: Topical capsaicin, antidepressant for chronic pain, anticonvulsants for chronic pain and benzodiazepines for acute muscle pain.
Describe the controlled opening exercise that can be used for TMD
- Do this set of exercises five times each day
- Retain tongue tip on roof of the mouth during exercise
- Slowly open (1 sec)
- Slowly close
- Repeat 5 times
