Orofacial Pain Flashcards

1
Q

List the 9 features of TM issues

A
  • 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
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2
Q

List the 6 risk factors for TM issues

A
  • Jaw parafunction
  • Somatic symptoms
  • Poor sleep
  • Stress
  • Genotype
  • Comorbid conditions/ poor health
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3
Q

List the 4 categories of temporomandibular disorders

A
  • Temporomandibular joint disorders
  • Masticatory muscle disorders
  • Headache
  • Associated structures
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4
Q

For arthralgia, state:

- Definition

A

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.

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5
Q

For arthralgia, state:

- How a diagnosis is formed

A
  • 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

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6
Q

State what myalgia is

A
  • 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).
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7
Q

Explain how myalgia is diagnosed

A
  • 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

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8
Q

For disc disorders, explain how a diagnosis is made

A
  • 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
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9
Q

For disc disorders, explain how an imaging diagnosis is made

A

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

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10
Q

For disc disorders with reduction, state:

- Define what it is

A

Disc disorders with reduction:
• The articular disc is displaced anteriorly (ahead of condyle) and it may return to its normal position with opening/ closing

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11
Q

For disc disorders with reduction, state:

- How a diagnosis is formed

A

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
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12
Q

For disc disorders without reduction with limited opening, state:
- Define what it is

A

• The articular disc is displaced anteriorly (ahead of condyle) and it does not return to its normal position

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13
Q

For disc disorders without reduction with limited opening, state:
- How a diagnosis is formed

A

Diagnosis:
• Jaw lock, mouth cannot open fully
• Limited jaw opening
• Not a very wide opening (below 40 mm) and there is vertical incisal overlap

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14
Q

For disc disorders without reduction with limited opening, state:
- How an imaging diagnosis is made

A

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

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15
Q

For hypermobility disorders such as subluxation state:

- Define what it is

A

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.

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16
Q

For hypermobility disorders such as subluxation state:

- Diagnosis

A

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

17
Q

For hypermobility disorders such as subluxation state:

- Luxation

A

Luxation:
• When the patient needs the assistance of the clinician to reduce the dislocation and normalize jaw movement; this is referred to as luxation

18
Q

Discuss what types of things would be included when screening methods patients with jaw issues

A
  • 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
19
Q

List the 8 things you would include in a pain history

A
  • Site
  • Onset
  • Character
  • Radiation
  • Associated factors
  • Time
  • Exacerbating/relieving factors
  • Severity
20
Q

Explain some clinical measurements that can be taken to assess jaw function

A
  • 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
21
Q

List the first step of explanation and reassurance when attempting to address orofacial pain

A
  • 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
22
Q

List the things that would be used as a self care to help with TMD issues

A
  • Education about the causes
  • Self exercises
  • Self massages
  • Thermal therapies
  • Dietary advice and nutrition
  • Parafunctional behaviour identification, monitoring and avoidance
23
Q

List 3 the types of pain killers

A
  • 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.
24
Q

Describe the controlled opening exercise that can be used for TMD

A
  • 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