Orofacial Pain and Diseases Affecting the TMJ Flashcards
What is burning mouth disorder?
- Unexplained and usually continuous burning sensation of the oral soft tissues (tongue, lips and hard palate)
- Most likely a neuropathic etiology
- Onset usually spontaneous
- Careful workup required- lab testing may reveal undiagnosed disorders such as diabetes or anemia
- Treat symptoms: antianxiety and antidepressants. Catuama use as an herbal supplement
What is trigeminal neuralgia?
- Pathological condition involving the 5th cranial nerve
- Unilateral, sharp, shooting, knifelike or electric shock-type pain
- Unknown etiology
- Diagnosis based on history and onset of pain and associated clinical symptoms
- Gamma Radiosurgery
What is Bell’s Palsy?
- Acute, self-limiting loss of muscle control on one side of the face
- Diagnosis made after excluding other causes of paralysis
- Occurs in all ages but mostly btw 15 and 45
- Variety of tx’s used but will resolve on its own
What are the diseases affecting the TMJ?
- Myofascial pain and dysfunction (MPD)
- Internal derangement syndrome
- Osteoarthritis
- Rheumatoid arthritis
- Benign and malignant tumors
What muscles are included in the anatomy of the TMJ?
- Masseter
- Temporalis
- Medial pterygoid
- Lateral pterygoid
- Anterior digastric
- Mylohyoid
What is the position of the mandibular condyle when in the position of maximal occlusal contact?
Resting within the glenoid fossa
What is the first phase of opening characterized by?
Rotational (hinge) movement of the condyle followed by an anterior translation (sliding)
Demographic characteristics of temporomandibular disorders
- Most pts are female- sex hormones play a role
- Btw 20 and 40 yrs
- Iatrogenic cause
What may cause TMDs?
- Trauma: direct (assault), indirecy (whiplash injury), resulting from parafunctional habits such as clenching or bruxism
- Psychosocial factors (stress)
- Dentofacial deformities
- May be associated w/ disorders in growth and development as in condylar hyperplasia or hypoplasia
Systemic diseases associated with TMD abnormalities
- Depression
- Rheumatoid arthritis
- Chronic fatigue syndrome
- Chronic headache
- Fibromyalgia
- Sleep disturbances
- IBS
What information should be collected as a part of the patient evaluation?
- Chief complaint:
-Joint symptoms
-Pain
-Problems w/ mastication
-Trismus
-Malocclusion - History:
-Extensive dental or orthodontic tx
-Hx of surgical tx of the jaws - Examination:
-Parafunctional habits
Types of imaging that may be done when evaltuating a pt w/ a TMD
- PAN
- Transcranial imaging
- CT
- Cone beam CT
- MRI
- Arthrography
What are the 3 cardinal features of TMDs?
- Orofacial pain
- Joint noise
- Restricted jaw function
What may be included as a part of a clinical examination?
- Exam of the joint, MOM, oral cavity and cervical spine
- Auscultation
- Palpation
- Are noises elated to mandibular movement?
- Evaluate movement of mandible in a normal rotation and translatory cyle
- Measure interincisal opening and note any obvious deflection to right or left sides
- Note lateral excursions, protrusions, deviations and deflection
- Evaluate occlusion
Types of TMDs
- Myofascial pain and dysfunction (MPD)
- Internal derangements
- Arthritis
What is myofascial pain and dysfucntion (MPD)?
- A dysfunctional hyperactivity w/ regional pain, tenderness in affected muscles and variable amts of reduced opening and complaints of malocclusion
- Comprises at least 50% of all TMDs
How is the pain of MPD usually described?
Dull or achy, diffuse and cyclic, frequently worse in the AM, particularly in pts who clench or grind their teeth during sleep
What are internal derangements?
- An abnormal positional relationship of the disk relative to the mandibular condyle and the articular eminence
- Continuous pain exacerbated by jaw movement
Disk displacement with reduction
May be displaced anteriorly and returns to normal position when the mouth is opened or movement is away from the affected side
Disk displacement without reduction
- May act as an obstacle to the sliding condyle
- Patients may complain of problems such as intermittent locking of the jaw- sudden onset of limited mouth opening, deflection of mandible, restricted lateral excursive movements away from affected side
WHat is osteoarthritis characterized by?
- Degenerative changes of the cartilage
- Pain symptoms that are worse in the evening
- Limited opening
- Muscle splinting
- Crepitus
Characteristics of rheumatoid arthritis
- An inflammatory, immunologic disorder of the joints
- Symptoms are worse in the AM
- Limited opening
- Occlusal changes
- Preauricular edema
- Tenderness
50-75% of pts w/ RA have involvement of the TMJ
Hypermobility disorders
- Dislocation: when one or both condyles moves anterior to articular eminence, leading to an open lock the pt cannot reduce
- Subluxation: Hypermobility in which the pt can relocate the mandible back into the glenoid fossa
What is ankylosis?
Immobility of the condyle caused by fibrous or bony union btw articulating surfaces
- Joint infection after trauma accounts for 50% of cases
- 30% result from trauma without infection
What is ankylosis classified by?
- Tissue type (fibrous, bony)
- Location (intraauricular, extraauricular)
- Extent of fusion (complete, incomplete)
Treatments for TMDs
- Nonsurgical
- Surgical
- Multidisciplinary
Nonsurgical treatment for TMDs
Goals are to improve function and reduce pain
* Pharmacologic therapy: pain meds, muscl relaxants, antianxiety agents
* Moist heat
* PT
* Soft mechanical diet
* Jaw stretching
* Coordination exercises
* Occlusal adjustments
Second phase will involve the use of occlusal appliances
Surgical treatments for TMDs
- Arthrocentesis- lavaging the joint though a needle
- Arthoscopy- Allows direct visualization and manipulation of the jint
- Open joint surgery- Used to perform disk reconstruction w/ a prosthetic device or autogenous graft
- Eminectomy- Removal of the articular eminence of the temporal bone
