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241 Oral Pathology > Orofacial Pain and Diseases Affecting the TMJ > Flashcards

Orofacial Pain and Diseases Affecting the TMJ Flashcards

1
Q

What is burning mouth disorder?

A
  • 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
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2
Q

What is trigeminal neuralgia?

A
  • 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
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3
Q

What is Bell’s Palsy?

A
  • 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
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4
Q

What are the diseases affecting the TMJ?

A
  • Myofascial pain and dysfunction (MPD)
  • Internal derangement syndrome
  • Osteoarthritis
  • Rheumatoid arthritis
  • Benign and malignant tumors
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5
Q

What muscles are included in the anatomy of the TMJ?

A
  • Masseter
  • Temporalis
  • Medial pterygoid
  • Lateral pterygoid
  • Anterior digastric
  • Mylohyoid
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6
Q

What is the position of the mandibular condyle when in the position of maximal occlusal contact?

A

Resting within the glenoid fossa

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7
Q

What is the first phase of opening characterized by?

A

Rotational (hinge) movement of the condyle followed by an anterior translation (sliding)

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8
Q

Demographic characteristics of temporomandibular disorders

A
  • Most pts are female- sex hormones play a role
  • Btw 20 and 40 yrs
  • Iatrogenic cause
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9
Q

What may cause TMDs?

A
  • 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
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10
Q

Systemic diseases associated with TMD abnormalities

A
  • Depression
  • Rheumatoid arthritis
  • Chronic fatigue syndrome
  • Chronic headache
  • Fibromyalgia
  • Sleep disturbances
  • IBS
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11
Q

What information should be collected as a part of the patient evaluation?

A
  • 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
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12
Q

Types of imaging that may be done when evaltuating a pt w/ a TMD

A
  • PAN
  • Transcranial imaging
  • CT
  • Cone beam CT
  • MRI
  • Arthrography
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13
Q

What are the 3 cardinal features of TMDs?

A
  • Orofacial pain
  • Joint noise
  • Restricted jaw function
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14
Q

What may be included as a part of a clinical examination?

A
  • 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
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15
Q

Types of TMDs

A
  • Myofascial pain and dysfunction (MPD)
  • Internal derangements
  • Arthritis
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16
Q

What is myofascial pain and dysfucntion (MPD)?

A
  • 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
17
Q

How is the pain of MPD usually described?

A

Dull or achy, diffuse and cyclic, frequently worse in the AM, particularly in pts who clench or grind their teeth during sleep

18
Q

What are internal derangements?

A
  • An abnormal positional relationship of the disk relative to the mandibular condyle and the articular eminence
  • Continuous pain exacerbated by jaw movement
19
Q

Disk displacement with reduction

A

May be displaced anteriorly and returns to normal position when the mouth is opened or movement is away from the affected side

20
Q

Disk displacement without reduction

A
  • 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
21
Q

WHat is osteoarthritis characterized by?

A
  • Degenerative changes of the cartilage
  • Pain symptoms that are worse in the evening
  • Limited opening
  • Muscle splinting
  • Crepitus
22
Q

Characteristics of rheumatoid arthritis

A
  • 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
23
Q

Hypermobility disorders

A
  • 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
24
Q

What is ankylosis?

A

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

25
Q

What is ankylosis classified by?

A
  • Tissue type (fibrous, bony)
  • Location (intraauricular, extraauricular)
  • Extent of fusion (complete, incomplete)
26
Q

Treatments for TMDs

A
  • Nonsurgical
  • Surgical
  • Multidisciplinary
27
Q

Nonsurgical treatment for TMDs

A

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

28
Q

Surgical treatments for TMDs

A
  • 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

241 Oral Pathology (13 decks)

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