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face pain > pathology and diagnosis pt 2 > Flashcards

pathology and diagnosis pt 2 Flashcards

1
Q

% of general population in America experienced 1 of 5 of ofacial pain types in the past 6
months (3)

A

22%

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2
Q

% reported Toothache

A

12

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3
Q

% reported TemporomandibularJoint (TMJ) pain

A

5

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4
Q

% reported face or cheek

A

1.4

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5
Q

% of general population reported pain in the head, face or neck. (1)

A

10% of general population reported pain in the head, face or neck. (1)

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6
Q

% reported facial pain in the previous 6 months (2)

A

12% reported facial pain in the previous 6 months (2)

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7
Q

% reported headaches in the previous 6 months

A

26% reported headaches in the previous 6 months

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8
Q

OROFACIAL PAIN
PREVALENCE
* % of patients reporting to an
orofacial pain center had pain
sources beyond the trigeminal
system (i.e. chronic low back pain)

A
  • 81% of patients reporting to an
    orofacial pain center had pain
    sources beyond the trigeminal
    system (i.e. chronic low back pain)
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9
Q

MEDICAL CONDITIONS COMORBID WITH TMD

A
  1. Fibromyalgia
  2. Chronic fatigue syndrome
  3. Headache
  4. GERD
  5. IBS
  6. Multiple chemical sensitivity
  7. PTSD
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10
Q

TMJ TRANSLATION - NORMAL diagrammed

A
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11
Q

DISC DERANGEMENT DISORDERS

A
  1. Disc displacement with reduction
  2. Disc displacement without reduction: acute & chronic
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12
Q

Articular Disc Displacement:
1. relationship of articular disc and condyle.
2. Displacement is usually in what direction?
3. Pain or mandibular symptoms?

A
  1. Abnormal relationship/misalignment of articular
    disc and condyle.
  2. Displacement is usually anterior or anteromedial direction. vertical and lateral moves affected
  3. Pain or mandibular symptoms are not specific
    for disc derangement disorders.
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13
Q

DISC DISPLACEMENT WITH REDUCTION
1. From a closed mouth position, the disc?
2. click?
3. Asymptomatic tx?
4. Also called

A
  1. From a closed mouth position, the “temporarily”
    misaligned disc reduces or improves its
    structural relation with the condyle during
    translation resulting in a joint noise (clicking or
    popping).
  2. Reciprocal click (opening/closing click)
  3. Asymptomatic clicking does not require
    treatment.
  4. Also called internal derangement
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14
Q

ETIOLOGY: DISC DISPLACEMENT WITH REDUCTION
1. Macrotrauma?
2. Microtrauma?
3. Poor?
4. mm hyperactivity?
5. joint mobility?

A
  1. Macrotrauma- direct trauma/injury to the jaw
  2. Microtrauma-chronic bruxism
  3. Poor lubrication
  4. Lateral pterygoid hyperactivity
  5. Joint hypermobility/Ligament laxity
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15
Q

DISC DISPLACEMENT WITH
REDUCTION opening pattern

A

shift to affected side

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16
Q

DISC DISPLACEMENT WITH REDUCTION
 Diagnostic Criteria (must be present)
1. Reproducible?
2. Soft tissue imaging reveals?
3. Absence of?

A
  1. Reproducible joint noise occurring during opening & closing.
  2. Soft tissue imaging reveals displaced disc which improves its position during opening.
  3. Absence of extensive degenerative bone changes.
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17
Q

DISC DISPLACEMENT WITH REDUCTION tx pyramid

A
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18
Q

DISC DISPLACEMENT WITH INTERMITTENT NON-REDUCTION
 Diagnostic Criteria (must be present):
1. mouth opening?
2. Deflection?
3. ROM
4. Patient can?

A
  1. Persistent limited mouth opening <35mm with hx of sudden onset and PAIN.May last
    seconds to a few minutes.
  2. Deflection to affected side on mouth opening
  3. Marked limited laterotrusion to the contralateral side (if unilateral disorder)
  4. Patient can apply pressure to the affected joint, relax and wait for disc to reduce.
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19
Q

DISC DISPLACEMENT WITHOUT REDUCTION
1. Disc is?
2. Disc does not?
3. closed?
4. MRI shows?

A
  1. Disc is non-reducing or permanently
    displaced.
  2. Disc does not improve its relation with
    the condyle on translation.
  3. “closed lock”
  4. MRI shows no disc recapture on mouth
    opening
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20
Q

DISC DISPLACEMENT WITHOUT REDUCTION diagrammed

A

result of a dysmorphic disc

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21
Q

DISC DISPLACEMENT
WITHOUT REDUCTION opening pattern

A

deflection to affected side

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22
Q

DISC DISPLACEMENT WITHOUT REDUCTION (ACUTE)
1. Sudden?
2. Secondary to?
3. Pain?
4. deflection?

A
  1. Sudden & marked limited mouth opening due to jamming or fixation of disc .
  2. Secondary to disc adhesion, deformation, or dystrophy.
  3. Pain is often present when attempting to open mouth.
  4. Straight line deflection to affected side on opening.
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23
Q

DISC DISPLACEMENT WITHOUT REDUCTION (ACUTE)
 Diagnostic Criteria (must be present):
1. mouth opening?
2. Deflection?
3. Marked limited movement where?
4. MRI reveals?

A
  1. Persistent limited mouth opening <35mm with hx of sudden onset
  2. Deflection to affected side on mouth opening
  3. Marked limited laterotrusion to the contralateral side (if unilateral disorder)
  4. MRI reveals displaced disc without reduction. X-rays show no extensive
    osteoarthritic changes.
24
Q

DISC DISPLACEMENT PROGNOSIS

A

The Majority of patients with Disc displacement with reduction do
not progress to disc displacement without reduction!!

25
Q

ARTHROCENTESIS
1. needle insertion?
2. A second needle?
3. During arthrocentesis, the jaw can be?
4. Local anesthetic &/or steroids?

A
  1. Needle is inserted into the superior joint
    space and lactated Ringer’s solution is
    used to distend joint space. Done under
    IV sedation.
  2. A second needle is then placed into the
    superior joint space and the TMJ is
    lavaged.
  3. During arthrocentesis, the jaw can be
    gently manipulated to increase range of
    motion since patient is sedated.
  4. Local anesthetic &/or steroids are
    injected at completion of procedure for
    pain management.
26
Q

ARTHROCENTESIS
 Once procedure is done, patient will need?
 The disc may?

A

 Once procedure is done, patient will need physical
therapy and possibly an anterior repositioning splint
to keep disc from becoming non-reducing and to
help prevent re-formation of fibrous adhesions or
capsular constriction.
 The disc may displace in the future

27
Q

ARTHROCENTESIS INDICATIONS

A

For treatment of intra-articular joint restrictions of jaw movement. Examples follow:

    1. Acute closed lock with limited ROM that does not resolve. Best success occurs if procedure is done within 2-3 weeks following jaw locking.
  2. Acute pain in TMJ not responsive to medications and conservative treatment (i.e. splint therapy , physical therapy or intra-articular steroid injection).
28
Q

DISC DISPLACEMENT WITHOUT
REDUCTION (CHRONIC)
 Diagnostic Criteria (must be present):
1. Hx of ?
2. MRI reveals ?
3. Hard tissue imaging reveals?

A
  1. Hx of sudden onset of limited mouth
    opening that occurred > 4 months
    ago
  2. MRI reveals displaced disc without
    reduction.
  3. Hard tissue imaging reveals no
    extensive osteoarthritic changes.
29
Q

DISC DISPLACEMENT
WITHOUT REDUCTION tx pyramid

30
Q

ARTHROSCOPY
1. Allows visualization of ?
2. what can be used through the
arthroscope to correct problem?
3. Small cannula is inserted into the
superior joint space & is connected to?
4. Lasers?

A
  1. Allows visualization of glenoid fossa and
    superior aspect of disc
  2. Forceps, scissors, sutures, medication,
    needles, cautery probes, burs and
    shavers can be used through the
    arthroscope to correct problem.
  3. Small cannula is inserted into the
    superior joint space & is connected to a
    TV camera and video monitor
  4. Lasers can be used to eliminate
    adhesions, inflamed tissue, & incise tissue
    within the joint.
31
Q

ARTHROSCOPY
 Arthroscopy surgically corrects a variety of
intracapsular disorders including:
1. examples?
2. Patients receive what following this?

A
  1. disc displacement without reduction, hypomobility as a result of fibrosis or adhesions, degenerative joint disease and hypermobility. It is useful for minor debridement and lavage, incision of minor adhesions, and biopsies
  2. Patients receive physical therapy following surgical treatment
32
Q

INDICATIONS FOR ARTHROSCOPY
1. Chronic?
2. Always what patient prior to arthroscopy?

A
  1. Chronic TMJ pain with limited range of opening that has failed to respond to conservative treatment or arthrocentesis
  2. Always re-evaluate patient prior to arthroscopy
33
Q

Equipment for Arthroscopy

34
Q

ARTHROSCOPY research
1. A recent prospective, randomized clinical trial on efficacy?
2. Upper joint space lavage may be ineffective in ?
3. further research?

A
  1. A recent prospective, randomized clinical trial found arthroscopy no better than physical therapy in the treatment of restricted jaw range of motion and pain due to intraarticular disease.
  2. Upper joint space lavage may be ineffective in decreasing pain & increasing mouth opening in patients treated for disc displacement without reduction.
  3. Clearly, further research is needed to determine the appropriate application of arthroscopy and adjunctive technologies such as the laser.
35
Q

INFLAMMATORY DISORDERS of TMJ

A
  1. Synovitis/capsulitis/arthralgia
  2. Polyarthritides
36
Q

SYNOVITIS/CAPSULITIS
(ARTHRALGIA)

A

 Inflammation of synovial lining of TMJ due to trauma or
infection

37
Q

SYNOVITIS/CAPSULITIS (ARTHRALGIA) Diagnostic Criteria (must be present):
1. pain?
2. x-rays?

A
  1. Localized TMJ pain exacerbated by function (esp.
    posterior or superior loading)
  2. No extensive osteoarthritic changes seen on x-rays.
38
Q

SYNOVITIS/CAPSULITIS (ARTHRALGIA):
 Minor Criteria (may be present):
 pain?
 ROM?
 swelling? occlusion?
 Ear?
 MRI?

A

 Localized TMJ pain at rest
 Limited ROM secondary to pain
 Fluctuant swelling (due to effusion) that decreases ability to occlude on ipsilateral
posterior teeth.
 Ear pain
 Bright MRI signal when fluid is present

39
Q

SYNOVITIS AND CAPSULITIS
(ARTHRALGIA)
1. Inflammation of?
2. Occurs after?
3. pain?
4. Movement of TMJ?
5. Palpation?

A
  1. Inflammation of the synovial structures
  2. Occurs after trauma, bruxism or wide opening
  3. Continuous pain in TMJ
  4. Movement of TMJ increases pain
  5. Palpation over capsule increases pain
40
Q

SYNOVITIS AND CAPSULITIS
(ARTHRALGIA)
1. opening?
2. Edema?
3. Posterior teeth ?

A
  1. Limited mandibular opening due to pain
  2. Edema can cause inferior displacement of the
    mandible due to swelling creating a
    malocclusion. Edema is visible on MRI of TMJ.
  3. Posterior teeth do not occlude on closing
41
Q

RETRODISCITIS
 Inflammation of ?
 Occurs following ?
 Occurs after ?
 Constant sensation?

A

 Inflammation of retrodiscal tissue (posterior attachment)
 Occurs following trauma, bruxism or wide opening
 Occurs after constant clicking or dislocation
 Constant deep pain

42
Q

POLYARTHRITIDES

A
  1. Rheumatoid arthritis
  2. Juvenile arthritis
  3. Ankylosing spondylitis
  4. Psoriatic arthritis
  5. Infectious arthritis
  6. Gout (crystal-induced disease)
43
Q

POLYARTHRITIDES DIAGNOSTIC CRITERIA
Must be present:
1. Pain ?
2. tenderness?
3. ROM?
4. Radiographic evidence of?

A

Must be present:
1. Pain with jaw function
2. Point tenderness on TMJ palpation
3. Limited range of motion secondary to pain
4. Radiographic evidence of extensive TMJ changes

44
Q

POLYARTHRITIDES imaging changing

A

flattened condyle, limited space, limited translation

45
Q

POLYARTHRITIDES DIAGNOSTIC CRITERIA
 May be present:
1. Any of characteristics of ?
2. Pain while?
3. lab tests?
4. noises?

A
  1. Any of characteristics of osteoarthritis
  2. Pain while mandible is at rest
  3. Positive laboratory serology test (rheumatoid factor, sedimentation rate, antinuclear antibody- ANA)
  4. Crepitus (grinding noises) with condylar translation
46
Q

NON-INFLAMMATORY DISORDERS

A
  1. Osteoarthritis
  2. Osteoarthrosis
47
Q

OSTEOARTHRITIS DIAGNOSTIC CRITERIA
 Primary: All of the following must be present:
1. No other?
2. Pain with?
3. tender?
4. Radiographic evidence of?

A

All of the following must be present:
1. No other identifiable etiological factor
2. Pain with jaw function & movement
3. Point tenderness on TMJ palpation
4. Radiographic evidence of structural bony change (not as
extensive as seen in inflammatory arthritis)

48
Q

OSTEOARTHRITIS imaging of closed mouth

49
Q

OSTEOARTHRITIS imaging of open mouth

50
Q

OSTEOARTHRITIS
May be present:
1. rom?
2. noise?

A
  1. Limited range of motion, deviation to the
    affected side
  2. Crepitus or multiple joint noises
51
Q

OSTEOARTHROSIS
1. defined?
2. pain?
3. what during any movement
4. radiographs

A
  1. Chronic arthritis of non-inflammatory character
  2. No pain report or pain on palpation
  3. Coarse crepitus in TMJ during any movement
  4. NO radiographic degenerative changes
52
Q

ARTHRALGIA
Pain with? noises?

A
  1. Pain with jaw function
  2. Pain on TMJ palpation
  3. No TMJ noises
53
Q

ARTHRALGIA TREATMENT pyramid

54
Q

DENTAL MANAGEMENT OF OROFACIAL PAIN PATIENTS
1. appt length
2. jaw opening?
3. scaling?
4. NSAIDs or Tylenol use?
5. Ethyl chloride?

A
  1. Keep appointment shorter than 1-2 hours. Frequent rest periods during
    appointment.
  2. Limit jaw opening when possible.
  3. Use sonic scaler/Cavitron when possible to expedite hygiene appointment.
  4. NSAIDs or Tylenol 30 minutes prior to appt and for 24h (if no contraindications).
  5. Ethyl chloride spray during appointment.
55
Q

POTENTIAL PROBLEMS RELATED TO
DENTAL CARE IN OROFACIAL PAIN
PTS: hygiene/ hygiene appts

A

 Oral hygiene may be less than optimal due to restricted range of motion &/or pain on opening (i.e. flossing).
 Patient’s pain may increase following hygiene appt. due to length of time required to keep mouth open (i.e. digastric & inferior lateral pterygoid may result in referred pain to TMJ, maxillary sinus, & mandibular incisors).

56
Q

POTENTIAL PROBLEMS RELATED TO DENTAL CARE IN OROFACIAL PAIN
PTS
 Clenching/bruxism?
 ROM?
 Sensation of malocclusion may occur due to?

A

 Clenching/bruxism may cause teeth to be sensitive to
percussion and temperature changes (i.e. hot or cold).
 Restricted range of motion & muscle tiredness may make it
difficult for patient to remain open for extended period of
time.
 Sensation of malocclusion may occur due to Trigger Point
tension with shortening of muscles seen in Myofascial Pain.

57
Q

POTENTIAL PROBLEMS RELATED TO DENTAL CARE IN OROFACIAL PAIN
PTS
 Locking ? open locking?
 Clicking sounds in the TMJ may result fromthe dysfunction of?

A

 Locking may occur during dental appointment. If OPEN LOCK, get Oral Surgeon immediately to reduce mandible.
 Clicking sounds in the TMJ may result from dysfunction of the lateral pterygoid muscles (i.e. extended opening).

face pain (12 decks)

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