Pre-prosthetic dentistry and TM dysfunction Flashcards

1
Q

Why may a pros pt get sent to oral surgery

A

For soft tissue excisional work
-Frenectomy/frenoplasty
-Papillary hyperplasia
-Flabby ridges
-Denture induced hyperplasia (Epulis fissuratum)
-Maxillary tuberosity reduction
-Retromolar pad reduction

Ridge extension procedures
-Vestibuloplasty, Maxillary, Mandibular

Augmentation procedures
-Soft tissue grafting

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2
Q

What hard tissue excisional work could pros ask for

A

-Removal of retained teeth/roots/pathology
-Ridge defect correction (alveoplasty)
-Mandibular tori
-Maxillary tori
-Maxillary tuberosity
- Bony Exostoses
-Undercuts
-Genial tubercle reduction
-Mylohyoid ridge reduction

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3
Q

What hard tissue augmentation procedures could pros ask for

A

Autografts
-e.g. Iliac crest bone, rib

Allografts
-Bone from other humans

Xenografts
-From animals, e.g. Bio-Oss

Synthetic grafts
-e.g. β Tricalcium Phosphate

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4
Q

What other names of temporomandibular dysfunction

A

Myofascial pain dysfunction

Pain dysfunction syndrome

Facial arthromyalgia

Costen’s syndrome

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5
Q

What is the blood supply around the TMJ and muscles of mastication

A

deep auricular artery (branch of 1st part of the maxillary artery)

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6
Q

What is the nerve supply around the TMJ and the muscles of mastication

A

auriculotemporal, masseteric, posterior (deep) temporal nerve

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7
Q

Why may patients with TMD also have pain in therer ear

A

The auriculotemporal nerve supplies ear as well

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8
Q

What are the suprahyoid muscles

A

Digastric
Mylohyoid
Geniohyoid
Stylohyoid

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9
Q

What are the infrahyoid muscles

A

Thyrohyoid
Sternohyoid
Omohyoid
Sternothyroid

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10
Q

Where is the articulator disc innervated

A

The posterior part and bilaminar zone

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11
Q

What are causes of TMD

A

Myofascial pain

Disc displacement
-Anterior with reduction
-Anterior without reduction

Degenerative disease
-Localised ,osteoarthritis
-Generalized (Systemic), rheumatoid arthritis

Chronic recurrent dislocation

Ankylosis (condyle fuses to skull)

Hyperplasia (one condyle grows bigger and means the jaw points one way)

Neoplasia (osteochondroma, osteoma, or sarcoma)

Infection

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12
Q

What is anterior disc displacement with reduction

A

The disc after being displaced but is able to move back at some point

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13
Q

What is the pathogenesis of the myofacial pain and TMD

A

Inflammation of muscles of mastication or TMJ secondary to parafunctional habits

Trauma, either directly to the joint or indirectly e.g. sustained opening during dental treatment

Stress

Psychogenic

Occlusal abnormalities

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14
Q

What are common clinical features of TMD

A

Females > males

Age: most common between 18-30 years

Intermittent pain of several months or years duration

Muscle / joint / ear pain, particularly on wakening

Trismus / locking

‘Clicking/popping’ joint noises

Headaches

Crepitus indicates late degenerative changes

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15
Q

What is the treatment for TMD

A

Patient education
-Counselling
-Electromyographic recording
-Jaw exercises
-Physiotherapy

Medication
-NSAIDs
-Muscle relaxants
-Tricyclic antidepressants
-Botox
-Steroids

Physical therapy
-Physiotherapy
-Massage/heat
-Acupuncture
-Relaxation
-Ultrasound therapy
-TENS (Transcutaneous Electronic Nerve Stimulation)
-Hypnotherapy

Splints
-Bite raising appliances
-Anterior repositioning splint

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16
Q

What info would you give to patients with TMD

A

Tell the patient what the condition is and what happens to the joint for it to happen in simple terms

The give them advice:

-Soft diet

-Masticate bilaterally

-No wide opening

-No chewing gum

-Don’t incise foods

-Cut food into small pieces

-Stop parafunctional habits e.g. nail biting, grinding

-Support mouth on opening e.g. yawning

17
Q

What irreversible treatment is there for TMD

A

Occlusal adjustment

TMJ surgery
-Arthrocentesis
-Arthroscopy
-Disc-repositioning surgery
-Disc repair/removal
-High condylar shave
-Total joint replacement

18
Q

What is disc displacement/internal derangement

A

the articular disc displaced from its original position on the mandibular condyle

19
Q

What will disc displacement present with

A

may present with a painful clicking TMJ

Joint clicking is due to lack of coordinated movement between the condyle and the articular disc

20
Q

What is the most common cause of TMJ clicking

A

Anterior disc displacement with reduction

21
Q

What happens in anterior disc displacement with reduction

A

Disc is initally displaced anteriorly by the condyle during opening until disc reduction occurs