Pre-prosthetic dentistry and TM dysfunction Flashcards
Why may a pros pt get sent to oral surgery
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
What hard tissue excisional work could pros ask for
-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
What hard tissue augmentation procedures could pros ask for
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
What other names of temporomandibular dysfunction
Myofascial pain dysfunction
Pain dysfunction syndrome
Facial arthromyalgia
Costen’s syndrome
What is the blood supply around the TMJ and muscles of mastication
deep auricular artery (branch of 1st part of the maxillary artery)
What is the nerve supply around the TMJ and the muscles of mastication
auriculotemporal, masseteric, posterior (deep) temporal nerve
Why may patients with TMD also have pain in therer ear
The auriculotemporal nerve supplies ear as well
What are the suprahyoid muscles
Digastric
Mylohyoid
Geniohyoid
Stylohyoid
What are the infrahyoid muscles
Thyrohyoid
Sternohyoid
Omohyoid
Sternothyroid
Where is the articulator disc innervated
The posterior part and bilaminar zone
What are causes of TMD
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
What is anterior disc displacement with reduction
The disc after being displaced but is able to move back at some point
What is the pathogenesis of the myofacial pain and TMD
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
What are common clinical features of TMD
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
What is the treatment for TMD
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
What info would you give to patients with TMD
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
What irreversible treatment is there for TMD
Occlusal adjustment
TMJ surgery
-Arthrocentesis
-Arthroscopy
-Disc-repositioning surgery
-Disc repair/removal
-High condylar shave
-Total joint replacement
What is disc displacement/internal derangement
the articular disc displaced from its original position on the mandibular condyle
What will disc displacement present with
may present with a painful clicking TMJ
Joint clicking is due to lack of coordinated movement between the condyle and the articular disc
What is the most common cause of TMJ clicking
Anterior disc displacement with reduction
What happens in anterior disc displacement with reduction
Disc is initally displaced anteriorly by the condyle during opening until disc reduction occurs
