Temporomandibular Disorder

Question 1

How do you classify patients who are complaining of TMJ pain?

Answer 1

Joint degeneration
-pain on use & crepitus, +/- rest pain
-arthritic changes - psoriatic arthritis
Internal derangement
-locking open or closed
No joint pathology

Question 2

What are the causes of TMD?

Answer 2

Occlusion
Grinding
Clenching
Stress

Question 3

What are the signs the patient has a parafunctional habit in TMD?

Answer 3

Linea alba is a sign of a clenching habit
A scalloped tongue
Wear facets on teeth

Question 4

What are some examination findings of a patient with TMD?

Answer 4

Focal muscle tenderness
Tenderness over the TMJ
Limitation of opening (progressive)
Joint noise
–incidental- degenerative OA changes
–related to muscle dysfunction- click
Deviation on opening
–common finding with muscle dysfunction
Dental occlusion upset

Question 5

What are the indications for imaging with TMD?

Answer 5

If there is functional visualisation of disc movement is needed then take an ultrasound
If a bony image of the disc is needed then CBCT
MRI gives the best image of the disc

Question 6

What is the management of TMD?

Answer 6

Information- how to self help
Physical therapy
–CBT education +/- exercises
–Soft diet and analgesia
–Supported yawning
–Bite splint
Biochemical manipulation
–Tricyclic (not SSRI)
–Anxiolytic medication
Physiotherapy
Acupuncture
Clinical psychology