Temporomandibular Disorder (TMD) Flashcards
What are the possible causes of TMD?
myofascial pain
disc displacement
- anterior disc displacement with reduction
- anterior disc displacement without reduction
degenerative disease
- localised e.g. osteoarthritis
- generalised e.g. rheumatoid arthritis
chronic recurrent dislocation
ankylosis
hyperplasia (one condyle growing more than the other)
neoplasia (osteochondroma, osteoma or sarcoma)
infection
How to correct a dislocated TMJ?
Sit patient up
Place thumbs in buccal mucosa
Push down and back slowly
What could you see intra-orally in a bruxist?
Linea alba
Tongue scalloping
Occlusal NCTSL
What are the differential diagnosis for TMD?
dental pain
sinusitis
ear pathology
salivary gland pathology
referred neck pain
headache
atypical facial pain
trigeminal neuralgia
angina (referred pain)
condylar fracture
temporal arteritis
How would you manage TMD?
Reversible options:
- patient advice and education
- reassurance, soft diet, masticate bilaterally, no wide opening, no chewing gum, don’t incise food, cut food into small pieces, stop parafunctional habits, support mouth on opening
- electromyographic recording
- jaw exercises (physiotherapy)
- medications
- NSAIDs, muscle relaxants, tricyclic antidepressants, botox, steroids
- physical therapy
- physiotherapy, massage/heat, acupuncture, relaxation, ultrasound therapy, TENS, hypnotherapy
- splints
- bite raising appliances, anterior repositioning splint, wenvac splint, Michigan splint
Irreversible options:
- TMJ surgery
How does a bite raising appliance (BRA) work?
BRAs stabilise the occlusion and improve the function of masticatory muscles, thereby decreasing abnormal activity. They also protect the teeth in cases of tooth grinding.
Pts need to wear their splint for several weeks before a benefit is felt (3-6 months to give for adjustment), Splint should be worn at the time of parafunction.
