Temporomandibular Disorders Flashcards
what is pain?
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage
what is orofacial pain?
refers to pain associated with the hard and soft tissues of the head, face, and neck.
orofacial pain is caused by
- Diseases or disorders of regional structures
- Dysfunction of the nervous system
- Through referral from distant sources
Orofacial Pain Includes:
▪ Musculoskeletal: Myogenous and Arthrogenous TMD
✓Myalgia, Arthralgia (TMJ)
▪ Neuropathic orofacial pain disorders: Neuralgia, neuropathy, orofacial movement disorders
✓Dyskinesias and dystonias
▪ Neurovascular orofacial pain disorders: various headache disorders
✓Migraine, Trigeminal Autonomic Cephalgias (TACs)
▪ Pain of nonorganic etiologies: Somatic Symptom Disorder
the TMJ is what type of joint?
Ginglymoarthrodial Joint
innervation of the TMJ area
Auriculotemporal nerve (branch of V3), deep temporal and masseteric nerves
vascuclar supply of the TMJ area?
Superficial temporal artery (external
carotid artery), internal maxillary artery and middle meningeal artery
muscles of the head neck and face
- Masseter
- Temporalis
- Medial pterygoid
- Lateral pterygoid
- Digastric
- Suprahhyoids
- Infrahyoids
*sternocleidomastoid
Masseter
Elevates the mandible, providing force for chewing
Temporalis
Elevates and retracts the mandible
Medial Pterygoid
Elevates and protrudes the mandible
Lateral Pterygoid (Inferior)
Causes mandibular protrusion; unilateral contraction moves the mandible to the opposite side
Lateral Pterygoid (Superior)
Active during power stroke (chewing against resistance)
Digastric
Depresses the mandible
Sternocleidomastoid (SCM)
Contributes to head posture and may refer pain to the TMJ
Trapezius
Upper back and shoulder muscle; often involved in TMD-related pain
Temporomandibular disorders (TMDs)
encompass a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints (TMJs), the masticatory muscles and all
associated tissues
what is the prevalence of TMD?
13% for masticatory muscle pain and 16% for disc derangement disorders
- only 3.6-7% warrant treatment
- peak occurrence between 20-40 yrs old
- 2:1 women to men
what is the Etiology that leads to TMD?
- Acute trauma
- Trauma from hyper-extension: dental procedures, oral intubation,
whiplash injuries - Parafunctional habits: daytime clenching, nocturnal bruxing, lip or
cheek biting - Postural imbalances
- Psychological factors: stress, anxiety, depression
- Systemic factors: rheumatoid arthritis, fibromyalgia, generalized joint laxity (hypermobility)
occlusal factors more prevalent in TMD patients
- Large overjet
- Anterior skeletal open bite
- Unilateral posterior crossbite
- Lack of posterior tooth contacts
Clinical Evaluation of TMD: History of Present Illness (HPI): Key questions to assess
When did symptoms start?
Any precipitating factors (e.g., trauma, dental work)?
Pain type, intensity, location, aggravating/alleviating factors?
Presence of joint noises (clicking, crepitus)?
Any jaw locking (open or closed)?
Any headaches, ear pain, neck pain?
Clenching or grinding history?
Mental health factors (stress, sleep disturbances, anxiety)?
Physical Examination: TMJ Palpation
Check for tenderness, pain, and movement restrictions
Physical Examination: Joint Sounds
- Clicking: often due to disc displacement with reduction
- Crepitation (grating sound): suggests osteoarthritis.
Physical Examination: Muscle Palpation
Identify pain and trigger points in masseter, temporalis, and pterygoids
Physical Examination: Cervical Exam
neck posture and pain can contribute to TMD
Physical Examination: Occlusal Exam
Checking for abnormal tooth wear, bite changes, and tongue scalloping (a sign of bruxism).
Acute malocclusion: sudden change in the ICP
- Muscle spasms
- Intracapsular disorders such as disc displacement, capsulitis, acute bony alterations
Disc Displacement with Reduction
Clicking or popping, but normal function
Disc Displacement without Reduction
Jaw may lock, reducing opening, pain
Dislocation (Luxation)
Jaw gets stuck in an open position
Referred to as subluxation/ partial dislocation when mouth closing is achieved by patient without the help of a clinician
Osteoarthritis (DJD)
Degenerative joint disease with joint deterioration and crepitus
Masticatory Muscle Disorders:
Local Myalgia
Pain localized to a specific muscle.
Masticatory Muscle Disorders: Myofascial Pain
Pain spreads to nearby areas, often with trigger points.
conservative treatment: homecare
Avoid wide jaw opening.
No gum chewing.
Apply warm compresses.
Maintain good posture.
conservative treatment: behavioral therapy
Reduce stress and modify habits.
conservative treatment: physical therapy
Jaw and neck exercises.
conservative treatment: Occlusal Appliances (Night Guards)
Protect teeth from grinding.
Pharmacotherapy:
NSAIDs (e.g., ibuprofen) for pain relief.
Muscle relaxants for severe cases.
Antidepressants if stress is a major factor.
Minimally Invasive Procedures
- Trigger Point Injections – Local anesthetic or Botox for muscle pain.
- Arthrocentesis – Flushing the joint with fluid to remove inflammation.
- Intra-Articular Injections – Steroid injections to reduce inflammation.
Surgical Interventions (For Severe Cases)
- Arthroscopy – Minimally invasive joint surgery.
- Arthroplasty – Reshaping the TMJ.
- Total Joint Replacement – Used in end-stage arthritis.
