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Dental Occlusion > Temporomandibular Disorders, Occlusion, and Splint Therapy > Flashcards

Temporomandibular Disorders, Occlusion, and Splint Therapy Flashcards

1
Q

If occlusion plays a significant role in the etiology of TMD, what is the role of the dentist?

A
  • management of TMJ disorders
  • no other health care providers can provide this treatment
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2
Q

if occlusion does not play a role in TMD, what is the role of the dentist?

A

any attempt by the dentist to alter the occlusal condition is misdirected and should be avoided

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3
Q

what is the term given to the condylar position that is in the most anterior and superior position within the glenoid fossa and with the articular disc properly interposed against the articular eminence?

A
  • centric relation
  • there is no tooth contact in the CR position
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4
Q

When the mouth closes, the condyles are in their most ___ position (musculoskeletally stable), resting against the posterior slopes of the articular eminences with the discs properly interposed. In this position there is ___ and ___ contact of all posterior teeth. The anterior teeth also come into contact but more ___ than the posterior teeth.

A
  • superoanterior
  • even and simultaneous
  • lightly
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5
Q

do all tooth contacts provide axial loading of occlusal forces?

A

yes

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6
Q

When the mandible moves into ___ positions, there are adequate tooth-guided contacts on the ___ (working) side to disocclude the ___ (nonworking/balancing) side immediately. The most desirable guidance is provided by the canines (called “___”).

A
  • laterotrusive
  • laterotrusive
  • mediotrusive
  • “canine guidance”
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7
Q

When the mandible moves into a protrusive position, there are adequate tooth-guided contacts on the anterior teeth to ___ all posterior teeth immediately

A

disocclude

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8
Q

In the upright head position and alert feeding position, posterior tooth contacts are ___ than anterior tooth contacts.

A

heavier

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9
Q

what are the 3 requirements for occlusal stability and function?

A
  1. CRTC = CO/HB/MIP with tooth contacts occurring as bilateral, simultaneous and stable (BSS); eg. No occlusal prematurities
  2. Optimum cuspid protection and anterior guidance. Encourages vertical chewing.
  3. No posterior interfering tooth contacts in eccentric jaw movements, ie. balancing, protrusive and working interferences.
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10
Q

what does TMDI stand for?

A

temporomandibular disorder index

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11
Q

what are the 9 questions included in the recommended screening questionnaire for TMD?

A
  1. do you have difficulty or pain, or both, when opening your mouth?
  2. does your jaw get “stuck”, “locked”, or “go out”?
  3. do you have difficulty or pain, or both, when chewing, talking, or using your jaw?
  4. are you aware of noises in the jaw joints?
  5. do you have pain in or about the ears, temples or cheeks?
  6. does your bite feel uncomfortable or unusual?
  7. do you have frequent headaches?
  8. have you had a recent injury to your head, neck, or jaw?
  9. have you previously been treated for a jaw joint problem? if so, when?
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12
Q

describe the 7 procedures included in the recommended screening examination for TMD

A
  1. measure range of motion of mandible on opening (>40 mm) and lateral excursions (>8 mm)
  2. palpate for preauricular tenderness
  3. palpate for TMD crepitus
  4. palpate for TMJ clicking
  5. palpate for tenderness in the masseter and temporalis muscles
  6. note the excessive occlusal wear, excessive tooth mobility, fremitus or migration in the absence of periodontal disease and soft tissue alterations
  7. inspect symmetry and alignment of the face, jaws, and dental arches
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13
Q

describe type I TMDI

A

noticeable malocclusion, lack of anterior guidance, has posterior interferences but no symptoms or signs of dysfunctions

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14
Q

describe type II TMDI

A

presence of noises in the joint, but no pain. occlusal wear and/or malocclusion, normal ROM, facial asymmetry. muscle hypertrophy, normal joint appearances on radiograph. chronic non-painful signs and symptoms. elevated psychological factors.

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15
Q

describe type III TMDI

A

painful joint sounds, restricted ROM, muscle tension pain, with or without malocclusion, acute symptoms. bone changes evident on radiograph. elevated psychological factors.

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16
Q

what are the 4 main preventive measures for treating TMD patients

A
  • inform and educate the patient as to your findings
  • modify appointments according to the patients condition
  • select less traumatic techniques
  • be prepared to handle unwanted complications
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17
Q

describe the selection of less traumatic techniques in the preventive measured taken when treating TMD patients

A
  • impression technique
  • use mouth props
  • minimize vertical opening
  • use frequent rests
18
Q

describe handling unwanted complications as a preventive measure when treating TMD patients

A
  • muscle relaxants
  • ice packs
  • moist heat
  • physical therapy
19
Q

what are splints used for?

A

helps improve or relieve the symptoms of TMD

20
Q

what are the 4 features important in the design and function of splints?

A
  • stable and passive: orthopedically and occlusally stable
  • minimally invasive
  • incorporates functionally idea occlusal principles
  • maintain symptom improvement over time
21
Q

describe how splints incorporate functionally ideal occlusal principles

A
  • bilateral, simultaneous, stable CO/ICP tooth contacts at CR (BSS)
  • canine guidance and incisal guidance
    • no interfering tooth contacts in eccentric jaw positions
22
Q

describe how splints maintain sumptom improvement over time

A
  • 3 months of update visits every two weeks
  • symptom improvement levels over 50% since initiation of splint therapy
23
Q

describe treatment fees for splints

A
  • should reflect time, effort, and expertise
    • equivalent to fee for indirect restorations
    • follow-up visits billed as consultation fees
    • occlusal analysis with mounted models
    • diagnostic photos, etc.
24
Q

describe the 3 options for occlusal therapy following splint stabilization

A
  • discontinue daytime wear and use only for night-time wear
    • or, discontinue althogether and use only as needed
  • perform occlusal analysis with articulator mounted models
  • pending results of occlusal analysis and diagnosis:
    • equilibration: selective grinding vs. resculpting
    • orthodontic stabilization
    • restorative/occlusal reconstructive therapy
25
Q

describe occlusal analysis with articulator mounted diagnostic models

A
  • occlusal records:
    • centric relation wax record
    • earbow transfer record
    • diagnostic quality models (two sets, one baseline and one working)
26
Q

describe the 6 equilibration treatment goals

A
  • bilateral, simultaneous, and stable CO contacts in CR (BSS)
  • optimum protective guidance in eccentric movements (canine guidance and group function)
  • refine, smooth, and polish adjusted tooth surfaces
  • recall after 2 weeks of night-time only wear of splint
  • recall after 3 months of night-time only wear of splint
  • patient has option to wean off splint and use only as needed
27
Q

describe orthodontic stabilization in the treatment of TMD using splints

A
  • review articulated models with orthodontist to communicate findings of occlusal disharmony
  • monitor progress and orthopedic stability during treatment
  • may need to provide dual purpose, retainer/splint following case completion
  • refinement of occlusal contacts may be beneficial 6 months to one year post orthodontic treatment
28
Q

describe restorative/occlusal reconstructive therapy

A
  • diagnostic wax-up of desired results: ideal anatomic design
  • staged operative procedures utilizing splint to preserve joint stability
  • reverse order when fabricating permanent restorations
  • final splint for night-time wear if needed
29
Q

for restorative/occlusal reconstructive therapy, describe staged operative procedures utilizing splint to preserve joint stability

A
  • anteriors: adjust and reline splint
  • mandibular posteriors: adjust occlusal contacts on splint
  • maxillary posteriors: eliminate splint
  • up to 8 week trial of new occlusal relationships in provisionals
30
Q

describe considerations of the patient’s treatment tolerance levels

A
  • frequent rests during equilibration and restorative procedures
  • reinsert splint to restabilize orthopedic relationships
  • where possible, have patient wear splint for a few hours post visit
  • plan treatment in tolerable segments based on patients needs
31
Q

what are 6 factors contributing to temporomandibular disorders?

A
  • trauma
  • parafunctional habits
  • emotional stress
  • occlusal imbalance
  • systemic disease
  • sleep disorders
32
Q

describe acute trauma that contributes to TMD

A
  • direct impact to mandible
  • sudden functional event
    • biting into hard food objects
    • yawning
    • kissing
    • hyperextension of joints
    • etc.
33
Q

describe chronic trauma that contributes to TMD

A
  • parafunctional habits
    • nail biting
    • gum chewing
    • clenching
    • posture
    • lip and/or cheek biting
    • pipe smoking
    • etc.
34
Q

describe emotional stresses that contribute to TMD

A
  • activities of daily living
  • personal crisis
  • major events
35
Q

describe systemic disease or growth abnormalities that contribute to TMD

A
  • arthritis
  • congenital defects
  • developmental defects
  • tumors
  • etc.
36
Q

what are the two classifications of TMD?

A
  • myofacial pain dysfunction
  • internal derrangement
37
Q

describe internal derrangement

A
  • disc dislocation
  • disc deformation
    • crepitus: soft tissue
    • crepitus: arthritic
      • bone to soft tissue
      • bone on bone due to perforation
38
Q

what are 6 main accepted forms of therapy for TMD?

A
  • occlusal therapies
  • physical therapy
  • biofeedback therapy
  • psychological counseling
  • surgical repair
  • sleep disorder therapy (CRAP, DENTAL)
39
Q

describe occlusal therapies

A
  • splints (orthotic appliances)
  • orthodontics, restorations, equilibrations, orthognathic surgery
40
Q

describe psychological counseling

A
  • stress management
  • obsessive compulsive behaviors

Dental Occlusion (2 decks)

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