Temporomandibular Dysfunction Flashcards
1
Q
Accessory MoM
A
Suprahyoid muscles
- digastric
- mylohyoid
- geniohyoid
- stylohyoid
Infrahyoid muscles
- thyrohyoid
- sternohyoid
- omohyoid
- sternothyroid
2
Q
Causes of TMD
A
- myofascial pain
- disc displacement : anterior with reduction/ without reduction
- degenerative disease : localised (osteoarthritis); generalised (sytemic, rheumatoid arthritis)
- chronic current dislocation
- ankylosis
- hyperplasia
- neoplasia (osteochondroma, osteoma, sarcoma)
- infection
3
Q
Pathogenesis of TMD
A
- inflammation of MoM
- TMJ inflammation due to parafunctional habits
- trauma directly to joint
- trauma indirectly to joint, ie: sustained opening during dental tx
- stress
- psychogenic
- occlusal abnormalities, ie: high occlusal height of restorations which causes muscle pain due to posturing
4
Q
Signs of parafunctional habits
A
- cheek biting (linea alba/ morsicatio buccarum)
- linea alba
- tongue scalloping
- occlusal NCTSL
5
Q
Common clinical features
A
- F > M
- most common between 18-30 yrs
- intermittent pain of several months / yrs duration
- muscles/ joint/ ear pain, on wakening
- trismus/ locking
- clicking/ popping joint noises
- headaches
- crepitus indicating late degenerative changes
6
Q
Differential diagnosis of TMD
A
- dental pain
- sinusitis
- ear pathology
- SG pathology
- referred neck pain
- headache
- atypical facial pain
- trigeminal neuralgia
- angina
- condylar fracture
7
Q
Treatment for TMD
A
Reversible
- patient education in counselling/ jaw exercises
- medications
- NSAIDs
- Muscles relaxant
- tricyclic antidepressants
- botox
- steroids
8
Q
Advice to give patients who haver TMD
A
- reassure
- soft diet
- masticate bilaterally to enable uniform muscle tension
- limit mouth opening, ie: support mouth when yawning
- incise food into smaller pieces
- stop parafunctional habits
9
Q
Physical therapy for TMD
A
- physiotherapy
- TENS (transcutaneous electronic nerve stimulation)
- hypnotherapy
- relaxation
- ultrasound therapy
10
Q
What can you provide TMD pts?
A
- bite raising appliances
- anterior repositioning splint
11
Q
Types of bite raising appliances
A
- anterior repositioning splint
- Wenvac splint
- Michigan splint
- Lucia jig
- hard acrylic bite raising appliances
12
Q
How does bite raising appliances work?
A
- stabilizes occlusion
- improves function of masticatory muscles
- protect teeth from tooth grinding
- pt needs to wear for several weeks for benefit to be felt
- should be worn at time of parafunction
13
Q
Types of TMJ surgery?
A
- arthrocentesis
- arthroscopy
- disc- repositioning surgery
- disc repair/ removal
- high condylar shave
- total joint replacement
14
Q
Why does joint clicking happen?
A
- lack of coordinated movement between condyle and articular disc
15
Q
Anterior disc displacement with reduction
A
- most common cause of TMJ clicking
- disc is initially displaced anteriorly by condyle during opening until disc reduction occurs
