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the face pain exam Flashcards

1
Q

what mm can we palpate for the exam

A

massetter and temporalis (ant, middle and posterior bellies)
indicate which side caused pain too

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2
Q

joint palpation and auscultation

A

palapte the joint and use sethoscope to listen for creptius or other noises present

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3
Q

TMJ ROM measures

A

incisal overlap
vertical range
R/L excursive movements
always note where pain occurs in any of these moves

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4
Q

what if one side has less excursive movement what should be suspected?

A

suspect disc displacement (anteromedial) on the opposite side

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5
Q

The Pain History is?
components of this?

A

The Pain History is Subjective
1. CC (Patient’s Chief PAIN Complaint)
2. HPI (History of Present Illness)
3. PMHx (Past Medical History) y)
4. psychosocial hx
5. ROS (Review of Medical Systems)

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6
Q
  1. CC (Patient’s Chief PAIN Complaint)
A
  1. CC (Patient’s Chief PAIN Complaint) – why is patient seeking
    treatment? IN THE PATIENT’S OWN WORDS
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7
Q
  1. HPI (History of Present Illness)
A
  1. HPI (History of Present Illness) Facial Pain (location, chronicity,
    quality, frequency, duration, triggers, modifying factors),
    associated trauma, and Habits- NOT MEDICAL HISTORY
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8
Q
  1. PMHx (Past Medical History)
A
  1. PMHx (Past Medical History) that is pertinent to PAIN CONDITION –
    surgical history, medications
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9
Q
  1. Psych/Soc (Psychosocial History)
A
  1. Psych/Soc (Psychosocial History)- anxiety, depression
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10
Q
  1. ROS (Review of Medical Systems)
A
  1. ROS (Review of Medical Systems)- includes an assessment of
    appetite, sleep patterns, activity levels, energy levels, headache
    history, ear, eye, sinus problems, jaw dysfunction including
    noises, locking history, cervical dysfunction and pain, back pain,
    lung, heart, GI, GU, Liver, Kidney problems, neurological and
    other musculoskeletal problems.
    Is there arthritis, fibromyalgia, migraines that may contribute or
    cause the pai
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11
Q

Screening Questions for TMD
 Ask your patient if she/he experiences:
1. Difficulty &/or pain with?
2. Jaw locking, sticking or the jaw going out of joint?
3. Pain with?
4. noises?
5. Stiffness, tightness or tiredness?
6. Pain in or near?
7. Frequent?
8. Recent changes in?
9. Recent injury to?

A
  1. Difficulty &/or pain with mouth opening
  2. Jaw locking, sticking or the jaw going out of joint
  3. Pain with chewing, talking or using jaw
  4. Jaw joint noises
  5. Stiffness, tightness or tiredness in the jaw
  6. Pain in or near the ears, temples, or cheeks
  7. Frequent headaches, neck aches or toothaches
  8. Recent changes in your bite
  9. Recent injury to the jaw, neck or head
  10. Past treatment for facial pain or a jaw joint problem
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12
Q

Comprehensive History for Orofacial Pain
 If the patient responded positively to any of the screening
questions, it may require?
 Your decision as a dentist to complete a TMD comprehensive
exam should be based on?

A

 If the patient responded positively to any of the screening
questions, it may require a comprehensive history and clinical
TMD examination
 Your decision as a dentist to complete a TMD comprehensive
exam should be based on the patient’s level of concern and
clinically significant findings from your oral exam and
extraoral exam

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13
Q

what factors should be assessed for a consult

A

pain quality, pain severity, duration, frequency, aggrevated by, 24hr variation, joint noises, locking, past tx, current tx

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14
Q

HPI (History of Present Illness): pain questions

A

 Date of Onset of Pain
 Pain Problem (i.e. Facial pain, toothache)
 Pain Location (ask pt to point, i.e. Left TMJ)
 Pain Quality
 Pain Severity

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15
Q

HPI (History of Present
Illness):
 Duration of?
 Frequency of?
 Variability:
 Habits-
 Aggravating and ameliorating factors?
 24 hour variation?

A

 Duration of pain
 Frequency of pain
 Variability: continuous or intermittent (ask pt if pain is there every minute all day long or does it come and go); is pain spontaneous or triggered
 Habits- clenching, biting on lips/cheeks, pens, fingernails, chewing gum
 Aggravating and ameliorating factors
 24 hour variation (i.e. worse on awakening
or during day

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16
Q

how can we see clenching if pt doesnt know

A

likely to have a scalloped tongue

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17
Q

other causes of scalloped tongue

A

hypothyroidism (due to macroglossia) and obstrucuve sleep apnea

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18
Q

what should we do with night guard pt has

A

examine, if cracked its useless

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19
Q

when is a TMD consult needed:
 mouth opening?
 noises?
 Change in?
 Masticatory Muscle?
 TMJ ?
 Abnormal pain in face, teeth or headache esp. following?
 Panorex shows?

A

Needed if patient has:
 Limited mouth opening < 35mm
 Clicking, popping or grinding noises in TMJ with PAIN
 Change in occlusion
 Masticatory Muscle pain
 TMJ pain or locking
 Abnormal pain in face, teeth or headache esp. following extraction, RCT, surgery or implant
 Panorex shows degenerative changes on TMJ, Fracture or other abnormality

20
Q

exam set up

A

shimstock for occ
load joint unilaterally with depressors
ruler to measure ROM
needle for noxious stim

21
Q

click vs crepitus

A

click is displaced crepitus is degen

22
Q

ROM components for extraoral exam

A

comfy opening 9no pain0
max unassisted open (pain present)
max assisted open (dentist opens further)
protrusion
R/L lat. extrusion

23
Q

+/- midline deviation to excursions

A

subtract from side going towards and add to opposite side

24
Q

normal opening

A

40-60mm

25
Q

normal r/l excursion

A

9-12mm

26
Q

Range of Motion
 Note pain location with?
 With passive stretch, note?
 Feel the TMJ’s on opening. Do they?

A

 Note pain location with all movements
 With passive stretch, note “end feel” – is it soft or hard?
 Feel the TMJ’s on opening. Do they both translate?

27
Q

what doe this patten indicate

A

Disc displacement with reduction and corrected deviation
shift to side of disc interference but returns after disc reduction

28
Q

what does thi pattern indicate

A

disc displacement with no reduction, deflection
midline is continulally deflected to affected side with limited opening

29
Q

Joint Sounds (Auscultation)

A
  • Listen with a stethoscope while the patient opens maximally &
    closes , protrudes, and moves laterally
  • Listen for clicking, popping, or crepitus (grinding) and note when it occurs during mouth opening & closing
30
Q

Muscle Palpation Exam
 1. Explain to patient that you will be? scale?
 NOTE: Leaving it blank means?
 2. Tell the patient that they should tell you if the pain?

A

Muscle Palpation Exam
 1. Explain to patient that you will be applying pressure on the
muscle and ask them to rate the pain as Mild, Moderate or Severe
or numerically as 0, 1, 2, 3 respectively
 Please RECORD pain rating as:
 “0”- No pain
 “1”- Mild pain
 “2”- Moderate pain
 “3”- Severe pain
 NOTE: Leaving it blank means that you did NOT do the
examination.
 2. Tell the patient that they should tell you if the pain spreads
out and point to the area where the pain is spreading to (this is
referred pain known as myofascial pain)

31
Q

trigger points of mm exam

A

Trigger Points (TPs) in any voluntary muscle which cause
referred pain and referred tenderness and may be
active or latent. (3

32
Q

Extraoral Muscle Palpation
Exam mm’s

A

 Temporalis
 Masseter

33
Q

Temporalis Muscle palpation

A

Temporalis Muscle: Palpate
Anterior, middle, posterior with
mouth open

34
Q

Superficial Masseter Muscle palpation

A

Superficial Masseter Muscle:
Palpate Superior, mid-, inferior &
deep masseter with mouth open

35
Q

Trigger Point Referral Patterns of the masseter (superficial and deep)

A
36
Q

Trigger Point Referral Patterns of the temporalis

A
37
Q

Intraoral Muscle Exam

A

 Medial pterygoid
 Lateral pterygoid area/tendon of temporalis- ask the
patient to move his/her jaw to the same side you are
palpating

38
Q

digastric pain referal patterns

A
39
Q

medial pterygoid referal patterns

A
40
Q

intraorla palpation could trigger?

A

electric pain, allodynia, burning pain

41
Q

Evidence of Parafunction

A

Defined Linea Alba from Teeth Clenching or scalloped tongue

42
Q

habits of interest to pain

A

 Clenching/bruxism
 Biting on nails, cheeks, lips, tongue, pens
 Protrusion
 Gum chewing
 Jaw tension
 Unilateral chewing
attrition

43
Q

Radiographic Exam
 ideal one? shows?
 Does NOT show?
 May request?
 May request an MRI to evaluate?

A

 Panorex- can evaluate maxilla, mandible, teeth and TMJ on
one film.
 Does NOT show Lateral view of TMJ
 Does NOT show open and closed mouth views so translation, joint spacing cannot be evaluated
 May request a lateral view with a CBCT or CT
 May request an MRI to evaluate disc displacement or other pathology

44
Q

How long should you palpate a masticatory muscle to determine if there is pain?

A

1-2 seconds

45
Q

When you perform the passive stretch during measuring mouth opening and there is no increase in motion with a hard end feel and opening <35mm, this commonly suggests restriction within which anatomical structure?

A

TMJ

face pain (12 decks)

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