The orofacial pain examination Flashcards
is the HPI a medical history
no
what subjective information do you take about the pain history
- chief pain complaint
- HPI - facial pain (location, chronicity, quality, frequency, duration, triggers, modifying factors), associated trauma, and habits
- past medical history that is pertinent to pain condition - surgical history, medications
- psychosocial history, anxiety, depression
- ROS
what are the screening questions for TMD
- difficulty and or pain with mouth opening
- jaw locking, sticking or the jaw going out of joint
- pain with chewing, talking or using the jaw
- jaw joint noises
- stiffness, tightness or tiredness in the jaw
- pain in or near the ears, temples or cheeks
- frequent headaches, neck aches or toothaches
- recent changes in your bite
- recent injury to the jaw, neck or head
- past treatment for facial pain or a jaw joint problem
if the patient responded positively to any of the screening questions it may require:
a comprehensive history and clinical TMD exam and TMD consult
your decision as a dentist to complete a TMD comprehensive exam should be based on:
the patients level of concern, pain and clinically significant findings from your oral exam and extraoral exam
how long should you ask your treatment co-coordinator to schedule the TMD consult for
1 hour
what is involved in the HPI
- date of onset of pain
- pain location
- pain problem
- pain quality
- pain severity
- duration of the pain
- frequency of pain
- variability
- habits
- aggravating and ameloriating factors
- 24 hour variation (worse on wakening or during day)
- joint noises
- jaw locking vs catching
- past treatment
- current treatment
when is a TMD consult needed
- if patient has:
- limited opening less than 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 especially following extraction, RCT, surgery or implant
- panorex shows degenerative changes in TMJ, fracture or other abnormality
what is the normal opening
40-60mm
what is the normal R/L lateral opening
9-12mm
how do you listen to the joint and what do you listen for
- stethoscope while patient opens maximally and closes, protrudes and moves laterally
- listen for clicking, popping, or crepitus, and note when it occurs during mouth opening and closing
what is the scale in the muscle palpation exam
- 0: no pain
- 1: mild pain
-2: moderate pain - 3: severe pain
leaving the muscle palpation exam blank means that you _______
did not do the exam
trigger points in any voluntary muscle which cause:
referred pain and referred tenderness and may be active or latent
what extraoral muscles are palpated
-temporalis
- masseter
