TMD Flashcards
How long are your teeth coming in contact in a day
during mastication and swallowing
20 minutes, thus just by occlusal equilibraition cannot solve TMD
classification of TMD
myogenous TMD
arthrogenous TMD
prevalence of TMD
9% TMJ 13% muscle 6% disc females > males women at childbearing age
what kind of joint in the TMJ
a gingymo-arthrodial joint
ginglymus (hinging joint, first 20-25mm)
arthrodial (sliding, afterwards translate)
whats the two most important muscles of mastication and where are they
masseter and temporalis
masseter (4cm thick): zygomatic arch to lateral surface of angle of mandible, for elevation and protrusion of mandible, support articular disc of TMJ
temporalis: from temporal fossa to medial surface of coronoid, for elevation and retrusion of mandible
why is medical history important
patient with multiple sites, patient with multiple drugs
statins- side effect is pain
signs of clenching
craze line, wear facets, crenated tongue
first line treatment of TMD
treat symptoms
non invasive methods first unless everything fails
non surgical ways
patient education self care: ice, control of oral habit medication: ibuprofen, paracetamol, dexamethasone for serious pain, muscle relaxant (cyclobenzaprine), cyclic antidepressant (notriptyline), LA, supplements (glucosamine, chondroitin, magnesium) physio: relaxation, stretching, splint: to prevent nocturnal bruxism psychiatric management
why got sound when you open and close
linked to internal derangement and degenerative disease
indications for surgery
absolute vs
arthrocentesis
lavage of joint without direct viewing of joint
for internal derangement or osteoarthritis with acute pain, anchored disc
do auriculotemporal nerve block just anterior to tragus
insertion of 19G needle posterior section of superior joint space
2nd needle in anterior section
lavage 80-100ml
inject marcaine and dress
post op- analgesia, antibiotic (maybe), jaw exercise, intra-oral splint (maybe)
internal derangement of disc
disc displacement with reduction: disc is anterior to condylar head and disc reduces upon opening of mouth, upon closing theres also residual click
disc displacement without reduction: condyle stays posterior to disc through out movement and does not reduce with opening of mouth, assoc w limited mandibular opening
what is normal mouth opening
35-55mm
arthroscopy
able to view joint
for: diagnosis, closed lock, lysis of adhesion and lavage, abrasion arthroplasty, laser electrocautery, disc plication
adaptation of arthroscopic techniques for larger joints
more complications: damage to temporal and zygomatic branches of facial nerve, damage to disc and articular surfaces, perforation of glenoid fossa, otitis, hemorrhage, extravation of irrigation fluid
open joint surgery
absolute indication: underdeveloped or hyperplastic condyle
mandibular ankylosis
benign and malignant tumours
relative: dislocation, fracture of TMJ (unless bilateral then need ), trauma (history of trauma ass w ankylosis), internal derangement, osteoarthritis
preauricular, post auricular, endaural, intra oral
condylectomy,
hypermobility disorders
in open mouth position, disc-condyle complex is positioned anterior to the articular eminence
subluxation- patient can reduce dislocation himself
luxation- patient needs assistance to reduce dislocation
confirmed with imaging
degenerative : osteo arthrotis or osteoarthritis
deterioration of articular tissue w concomitant osseous changes in condyle or articular eminence
difference: arthrosis no pain
diagnosis: TMJ noises w function, crepitus detected, call for CT w subchondral cyst, erosions, generalised sclerosis, osteophytes
what to do with disc displacement with reduction
asymptomatic: education and reassurance
symptomatic: self care, splint, analgesics
DD wo reduction
asymptomatic: education, reassurance, physio
symptomatic: self care, analgesics, physio
osteoarthritis
self care
nsaid/steroids
glucosamine
arthrocentesis
what to do when its a masticatory muscle problem
self-care, physio, medication, splint
