TMD

Question 1

How long are your teeth coming in contact in a day

Answer 1

during mastication and swallowing

20 minutes, thus just by occlusal equilibraition cannot solve TMD

Question 2

classification of TMD

Answer 2

myogenous TMD

arthrogenous TMD

Question 3

prevalence of TMD

Answer 3

9% TMJ
13% muscle
6% disc
females > males
women at childbearing age

Question 4

what kind of joint in the TMJ

Answer 4

a gingymo-arthrodial joint
ginglymus (hinging joint, first 20-25mm)
arthrodial (sliding, afterwards translate)

Question 5

whats the two most important muscles of mastication and where are they

Answer 5

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

Question 6

why is medical history important

Answer 6

patient with multiple sites, patient with multiple drugs

statins- side effect is pain

Question 7

signs of clenching

Answer 7

craze line, wear facets, crenated tongue

Question 8

first line treatment of TMD

Answer 8

treat symptoms

non invasive methods first unless everything fails

Question 9

non surgical ways

Answer 9

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

Question 10

why got sound when you open and close

Answer 10

linked to internal derangement and degenerative disease

Question 11

indications for surgery

Answer 11

absolute vs

Question 12

arthrocentesis

Answer 12

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)

Question 13

internal derangement of disc

Answer 13

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

Question 14

what is normal mouth opening

Answer 14

35-55mm

Question 15

arthroscopy

Answer 15

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

Question 16

open joint surgery

Answer 16

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,

Question 17

hypermobility disorders

Answer 17

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

Question 18

degenerative : osteo arthrotis or osteoarthritis

Answer 18

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

Question 19

what to do with disc displacement with reduction

Answer 19

asymptomatic: education and reassurance
symptomatic: self care, splint, analgesics

Question 20

DD wo reduction

Answer 20

asymptomatic: education, reassurance, physio
symptomatic: self care, analgesics, physio

Question 21

osteoarthritis

Answer 21

self care
nsaid/steroids
glucosamine
arthrocentesis

Question 22

what to do when its a masticatory muscle problem

Answer 22

self-care, physio, medication, splint