TMD Flashcards
What would you assess in a TMD history for pain?
character
site… jaw, ear, in front of ear, temple
affected by… jaw movement, function, or parafunction
what would you assess in a TMD history for noises?
clicking, snapping, popping, crepitus
on jaw movement
and in the past 30 days
what would you assess in a TMD history for movement?
restricted opening
interfering with ability to eat
locking - intermittent/ persistent; closed; open; able to release with a manoeuvre
deviation
what would you assess in a TMD history for habits?
Clenching, grinding, chewing/ biting, musical instruments, singing
what would you assess in a TMD history for co-morbidities?
- Fibromyalgia
- Chronic pain
- Psychological factors
what would you assess in a TMJ examination?
lateral pole of TMJ
temporalis
masseter
mouth opening
soft tissues
what are you looking for when you palpate the lateral pole of the TMJ?
- Does it elicit familiar pain?
3 repetitions each of opening, closing, lateral, protrusive movements: - Any noises palpable?
- Any noises audible to the patient?
how do you palpate the temporalis?
with teeth clenched above ear and forwards above eye
what do you assess with mouth opening?
- Deviation on opening
- Extent of opening – unassisted and assisted.
*Should be 40mm incisal overlap
what do you assess in the intra-oral soft tissues?
- Ridging buccal mucosa at level of occlusal plane.
- Scalloping of borders of tongue.
- Tooth wear
what ways can you investigate TMD?
- Plain radiographs not normally indicated.
- CBCT
- MRI
What are the 2 types of pain related TMD?
myalgia
arthralgia
what is pain of muscle origin, affected by jaw movement, function or parafunction AND replication of this pain on provocation testing of the masticatory muscles?
myalgia
what is a history of myalgia?
pain in jaw, temple, in front of ear or in the ear AND modified jaw movement, function/ parafunction
what does myalgia present as upon examination?
confirmation of pain location (s) in the temporalis/ masseter AND familiar in masseter/ temporalis with at least one of the provocation tests:
- Palpation of temporalis/ masseter
- Maximum unassisted/ assisted opening movements
what are the sub types of myalgia?
local, myofascial pain, myofascial pain with referral
what is pain of joint origin affected by jaw movement, function or parafunction AND replicated by provocation testing of the TMJ?
arthralgia
what is a history of arthralgia?
pain in the jaw, temple, ear or in front of the ear in the past month AND pain modified with jaw movement, function, and parafunction
what would you see upon examination of arthralgia?
confirmation of pain location in area of TMJ (s) AND familiar pain on:
- Palpation of lateral lobe
- Maximum unassisted or assisted opening, right or left lateral or protrusive movements
what are the types of intra-articular TMD?
disc displacement with reduction
disc displacement without reduction with limited opening
degenerative joint disease
subluxation
what is in closed mouth position the disc is in an anterior position relative to the condylar head and the disc reduces on mouth opening?
disc displacement with reduction
what is a history of disc displacement with reduction?
‘noise’ in the past 30 days in movement/ function OR report of any noise during examination
what would you see upon examination of disc displacement with reduction?
clicking, popping, snapping during opening and closing on palpation during at least 1 of the 3 repetitions.
OR
Clicking, popping, snapping during opening or closing on palpation during at least 1 of the 3 repetitions.
AND
clicking, popping, snapping during opening and closing on palpation during at least 1 of the 3 repetitions of left/ right lateral or protrusive movements.
what is the disc does not reduce with opening, persistent limited mandibular movement which does not reduce when the patient or clinician performs a manoeuvre. Closed lock?
disc displacement without reduction with limited opening
what is history of disc displacement without reduction with limited opening?
jaw locked so that the mouth would not open all way (interfering with eating).
what would you see upon examination of disc displacement without reduction with limited opening?
maximum assisted opening (passive stretch) movement <40mm including vertical incisal overlap.
what is – deterioration of articular tissue with concomitant osseous changes in the condyle and/or articular eminence?
degenerative joint disease
what is history of degenerative joint disease?
‘noise’ in the past 30 days on jaw movement or in function OR any noise during examination
what would you see upon examination of degenerative joint disease?
crepitus detected with palpation during at least one of the following: opening, closing, right/ left lateral or protrusive movements
what is hypermobility disorder involving the disc condyle complex and articular eminence?
subluxation
with subluxation what happens when the mouth is open?
complex anterior to articular eminence and is unable to return to normal closed position without a manipulative manoeuvre
what differentiates subluxation and luxation?
Subluxation – if patient can manoeuvre joint back into position.
Luxation – if assistance of clinician required
what is history of subluxation?
last 30 days jaw locking or catching in a wide mouth open position AND inability to close from wide open position.
what are conservative TMD management appraoches in primary care?
- Rest and relaxation
- Modify diet.
- Avoid wide mouth opening.
- Regular application of gentle heat – chronic conditions.
- Regular application of cold pack – acute onset pain and/ or restricted mouth opening.
- Jaw exercises
- NSAIDs – ibuprofen if not contra-indicated 14 days.
- Diazepam 5 days for disc displacement without reduction with limited opening.
when would you refer someone with TMD?
- Chronic TMD more than 3 months
- Persistent/ worsening symptoms despite primary treatment
- Uncertain diagnosis
- Marked psychological distress associated.
- unexplained persistent pain or chronic widespread pain
what is FLAT?
F – fear of pain
L – low mood
A – avoidance of functional activity
T – thinking the worst.
