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Module 4 - mastication and Occlusion > TMD > Flashcards

TMD Flashcards

1
Q

What would you assess in a TMD history for pain?

A

character
site… jaw, ear, in front of ear, temple
affected by… jaw movement, function, or parafunction

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2
Q

what would you assess in a TMD history for noises?

A

clicking, snapping, popping, crepitus
on jaw movement
and in the past 30 days

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3
Q

what would you assess in a TMD history for movement?

A

restricted opening
interfering with ability to eat
locking - intermittent/ persistent; closed; open; able to release with a manoeuvre
deviation

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4
Q

what would you assess in a TMD history for habits?

A

Clenching, grinding, chewing/ biting, musical instruments, singing

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5
Q

what would you assess in a TMD history for co-morbidities?

A
  • Fibromyalgia
  • Chronic pain
  • Psychological factors
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6
Q

what would you assess in a TMJ examination?

A

lateral pole of TMJ
temporalis
masseter
mouth opening
soft tissues

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7
Q

what are you looking for when you palpate the lateral pole of the TMJ?

A
  • Does it elicit familiar pain?
    3 repetitions each of opening, closing, lateral, protrusive movements:
  • Any noises palpable?
  • Any noises audible to the patient?
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8
Q

how do you palpate the temporalis?

A

with teeth clenched above ear and forwards above eye

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9
Q

what do you assess with mouth opening?

A
  • Deviation on opening
  • Extent of opening – unassisted and assisted.
    *Should be 40mm incisal overlap
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10
Q

what do you assess in the intra-oral soft tissues?

A
  • Ridging buccal mucosa at level of occlusal plane.
  • Scalloping of borders of tongue.
  • Tooth wear
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11
Q

what ways can you investigate TMD?

A
  1. Plain radiographs not normally indicated.
  2. CBCT
  3. MRI
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12
Q

What are the 2 types of pain related TMD?

A

myalgia
arthralgia

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13
Q

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?

A

myalgia

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14
Q

what is a history of myalgia?

A

pain in jaw, temple, in front of ear or in the ear AND modified jaw movement, function/ parafunction

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15
Q

what does myalgia present as upon examination?

A

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

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16
Q

what are the sub types of myalgia?

A

local, myofascial pain, myofascial pain with referral

17
Q

what is pain of joint origin affected by jaw movement, function or parafunction AND replicated by provocation testing of the TMJ?

A

arthralgia

18
Q

what is a history of arthralgia?

A

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

19
Q

what would you see upon examination of arthralgia?

A

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

20
Q

what are the types of intra-articular TMD?

A

disc displacement with reduction
disc displacement without reduction with limited opening
degenerative joint disease
subluxation

21
Q

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?

A

disc displacement with reduction

22
Q

what is a history of disc displacement with reduction?

A

‘noise’ in the past 30 days in movement/ function OR report of any noise during examination

23
Q

what would you see upon examination of disc displacement with reduction?

A

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.

24
Q

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?

A

disc displacement without reduction with limited opening

25
Q

what is history of disc displacement without reduction with limited opening?

A

jaw locked so that the mouth would not open all way (interfering with eating).

26
Q

what would you see upon examination of disc displacement without reduction with limited opening?

A

maximum assisted opening (passive stretch) movement <40mm including vertical incisal overlap.

27
Q

what is – deterioration of articular tissue with concomitant osseous changes in the condyle and/or articular eminence?

A

degenerative joint disease

28
Q

what is history of degenerative joint disease?

A

‘noise’ in the past 30 days on jaw movement or in function OR any noise during examination

29
Q

what would you see upon examination of degenerative joint disease?

A

crepitus detected with palpation during at least one of the following: opening, closing, right/ left lateral or protrusive movements

30
Q

what is hypermobility disorder involving the disc condyle complex and articular eminence?

A

subluxation

31
Q

with subluxation what happens when the mouth is open?

A

complex anterior to articular eminence and is unable to return to normal closed position without a manipulative manoeuvre

32
Q

what differentiates subluxation and luxation?

A

Subluxation – if patient can manoeuvre joint back into position.
Luxation – if assistance of clinician required

33
Q

what is history of subluxation?

A

last 30 days jaw locking or catching in a wide mouth open position AND inability to close from wide open position.

34
Q

what are conservative TMD management appraoches in primary care?

A
  • 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.
35
Q

when would you refer someone with TMD?

A
  • 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
36
Q

what is FLAT?

A

F – fear of pain
L – low mood
A – avoidance of functional activity
T – thinking the worst.

Module 4 - mastication and Occlusion (8 decks)

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