TMD Flashcards
What are causes of TMD?
Myofascial pain - pain associated with muscles of the fascia
Disc displacement
Degenerative disease
- Localised - osteoarthritis
- Generalised (systemic) - rheumatoid arthritis
Chronic recurrent dislocation
Hyperplasia - one condyle growing faster than the other
Neoplasia
Infection
What conservative advice should you give to someone experiencing TMD?
Soft diet
Cut food into small pieces
Stop parafunctional habits - nail biting, grinding
No chewing gum
Massage joint/ MOM
No wide opening
Support mouth on opening
Heat/ cold therapy to affected areas
Why is an OPT beneficial as a special investigation for TMD?
Not usually required, but can exclude any possibility of dental pathology that may be causing the pain.
Common clinical features/ symptoms of TMD
Females > males
Intermittent pain of several months or years
Muscle/ joint/ ear pain, particularly on wakening
Trismus/ locking
Clicking/ popping noises
Headaches
What medication would be used (if any) for TMD?
NSAID’s
Muscle relaxants - diazepam
Tricyclic anti-depressants - amitriptyline
Botox
Steroids
What are other differential diagnoses that must be considered alongside TMD?
Dental pain
Sinusitis
Ear pathology
Salivary gland pathology
Referred neck pain
Headache
Atypical facial pain
Trigeminal neuralgia
Condylar fracture
Temporal arteritis
What are the 2 types of disc displacement and describe them?
Anterior with reduction - most common TMD disorder.
Disc slides forward past articular eminence but can get back in mandibular fossa.
Anterior without reduction - disc permanently stuck in front of articular eminence - prevents full opening of the mouth
What REVERSIBLE treatment can be given to someone with TMD?
Physiotherapy
Massage/ heat therapy
Acupuncture
Relaxation
Ultrasound therapy
TENS - transcutaneous electronic nerve stimulation
Hypnotherapy
What types of TMJ surgery are there?
Arthrocentesis
Arthoscopy
Disc-repositioning surgery
Dis repair/ removal
High condylar shave
Total joint replacement
What is the pathogenesis of TMD?
Inflammation of MOM or TMJ secondary to parafunctional habits
Trauma
Stress
Psychogenic
What may be seen intra-orally for someone with TMD?
Reduced mouth opening
Signs of parafunctional habits
- Cheek biting - linea alba
- Tongue scalloping
- Occlusal NCTSL
Extra-oral features of TMD?
Hypertrophic MOM
Click/ popping noise
Odd jaw movement - jerking when opening/ closing
Facial asymmetry
What does crepitus indicate?
Late degenerative changes in the joint
How does ultrasound therapy work in TMD?
Provides tissue relaxation
Breaks down any scar tissue and increases blood flow
What is TENS and what does it do for TMD?
Transcutaneous electrical nerve stimulation
Reduces pain transmission which may help relieve pain and relax muscles
