tmd Flashcards
What are some different names for TMD?
Temporomandibular dysfunction
Myofascial pain dysfunction
Pain dysfunction syndrome
Facial arthromyalgia
Costen’s syndrome
TMJ
Name the suprahyoid muscles
Digastric
Mylohyoid
Geniohyoid
Stylohyoid
Name the common causes of TMD
Myofascial pain
Anterior disc displacement with reduction
Anterior disc displacement without reduction
Localised degenerative disease
Generalised degenerative disease
What are some problems that may manifest as TMD?
Chronic recurrent dislocation
Ankylosis
Hyperplasia
Neoplasia
Infection
What factors can lead to the pathogenesis of myofascial pain as TMD.
Inflammation of muscles of mastication or TMJ secondary to parafunctional habits
Trauma
Stress
Psychogenic factors
Name the infrahyoid muscles
Omohyoid
Thyrohyoid
Stylohyoid
Sternohyoid
What steps are involved in the assessment of TMD?
Complaint
HPC
PH
PMH
PDH
SH
Examination
What aspects are examined during the extra-oral assessment for TMD?
Muscles of mastication
Joints (for clicking or crepitus)
Jaw movements
Facial asymmetry
What aspects are examined during the intra-oral assessment for TMD?
Inter incisal mouth opening
Signs of parafunctional habits
Muscles of mastication
What special investigations can be considered for TMD when pathology is suspected?
OPT
CT/CBCT
MRI
Nuclear imaging
Arthography
Ultrasound
What are some common clinical features of TMD?
Affects females more than males
Affects ages 18-30 most commonly
Intermittent pain of several months or years duration, Muscle/joint/ear pain
Trismus/locking
Clicking/popping noises
Headaches
Crepitus
Name 4 conditions that should be considered in the differential diagnosis of TMD?
Dental pain
Sinusitis
Ear pathology
Salivary gland pathology
Referred neck pain
Headache
Atypical facial pain
Trigeminal neuralgia
Angina
Temporal arteritis
What are the treatment options for reversible TMD?
Patient education
Counseling
Jaw exercises
Physiotherapy
Medications (NSAIDs, muscle relaxants, tricyclic antidepressants, Botox, steroids)
Physical therapy (massage/heat, acupuncture, ultrasound therapy, hypnotherapy)
Splints (Bite raising appliances, anterior repositioning splint)
What is the purpose of bite raising appliances in TMD treatment, and how do they work?
Bite raising appliances stabilize the occlusion, improve masticatory muscle function, and protect teeth from grinding.
The exact mechanism is unknown, and there’s limited scientific evidence to support their use.
What does counseling for TMD involve?
Reassurance
Soft diet
Masticate bilaterally
Avoid wide opening
Avoid chewing gum
Refrain from incising foods
Cut food into small pieces
Stop parafunctional habits (e.g - nail biting, grinding)
Support the mouth during opening (e.g - yawning)
What treatment options are available for irreversible TMD?
Occlusal adjustment (rarely done)
TMJ surgery
Name the different types of TMJ surgery
Arthrocentesis
Arthroscopy
Disc-repositioning surgery
Disc repair/removal
High condylar shave
Total joint replacement
What is anterior disc displacement with reduction in TMD, and what are the signs and symptoms?
The most common cause of TMJ clicking
The disc is initially displaced anteriorly during opening but reduces
Signs/symptoms include jaw tightness, locking, and the mandible may deviate to the affected side before returning at opening
What can cause trismus in TMD, and how is it managed?
Trismus can result from trauma such as IDB, prolonged dental treatment, or infection
Management may involve physiotherapy, Therabite, or a jaw screw if it doesn’t resolve spontaneously
What is a common manifestation of disc displacement in TMD
Painful clicking
Describe the cause of joint clicking in the TMJ
Lack of coordinated movement between the condyle and articular disc in the TMJ
What are the different classifications of TMJ clicks?
Early
Middle
Late
How is anterior disc displacement with reduction in the TMJ treated?
Counselling
Limiting mouth opening
Using a bite raising appliance
Surgery may be required in severe cases
Name 3 causes of trismus from trauma in the TMJ?
IDB
Prolonged dental treatment
Infection
