TMD Flashcards
what artery supplies the TMJ area
great auricular artery
(branch of 1st part of maxillary artery)
what nerves supply the TMJ area
auriculotemporal, masseteric, posterior (deep) temporal
why may patients complain of earache when infact they have TMD
auriculotemporal nerve provides somatosensory innervation to the posterior TMJ and the external auditory meatus
what are the 4 suprahyoids
geniohyoid
mylohyoid
stylohyoid
digastric
what are the 4 infrahyoids
thyrohyoid
sternohyoid
sternothyroid
omohyoid
discuss the posterior regio of the articular disc
only innervated part of the articular disc
Also known as bilaminar zone or retrodiscal tissue
what separates the upper and lower tempero mandibular joint cavities
articular disc
discuss pterygoideus externus
its the insertion of the lateral pterygoid which goes partly into condyle and partly into articular disc
name 5 potential causes of TMD
- myofascial pain - problems relating to muscles and fascia
- disc displacement
- degenerative disease - arthritis
- chronic recurrent disclocation
- ankylosis (condyle diffuse to base of skull - rare)
- hyperplasia (one condyle larger than the other)
- neoplasia - rare in TMJ area
- infection - rare
what degenerative diseases may cause TMD
localised disease - osteoarthritis
systemic - rheumatoid
discuss anterior disc displacement with and without reduction
with reduction - disc able to slip back to its proper position at some point (reduce back)
without reduction - disc permanently stuck in front of condyle
Name four aetiological factors for myofascial pain
- inflammation of MOM or TMJ secondary to parafunctional habits
Trauma - either direct to joint or indirectly e.g sustained opening during dental treatment
Stress - tense muscles and clenching
Psychogenic
Occlusal abnormalities - limited evidence supporting this
why is social history particularly important when investigating TMD
may identify cause for stress or habit/ hobby putting extra strain on MOM
should enquire about occupation, home circumstances, sleeping pattern, recent bereavement, relationships, habits, hobbies
Anything that causes a patient to repeatedly bring their teeth together can contribute to TMD
where is mouth opening measured
incisor edges
use willis bite gauge
name 3 intra oral signs of parafunctional habits
linea alba
tongue scalloping
attrition
what special investigations may be done if pathology of TMJ suspected
CBCT
MRI
arthrography
ultrasound
what demographic does TMD most commonly affect
females ages 18-30
name 3 common clinical features of TMD
intermittent pain for several months or years
muscle, joint or ear pain - particularly when wakening due to overnight clenching
trismus
clicking/ popping joint
headaches - pain from temporalis
crepitus - indicates late degenerative changes
name 4 examples of possible differential diagnoses of TMD
sinusitis
dental pain
ear pathology
salivary gland pathology (parotid in close proximity)
headache
atypical facial pain
trigeminal neuralgia
temporal arteritis
angina (small portion of skin near joint supplied by same nerve as heart)
condylar fractures
name 4 reversible treatments of TMD
patient education
medications
physical therapy
splints
name 2 irreversible treatments of TMD
occlusal adjustment (no evidence of benefit)
TMJ surgery
what does patient education for TMD involve
counselling - reassurance, soft diet, no wide opening, no chewing gum, masticate bilaterally, stop parafunctional habits
name 3 medications that may be given for TMD
NSAIDS (ibuprofen,naproxen)
muscle relaxants (cyclobenzaprine)
tricyclic antidepressants (amitriptyline)
botox (massetter)
steroid injections
name 3 examples of physical therapy for TMD
massage
heat
acupuncture
relaxation
hypnotherapy
TENS (transcutaneous electronic nerve stimulation)
what is the theory behind using a splint for TMD
‘bite raising appliances)
stabilise occlusion and improve function of MOMs therefore decreasing abnormal activitty
also protect the teeth during grinding
name 2 examples of splints that may be used in treating TMD
hard splint
soft splint
michigan splint
internal derangement of TMJ
disc displacement
what is the anatomical cause of a painful clicking TMJ
disc slipping (reducing) back to correct location over the condylar head
signs and symptoms of disc displacement with reduction
clicking TMJ
jaw tightness/ locking
initial deviation of mandible
treatment for disc displacement with reduction
if painless, no treatment required, give reassurance
limiting mouth opening
counselling
bite raising appliance (splint)
surgery very occasionally required
most likely pathology causing trismus post trauma
haematoma in medial pterygoid
what equipment may be used to aid mouth opening in a patient experiencing trismus
jaw screws
stacking wooden sticks
therabite
