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4 Mastication and Occlusion > TMD > Flashcards

TMD Flashcards

1
Q

define temporomandibular disorders

A

a group of conditions affecting the temporomandibular joint and/or the muscles of mastication

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2
Q

what does CMD stand for?

A

craniomandibular disorders

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3
Q

what does TMD stand for?

A

temporomandibular disorders

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4
Q

remember TMD and CMD is the same

A
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5
Q

TMD are more common in males or females?

A

females

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6
Q

what is the peak incidence age range for TMD?

A

18-44yrs

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7
Q
A
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8
Q

what do you assess in an extra-oral exam for TMD? 4

A

TMJ
masseter
temporalis
mouth opening

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9
Q

during an extra oral exam for TMD how many times do u ask the patient to open and close?

A

3 times

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10
Q

during an extra oral exam what are u looking for when palpating the TMJ?

A

does palpation elicit the same pain they are complaining of

feel for clicking, grinding, popping

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11
Q

during an extra-oral exam what are you looking for when palpating the masseter and TMJ?

A

does palpation elicit the same pain they are complaining of?

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12
Q

when palpating the masseter where do you palpate?

A

origin
midpoint
insertion

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13
Q

what doe you asses in mouth opening during an extra-oral exam?

A

deviation
extent of mouth opening

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14
Q

how do you assess extent of mouth opening?

A

ruler
measure non assisted opening and assisted opening

Assisted opening -> gently place 2 fingers between the patients upper and lower teeth and gently try to move upper and lower teeth apart

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15
Q

what counts as normal mouth opening?

A

40mm including incisal overlap -> important

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16
Q

what do u look out for in an intra oral soft tissue exam for TMD?

A

Ridging of buccal mucosa at level of occlusal plane

Scalloping of borders of tongue

Tooth wear

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17
Q

what does crepitus mean and what is it a sign of?

A

grinding crunching noise indicative of degenerative changes affecting the TMJ

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18
Q

what investigations do you do if degenerative TMJ is suspected (cripitus)?

A

CBCT radiograph

19
Q

what investigations do you do if disc displacement is suspected especially without reduction?

A

MRI

20
Q

what is myalgia?

A

pain related to TMD
Muscle pain affected by jaw movements

21
Q

how does myalgia present in a patient history?

A

Pain in jaw, temple, in front of / in ear

22
Q

how does myalgia present on examination?

A

Pain when palpating temporalis/masseter or on opening

23
Q

what is arthralgia?

A

pain relating to TMJ
joint pain affected by jaw movements

24
Q

how does arthralgia present in a patient history?

A

Pain in jaw, temple, in front / in ear

25
Q

how does arthralgia present on examination?

A

Familiar pain in TMJ on palpation or lateral or protrusive movements

26
Q

what is disc displacement with reduction?

A

intra-articular TMD
Disc is in anterior position relative to condylar head and reduces on opening

27
Q

how does disc displacement with reduction present in patient history?

A

Noise in past 30 days or during examination

28
Q

how does disc displacement without reduction present on clinical examination?

A

Clicking, popping and/or snapping on at least one of three repetitions of jaw opening and/or closing. And on lateral or protrusive movements

29
Q

what is Disc displacement without reduction and limited opening?

A

intra-articular TMD
Disc doesn’t reduce and limited mandibular movement even with manoeuvre -> closed lock

30
Q

how does disc displacement without reduction and limited opening present in patient history?

A

Limited opening

Interferes with ability to eat

Previous joint clicking that stopped when limited movement started

31
Q

how does disc displacement without reduction and limited opening present on clinical examination?

A

Maximum assisted opening <40mm including vertical incisal overlap

32
Q

what is degenerative joint disease?

A

intra-articular TMD

Deterioration of articular tissue with osseus changes in condyle or articular eminence

33
Q

how does degenerative joint disease present in patient history?

A

Noise in past 30 days during function
Or noise during examination

34
Q

how does degenerative joint disease present on clinical examination?

A

Crepitus (grinding/crunching sensation) on TMJ palpation during opening, closing, lateral or protrusive movements

35
Q

what are the two diagnoses of degenerative joint disease?

A

Osteoarthrosis -> no pain

Osteoarthritis -> Crepitus and arthralgia

36
Q

what is subluxation?

A

intra-articular TMD

Open mouth lock -> open mouth condyle is anterior to articular eminence and unable to move without manipulative manoeuvre by patient

37
Q

what is luxation?

A

open mouth lock which the patient cant unlock themselves requiring a clinician to perform a manipulative manoeuvre

-> true dislocation

38
Q

how does subluxation present in patient history?

A

Jaw locking or catching in the last 30 days so patient could not close their mouth without manipulative manoeuvre

39
Q

how does subluxation present on clinical examination?

A

No examination required

Cant close mouth after wide opening without manipulative manoeuvre

40
Q

how is TMD managed in primary care?

A

Explanation of condition to patient

Self management advice and home physiotherapy

Analgesia should only be prescribed when necessary

41
Q

Self management advice and home physiotherapy

Rest and relaxation
Modified diet
Avoid wide opening
Apply heat if chronic
Apply cold if acute
Jaw exercises
NSAIDs

A
42
Q

when should TMD be referred to secondary care?

A

Chronic TMD symptoms last >3months

Primary care management has not improved symptoms or they have got worse

Uncertain of diagnosis

Unexplained pain

Psychological distress from symptoms and/or occlusal preoccupation (hyperawareness of their occlusion)

Patients at risk of developing chronic symptoms

43
Q

how do you know if a patient is at risk of developing chronic symptoms and should be referred?

A

F - fear of pain

L - low mood

A - avoidance of functional activities

T - thinking the worst

S - social impact -> negative impact on their interaction with others e.g. avoid socialising

4 Mastication and Occlusion (7 decks)

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