TMD Flashcards
define temporomandibular disorders
a group of conditions affecting the temporomandibular joint and/or the muscles of mastication
what does CMD stand for?
craniomandibular disorders
what does TMD stand for?
temporomandibular disorders
remember TMD and CMD is the same
TMD are more common in males or females?
females
what is the peak incidence age range for TMD?
18-44yrs
what do you assess in an extra-oral exam for TMD? 4
TMJ
masseter
temporalis
mouth opening
during an extra oral exam for TMD how many times do u ask the patient to open and close?
3 times
during an extra oral exam what are u looking for when palpating the TMJ?
does palpation elicit the same pain they are complaining of
feel for clicking, grinding, popping
during an extra-oral exam what are you looking for when palpating the masseter and TMJ?
does palpation elicit the same pain they are complaining of?
when palpating the masseter where do you palpate?
origin
midpoint
insertion
what doe you asses in mouth opening during an extra-oral exam?
deviation
extent of mouth opening
how do you assess extent of mouth opening?
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
what counts as normal mouth opening?
40mm including incisal overlap -> important
what do u look out for in an intra oral soft tissue exam for TMD?
Ridging of buccal mucosa at level of occlusal plane
Scalloping of borders of tongue
Tooth wear
what does crepitus mean and what is it a sign of?
grinding crunching noise indicative of degenerative changes affecting the TMJ
what investigations do you do if degenerative TMJ is suspected (cripitus)?
CBCT radiograph
what investigations do you do if disc displacement is suspected especially without reduction?
MRI
what is myalgia?
pain related to TMD
Muscle pain affected by jaw movements
how does myalgia present in a patient history?
Pain in jaw, temple, in front of / in ear
how does myalgia present on examination?
Pain when palpating temporalis/masseter or on opening
what is arthralgia?
pain relating to TMJ
joint pain affected by jaw movements
how does arthralgia present in a patient history?
Pain in jaw, temple, in front / in ear
how does arthralgia present on examination?
Familiar pain in TMJ on palpation or lateral or protrusive movements
what is disc displacement with reduction?
intra-articular TMD
Disc is in anterior position relative to condylar head and reduces on opening
how does disc displacement with reduction present in patient history?
Noise in past 30 days or during examination
how does disc displacement without reduction present on clinical examination?
Clicking, popping and/or snapping on at least one of three repetitions of jaw opening and/or closing. And on lateral or protrusive movements
what is Disc displacement without reduction and limited opening?
intra-articular TMD
Disc doesn’t reduce and limited mandibular movement even with manoeuvre -> closed lock
how does disc displacement without reduction and limited opening present in patient history?
Limited opening
Interferes with ability to eat
Previous joint clicking that stopped when limited movement started
how does disc displacement without reduction and limited opening present on clinical examination?
Maximum assisted opening <40mm including vertical incisal overlap
what is degenerative joint disease?
intra-articular TMD
Deterioration of articular tissue with osseus changes in condyle or articular eminence
how does degenerative joint disease present in patient history?
Noise in past 30 days during function
Or noise during examination
how does degenerative joint disease present on clinical examination?
Crepitus (grinding/crunching sensation) on TMJ palpation during opening, closing, lateral or protrusive movements
what are the two diagnoses of degenerative joint disease?
Osteoarthrosis -> no pain
Osteoarthritis -> Crepitus and arthralgia
what is subluxation?
intra-articular TMD
Open mouth lock -> open mouth condyle is anterior to articular eminence and unable to move without manipulative manoeuvre by patient
what is luxation?
open mouth lock which the patient cant unlock themselves requiring a clinician to perform a manipulative manoeuvre
-> true dislocation
how does subluxation present in patient history?
Jaw locking or catching in the last 30 days so patient could not close their mouth without manipulative manoeuvre
how does subluxation present on clinical examination?
No examination required
Cant close mouth after wide opening without manipulative manoeuvre
how is TMD managed in primary care?
Explanation of condition to patient
Self management advice and home physiotherapy
Analgesia should only be prescribed when necessary
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
when should TMD be referred to secondary care?
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
how do you know if a patient is at risk of developing chronic symptoms and should be referred?
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
