TMD

Question 1

name 2 systems that clarify orofacial pain

Answer 1

ICHD3 & ICOP

Question 2

what do TMDs affect?

Answer 2

TMJ and/or muscles of mastication

Question 3

how do TMDs present?

Answer 3

dull aching pain
affects ear, jaw and in front of temple
pain affected by jaw movement, function and parafunction
pain worse on clenching, wide opening and eating crunchy food
clicking, popping, snapping, crepitus in last 30 days
restricted opening, interefring w/ eating, locking
associated w/ clenching, grinding, chewing habits, musical instruments & singing
past hx of trauma

Question 4

how do you examine the TMJ?

Answer 4

palpate lateral TMJ pole get pt to do the following 3 times:
open
close
lateral
protrusive
assess for any pain, noises

Question 5

how do you examine the masticatory muscles - temporalis and masseter?

Answer 5

palpate muscles w/ teeth clenched
for masseter do bimanual palpation - finger on either side of the cheek

Question 6

what is normal mouth opening (mm)?

Answer 6

> =40mm

Question 7

list intraoral signs of TMD

Answer 7

ridging of buccal mucosa at level of occlusal plane
scalloping of borders of tongue
tooth wear

Question 8

what radiographs are indicated for TMD investigation?

Answer 8

CBCT & MRI - not plain radiographs

Question 9

give 2 groups of TMD

Answer 9

pain related & intra articular

Question 10

name 2 types of pain related TMDs

Answer 10

myalgia - local myalgia, myofascial pain w/ or w/o referral
arthralgia - headache related to TMD

Question 11

name 4 types of intrarticular TMDs

Answer 11

DD w/ reduction
DD without reduction
degenerative joint disease
subluxation

Question 12

myofascial pain

Answer 12

pain from masseter or temporalis when palpate them on max opening

Question 13

arthrlagia

Answer 13

pain on palpation of TMJ pole on max opening, excursions and protrusion

Question 14

DD w/ reduction

Answer 14

disc anterior to condyle when at rest - clicks back over condyle on opening

clicking/popping/snapping

Question 15

DD w/o reduction

Answer 15

limited opening - as disc does not reduce over condyle
closed lock
max assisted opening <40mm including incisal vertical overlap

Question 16

degenerative joint diseases

Answer 16

articular tissue degenerated and osseous changes in condyle and/or articular eminence
crepitus

Question 17

subluxation (open lock)

Answer 17

hypermobility disorder involving disc/condyle complex and AE

disc/condyle complex anterior to AE and unable to return to normal position without manipulation

jaw catches/locks in wide opening - for a moment or prolonged duration

pt could not close from wide open without manipulation

Question 18

explain difference between subluxation and luxation

Answer 18

subluxation - pt manipulates jaw back into place
luxation - clinician required to manipulate jaw back into place

Question 19

what medication should be used for TMDs? what should be used if there’s a muscle spasm or DD w/o reduction?

Answer 19

14 day course of ibuprofen (paracetamol as alternative)

if muscle spasm or DD w/o reduction then use diazepam for 5 day course