TMD Flashcards
causes of TMD
myofascial pain
disc displacement
- anterior with reduction
- anterior without reduction
degenerative disease
- localised - osteoarthritis
- generalised/systemic - rheumatoid arthritis
chronic recurrent dislocation
ankylosis
hyperplasia
neoplasia
infection
TMD pathogenesis
inflammation of muscles of mastication or TMJ secondary to parafunctional habits
trauma, either directly to the joint or indirect e.g. sustained opening during dental treatment
stress
psychogenic
occlusal abnormalities
TMD history features
C/O
HPC -pain
- SOCRATES
- in the morning = bruxism, during the day = habits
PMH
PDH
SH
- important
- occupation, stress, home circumstances, sleeping pattern, recent bereavement, habits, hobbies
TMD assessment
E/0
- Muscles of mastication
- hints - clicks, crepitus
- jaw movements
- facial asymmetry
I/O
- moth opening
signs of parafunction
- cheek biting
- linea alba
- tongue scalloping
- occlusal NCTSL
- muscles of mastication
TMD common clinical features
more common in females
more common between 18-30 years
intermittent pain of several months or years
muscle/joint/ear pain, particularly on wakening
trismus/locking
clicking/popping joint noises
headaches
crepitus - indicates late degenerative changes
TMD differential diagnoses
dental pain
headache
sinusitis
ear pathology
salivary gland pathology
referred neck pain
atypical facial pain
trigeminal neuralgia
angina
condylar fracture
temporal arteritis
TMD treatment
patient education
- counselling
- electromyographic recording
- jaw exercises - physiotherapy
medication
- NSAIDs
- muscle relaxants
- tricyclic antidepressants
- botox
- steroids
TMD counselling features
reassurance
soft diet
masticate bilaterally
no wide opening
no chewing gum
don’t incise foods
cut food into small peeves
stop parafunctinal habits e.g. nail biting, grinding
support mouth on opening e.g. yawning
physical therapy for TMD
massage/heat
relaxation
hypnotherapy
acupuncture
ultrasound therapy
TENS - transcutaneous electronic nerve stimulation
splints
- bite raising appliances
- anterior repositioning splint
types of anterior repositioning splint
wenvac splint
Michigan splint
types of bite raising appliances
Lucia jig
hard, acrylic bite rising appliance
How do bite raising appliances treat TMD?
by stabilising the occlusion and improving the function of the masticatory muscles, thus decreasing abnormal activity
also protect teeth in cases of tooth grinding
how long should bite raising appliance be worm?
for several weeks before benefit is felt
splint should be worn at time of parafunction
irreversible treatment options for TMF
occlusal adjustment - rarely done
TMJ surgery
- arthroscopy
- arthrocentisis
- disc-repositioning surgery
- disc repair or removal
- high condylar shave
- total joint replacement
disc displacement (internal derangement) features
patients with disc displacement may present with painful clicking TMJ
joint clicking due to lack of coordinated movement between condyle and articular disc
condyle has to overcome mechanical obstruction before full joint movement can be achieved
- clicks may occur on opening or closing - can be classified as early, middle or late
What is anterior disc displacement with reduction?
most common cause of TMJ clicking
disc initial displaced anteriorly by the condyle during opening until disc reduction occurs
anterior disc displacement with reduction - signs and symptoms
jaw tightness/locking
- jaw movement impaired for a short period of time time until the disc reduces
- mandible may initially deviate to affected side before returning to the midline
may progress to osteoarthritis if left untreated
anterior disc displacement with reduction -treatment
if painless - no tx required
- reassure patient
if symptomatic
- counselling
- bite raising appliance
- surgery may occasionally be required
trismus from trauma - causes
can occur after minor ‘traumatic events’ - usually resolves spontaneously:
- IDB
- prolonged dental tx
- infection
truisms from trauma - treatment if no resolution following acute phase
physiotherapy
therabite
jaw screw
