TMD

Question 1

causes of TMD

Answer 1

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

Question 2

TMD pathogenesis

Answer 2

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

Question 3

TMD history features

Answer 3

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

Question 4

TMD assessment

Answer 4

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

Question 5

TMD common clinical features

Answer 5

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

Question 6

TMD differential diagnoses

Answer 6

dental pain
headache
sinusitis
ear pathology
salivary gland pathology
referred neck pain
atypical facial pain
trigeminal neuralgia
angina
condylar fracture
temporal arteritis

Question 7

TMD treatment

Answer 7

patient education
- counselling
- electromyographic recording
- jaw exercises - physiotherapy
medication
- NSAIDs
- muscle relaxants
- tricyclic antidepressants
- botox
- steroids

Question 8

TMD counselling features

Answer 8

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

Question 9

physical therapy for TMD

Answer 9

massage/heat
relaxation
hypnotherapy
acupuncture
ultrasound therapy
TENS - transcutaneous electronic nerve stimulation

splints
- bite raising appliances
- anterior repositioning splint

Question 10

types of anterior repositioning splint

Answer 10

wenvac splint
Michigan splint

Question 11

types of bite raising appliances

Answer 11

Lucia jig
hard, acrylic bite rising appliance

Question 12

How do bite raising appliances treat TMD?

Answer 12

by stabilising the occlusion and improving the function of the masticatory muscles, thus decreasing abnormal activity
also protect teeth in cases of tooth grinding

Question 13

how long should bite raising appliance be worm?

Answer 13

for several weeks before benefit is felt
splint should be worn at time of parafunction

Question 14

irreversible treatment options for TMF

Answer 14

occlusal adjustment - rarely done
TMJ surgery
- arthroscopy
- arthrocentisis
- disc-repositioning surgery
- disc repair or removal
- high condylar shave
- total joint replacement

Question 15

disc displacement (internal derangement) features

Answer 15

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 e classified as early, middle or late

Question 16

What is anterior disc displacement with reduction?

Answer 16

most common cause of TMJ clicking
disc initial displaced anteriorly by the condyle during opening until disc reduction occurs

Question 17

anterior disc displacement with reduction - signs and symptoms

Answer 17

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

Question 18

anterior disc displacement with reduction -treatment

Answer 18

if painless - no tx required
- reassure patient
if symptomatic
- counselling
- bite raising appliance
- surgery may occasionally be required

Question 19

trismus from trauma - causes

Answer 19

can occur after minor ‘traumatic events’ - usually resolves spontaneously:
- IDB
- prolonged dental tx
- infection

Question 20

truisms from trauma - treatment if no resolution following acute phase

Answer 20

physiotherapy
therabite
jaw screw