TMD Flashcards
Causes of TMD
myofascial pain
- problems with the muscles
disc displacement
- anterior with reduction
- anterior without reduction
degenerative disease
- localised = osteoarthrtis
- generalised = rheumatoid arthrtis
chronic recurrent dislocation
ankylosis
hyperplasia
neoplasia
infection
TMJ myofascial pain aetiology
inflammation of muscles of mastication or TMJ itself
- usually secondary to parafunctional habits
may be a history of trauma, either directly to joint or indirectly e.g. sustained mouth opening during dental treatment
stress
- muscles tense up
TMD - common intra oral features
signs of parafunctional habits
- cheek biting
- linea alba
- occlusal NCTSL (PTs that grind)
TMD special investigations
not usually required
radiographic evaluation if pathology suspected:
- OPT
- CT/CBCT
- MRI
- Ultrasound
- Arthtography
- Transcranial view
- Nuclear imaging
TMD common clinical features
females > males
most common between 18-30
intermittent pain of several months or years
muscle/joint/ear pain, particularly on wakening
trismus/locking
cicking/poppung joint noises
headaches
crepitus indicates less degenerative changes
TMD - differential diagnosis
dental pain
sinusitis
headache
ear pathology
atypical face pain
trigemina neuralgia
salivary gland pathology
referred neck pain
condylar fracture
temporal arteritis
TMD treatment options
patient education
counselling
physical therapy
medications
splints
occlusal adjustment
TMJ surgery
advice to give patients with TMD
soft diet
masticate bilaterally
no wide opening
no chewing gym
cut foods into small prices
stop parafunctional habits e.g. nail biting, grinding
support mouth on opening e.g. yawning
TMD physical therapy options
Physiotherapy
massage/heat
relaxation
acupuncture
TENS (transcutaneous electronic nerve stimulation)
hypnotherapy
What is anterior disc displacement with reduction?
most common cause of TMJ clicking
disc is initially displaced anteriorly during opening until disc reduction occurs
signs/symptoms of anterior disc displacement with reduction
jaw tightness/locking
- jaw movement is impaired for a short period of time until disc reduces
mandible may initially deviate to affected side before returning to midline
may eventually progress to osteoarthritis if left untreated
Disc displacement with reduction - treatment
counselling
limited mouth opening
bite raising appliance
surgery occasionally may be required
no treatment required if painless
- reassurance
trismus from trauma - features
can occur after minor ‘traumatic events’
- IDB
- prolonged dental treatment
- infection
will usually resolve spontaneously
trismus management options` - if no resolution after cause phase
physiotherapy
Therabite
jaw screw
