TMD Flashcards
what type of cartilage and fluid
fibrous hyaline cartilage
synovial fluid
on opening, how does the joint move
articular disc slides down and forward with the condyle
what is clicking
disc displacement with reduction
what is anterior disc displacement without reduction
disc/cartilage is anterior to condylar head, cannot open
what is posterior disc displacement without reduction
disc behind condyle, cannot relocate, mouth stuck open
what is crepitus
crunching noises
indicates inflammation, arthritic change, osteoarthritis
causes of TMD
multifactorial
myofascial pain
inflammation MoM/TMJ by parafunction
trauma
stress
psychogenic
occlusal abnormalities
disc displacement
degenerative disease [OA, RA]
chronic recurrent dislocation
ankylosis
hyperplasia of joint
neoplasia
infection
symptoms of TMD
intermittent pain muscle, ear, joint, particularly on opening
trismus
locking
headaches
earaches
clicking/popping
female 18-30
crepitus
tinnitus
differentials for TMD
odontogenic pain
sinusitis
ear/salivary pathology
referred neck pain
atypical facial pain
TN
angina
condylar fracture
chronic otitis media
TMD reversible tx
education, counselling, reassurance, soft diet, bilateral mastication, jaw exercises, no wide opening, no gum, don’t incise foods, smaller foods, stop grinding, no nail biting
CBT, behaviour change, supportive, de-stress
physical therapy =
physio, massage/heat, relaxation, hypnotherapy, ultrasound therapy, TENS
acupuncture =
myogenous muscle symptoms, circuit breaker, adjunct
splints
medication
medication for TMD
NSAIDs, muscle relaxants, tricyclic antidepressants, steroids
diazepam
botox for TMD
adjunct, only if myofascial elements
contraindicated in muscle wasting disorder
risks = allergy, wrong placement, limited effectives
discuss splints for TMD
bite raising appliances
used to stabilise occlusion by reduce contact between teeth,
relax MoM
prevent bruxism + clenching + grinding
prevent abnormal activity
repositioning splints =
prevents joint heads rotating so far posteriorly in glenoid fossa, reduce TMD loading
anterior repositioning splints =
irreversible TMD tx
occlusal adjustment
disc plication
eminectomy
high condylar shave
condylotomy
meniscetomy
condylectomy
reconstructive
indications for surgical TMD intervention
joint destruction
ankylosis
congenital deformity
tumour [giant cell]
describe the 4 stages of ankylosis classification
1- flattening condyle, little joint space, extensive fibrous adhesions
2 - bony infusion outer edge articular surface
3 - marked fusion upper ramus and zygomatic arch
4 - entire joint replacement by mass of bone
what is arthrocentesis
minimally invasive option where synovial fluid is aspirated out of joint
removes inflammatory mediators, increased joint mobility, reposition disc, can inject steroids/LA
indications ; internal derangement, chronic pain, synovitis/capsulitis
explain trismus from trauma
how can it occur
tx
IDB, prolonged tx, infection, radiotherapy, sub mucous fibrosis, muscle spasm, arthritis, joint ankylosis
usually spontaneously resolves
after acute phase; physio, terabyte, twist device, lollipop sticks, diazepam
how does pain occur within TMJ
innervated structures; capsule, synovial tissue, posterior band
compressive forces damage proteoglycans which protect collagen
inflammation produces proteases which degrades tissue
synovitis; chronic adhesive capsulitis and disc displacement breaks up collagen fibres
why would there be degenerative pain in TMJ
cartilage degeneration; chrondomalacia
disc perforation
multiple adhesions and adhesive capsulitis
osteophytes
flattening of condyle + eminence
subchondral cysts
how would you further investigate TMD
OPT [open + closed mouth]
arthrogram - radiopaque lesion + injection to delineate upper joint space
MRI
arthroscopy - look inside joint, hyaluronic acid to increase lubrication
can be used to diagnose, biopsy, lysis and leverage, disc reduction, remove loose body
tx for dislocation without reduction
open joint surgery
how many mm is normal mouth opening
how to assess
35-55mm
‘3 finger’ test
what to ask pt re-TMD pain
Onset – When did the pain start? Sudden or gradual?
Duration – How long does each episode of pain last? Constant or intermittent?
Location – Is the pain localised to the TMJ or does it radiate? (e.g., ear, temple, jaw)
Character – Is the pain dull, aching, sharp, or throbbing?
Aggravating factors – Does it worsen with chewing, yawning, or talking?
Relieving factors – Does it improve with rest, heat, or analgesics?
Associated symptoms – Any headaches, ear pain, tinnitus, or dizziness?
History of trauma or parafunctional habits – Any recent injury, bruxism, or clenching?
