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Occlusion > TMD > Flashcards

TMD Flashcards

1
Q

Role of occlusion in TMD

A

Current understanding and evidence- based literatrue fail to demonstrate a causal relationship between these occlusal factors and TMD signs and symptoms

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2
Q

percentage of young adults that have detectable clicking that is not pathological
what do you with these patients

A

80%

- dont treat

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3
Q

do you treat joint noises?

A

NO — should be followed but do not require treatment

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4
Q

Etiology of TMD

definition plus 5 examples

A

A ‘collective term’ embracing a number of clinical problems that onvolve the masticatory musculature, the TMJ’s, and associated craniofacial structures

  1. Trauma
  2. Emotional Stress
  3. Deep pain input
  4. Parafunctional habits
  5. Occlusal Factors *
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5
Q

clinical signs of osteoarthritis

A

crepitis tendernous sometimes mal occlusion and limiting openeing

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6
Q

role of occlusion in TMD

A

occlusal interferences have been considered as a major risk factor for TMD’s

*OCCLUSAL EQUILIBRATIONS FOR AN IDEAL OCCLUSION TO TREAT TMD’s

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7
Q

Anterior open bite, increased overbite, excessive overjet, premature contacts (interferences), posterior cross bite, Centric relation and Centric occlusion differences are _____what to TMD

A

Role of occlusion in TMD and are considered potenetial RISK FACTORS but not direct causal for TMD’s

*subject with similar occlusal conditions may not develop similar disorders because there are many contributing factors

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8
Q

Current understanding in evidence for role of occlusion in TMD?

A

Current understanding and evidence based literature fail to demonstrate a causal relationship between these occlusal factors and TMD signs and symptoms

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9
Q

T/F changes in occlusion may cause muscular symptoms

A

TRUE – like improper crown and filling, changing occlusal vertical dimension, improper occlusal appliances and splints

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10
Q

improper stabilization splint implications?

A

may create muscle pain and TMJ pain due to sudden non-adjusted contacts

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11
Q

Capsulitis, synovitis, and retrodiscitits implication on occlusion?

A

can cause affects to occlusion – may cause open bite, occlusal discomfort

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12
Q

Osteoarthritis and RA implication on occlusion?

A

may cause open bite

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13
Q

Protective co-contraction of muscles implication on occlusion?

A

percieved a change in occlusion

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14
Q

what can osteoarthritis do to affect occlusion?

A

can increase overjet and can decrease overbite due osteoarthritis

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15
Q

T/F TMD may cause occlusal changes

A

TRUE – TMD may cause occlusal changes and therefore any dental treatment should be performed after the problem is resolved

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16
Q

list of TMD JOINT disorders (Five)

A
  1. disc displacement with reduction
  2. disc displacement without reduction
  3. inflammatory disease
  4. degenerative joint disease
  5. Dislocation TMJ - Subluxation
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17
Q

List of TMD MUSCLE disroders

A
  1. Protective Co-contraction
  2. Local muscle soreness
  3. Myofacial Pain (TrP)
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18
Q

List of TMD MUSCLE disroders

A
  1. Protective Co-contraction
  2. Local muscle soreness
  3. Myofacial Pain (TrP)
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19
Q

what do you do about joint noised without pain and dysfunction?

A

FOLLOW these patients - but do not require treatmnet

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20
Q

possible occlusal factors are?

A

risk factors for TMD

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21
Q

can TMD be observed in ideal occlusion?

A

yes

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22
Q

patient with non-ideal occlusion has TMD what is the correct order of tx?

A

do not recommend ortho tx right away - treat TMD then ortho (may result in not even needing ortho)

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23
Q

can TMD affect occlusion?

A

Yes

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24
Q

T/F TMD can cause occlusal problems that are more severe than non-ideal occlusions affect on TMD’s

A

TRUE
non-ideal occlusions can be considered more risk factors where as TMD disorders can have more implications on occlusion

so occlusal factors are NOT mostly related to TMD’s and any attempt to change the occlusion to treat TMD should be avoided

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25
Q

full range of motion in adult TMJ

A

40-60 mm of opening

less than 8mm upon protrusive and lateral excursions is also considered limited

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26
Q

disc displacement

A

disturbances of the normal anatomical relationship between the disc and the condyle

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27
Q

etiology of disc displacement - 4 major ones

A
  1. trauma
  2. parafunctin
  3. spasm of the superior lateral pterygoid
  4. disruption of lubrication system
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28
Q

effect of prolonged overload – leads to what?

A
  • affects disc VISCOELASTIC PROPERTIES
  • AFFECTS LUBRICATION SYSTEM
  • repeatative disc hesitation causes elongation –> disc displacement ANTERIORLY
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29
Q

disc displacement with reduction

A 
Reciprocal click : opening and closing 
Pain MAY be present (joint movement) 
Deviation of mouth opening 
UNRESTRICTED maximal mouth opening 
*there is a click upon opening and closing
30
Q

does disc displacement with reduction require treatment?

describe movements

A

if no pain – no treatment
unrestricted max opening
normal excursive movements
can deviate

THIS IS AN ADAPTIVE CONDITION – most of the time it DOES NOT progress to the next stage of disc displacement without reduction –90% Of these cases will not go to pain and need treatment

but showed us case when there WAS PAIN AND CLICK – have to treat
deviation when opened

31
Q

disc displacement without reduction

clinical features

A

limitation of mouth opening - less than 35 mm
deviation to the EFFECTED side on mouth opening
markedly limited contra-laterotrusion
pain on forced mouth opening
history of clicking - ceased
affected TMJ tender to palpation

LIMITED LATERAL EXCURSIVE MOVEMENT IS OBSERVED ON THE CONTRALATERAL SIDE

CLICKING SOUNDS HAVE CEASED - do not occur

32
Q

sounds when disc displacement without reduction

A

upon chewing

33
Q

deviation

A

any shift of the midline during opening that disappears with the continued opening

34
Q

deflection

A

any shift in the midline to one side that becomes greater with opening and DOES NOT disappear at max opening

35
Q

describe lateral movements in pt. with disc displacement without reduction w/ pain on left side

A

Left lateral movement = normal

Right lateral movement = LIMITED
cases limit lateral excursive movement on the contralateral side

36
Q

examples of inflammatory disorders

A

Synovitis and Capsulitis

37
Q

synovial inflammation implication on occlusion and treatment?

A

Can cause alterations in the occlusion and any dental treatment should be avoided until the inflammtion is fully resolved.

do NOT perform occlusal adjustments to comfort the patient

NO DENTAL TREATMENT until the inflammation is resolved - no prophy

38
Q

disc displacement with reduction usually displaces where?

A

TO AFFECTED side

39
Q

can pts. with displacement without reduction translate?

A

NO

that is also why we see limited lateral movements to the contralateral side because cannot translate

40
Q

protrusive deflection to what side with disc displacement without reduction

A

restricted deviation to the left if the effected side is left TMJ

41
Q

if patient clenches on tongue blade and has pain where is pain coming from?

A

Medial pterygoid muscle because muscle is contracting

where as if the pain is relieved then we know it is TMJ issue

42
Q

imprints of the upper teeth on an occlusal splint/ night guard?

A

this was a feature of a patient with an acute disc displacement without reduction – NOT GOOD

43
Q

Lateral movements restricted when?

A

when opposite side TMJ is messed up

44
Q

inflammation of the synovial fluid and capsular ligament is called?

A

Synovitits and Capsulitis

45
Q

diagnosis of inflammatory disorders

A
  1. difficult to diagnose
  2. usually follow trauma to the tissue
  3. localized TMJ pain
  4. pain ecacerbated by function, palpation, and joint loading
  5. pain may be present at rest - limited range of motion
  6. fluctuant swelling over affected TMJ
46
Q

Retrodiscitis

A

inflammation in the retrodiscal tissue

clenching will increase the pain and there can be limited jaw movement

47
Q

where can you see malocclusion with patient who has retrodicitis

A

on IPSILATERAL side (same side) because

48
Q 
osteoarthritis 
definition 
what type of joint disease
clinical signs 
radio-graphic signs
A

Type - degenerative joint disease

Characterized by DESTRUCTIVE PROCESS by which the bony articular surfaces of the condyle and the fossa become altered

Clinical signs
TMJ pain is localized to the joint
Tender to palpation
Crepitus (grading sounds of the two bones)
Limited range of motion
Malocclusion (anterior open bite or one side open bite)

radio-graphic signs
Condylar deformaties, erosion, osteophytes (bone spurs), reduced joint space

49
Q

two inflammatory disorders

A
  1. synovitits and capsulitits

2. retrodiscitis

50
Q

crepitis indicates what

A

Oseoarthritis / or potentially Rheumatoid

51
Q

Subluxation
definition
describe clinically

A

when the CONDYLE is positioned ANTERIOR to the articular eminence

  1. jaw clicking AFTER opening
  2. lateral pole can be observed
  3. depression in the preauricular region
52
Q

difference between dislocation and subluxation

A

Sublux- can close

dislocation - pt. cannot close jaw and needs your help

53
Q

dislocation
definition
describe clinically

A

AKA open-lock
Inability to close the mouth without specific manipulation maneuver

radiographic evidence reveals condyle well beyond the eminence

pain at time of dislocation with mild residual pain after episode

54
Q

what you see clinically with dislocated (open-lock) left TMJ

A

Severe pain

assymetric mandible shifted to the right

cannot close or open

occlusal disharmony

55
Q

where is condlye positioned in dislocation

A

ANTERIOR to articualr eminence

56
Q

list of muscle disorders

A
  1. protective co-contraction
  2. Local muscle soreness
  3. myofacial pain (trP)
57
Q

Protective co-contraction

A

Muscle Disorder
NOT a pathological condition but a physiologival response of the musculoskeletal system

CNS response to injury following an event **

muscle contraction alters to protect the injured area from further injury
will not resolve until the reason is eliminated (like hyperocclusion from porrly fitting crown)

58
Q

dont resolve muscle co-contraction?

A

goes to local muscle soreness

59
Q

causes of protective co-contraction?

A 
poorly fitting crown
long dental appointment 
wide opening
dental injection
constant deep pain input from tendons, ligaments, joints, teeth and muscles 
increased emotional stress
60
Q

implications of protective co-contraction on occlusoin and range of opening?

A

patient perceives change in occlusion and range of opening decreases

61
Q

local muscle soreness
describe
causes?

A

non-inflammatory myogenous pain disrorder often the first response of the muscle tissue to continued protective co-contraction- so have to treat the muscle too not just resolved when the reason is eliminated (like co-contraction) the tissues start reacting - not just CNS

due to trauma, parafunction, and stress mostly

62
Q

clinical symptoms of muscle soreness

A
  1. dull, aching pain during function of affected muscle
  2. no or minimal pain at rest
  3. tenderness to palaptation
  4. reduced range of motion, increase of pain on stretching and use
63
Q

myofacial pain AKA

definition and characterization

A

triger point myalgia

regional myogenous pain condition characterized by:

  1. regional dull, aching muscle pain
  2. presence of hypersensitive bands of muscle tissue known as trigger points
64
Q

trigger points

A

localized hardening of muscle tissue that is hypersensative - which typically REFERS PAIN

hypersensative bands of muscle tissues

65
Q

trigger point in masseter refers?

A

to the teeth - so do a blcok

66
Q

what type of response is protective co-contraction?

A

physiologic

67
Q

can muscle pain and protective co-contraction cause occlusal changes?

A

yes

68
Q

TMD symptoms are most prevelany in what ages?

A

15-25 years of age

69
Q

frequency of re-screening

A

every 6 months

70
Q

stabalization splints are what type?

A

permissive splints – allow the teeth to move on the splint unimpeded, allows the condylar head and disk to function anatomically

71
Q

aspects to the stabilization splint theory

A
  1. decrease muscle activity
    - allow free centric and eccentric movements
  2. easy to adjust occlusal surfaces
  3. easy to repair
  4. long term use (durability)
  5. Stable, retentive (passive adaption)
  6. NOT apply pressure to the teeth
  7. cover all occlusal surfaces - even 3rd molars if present
72
Q 
occlusion with splint 
what you want 
during close
during lateral 
during protrusive
A

when closed mouth - want bilateral contact

lateral - contact only on working (canine guidance)

protrusion - only contact in anterior -

remove eccentric contacts, remove heavy contacts, only want light contacts in anterior - can be harder in posterior

v shaped at canines

Occlusion (10 decks)

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