TMD Flashcards
Role of occlusion in TMD
Current understanding and evidence- based literatrue fail to demonstrate a causal relationship between these occlusal factors and TMD signs and symptoms
percentage of young adults that have detectable clicking that is not pathological
what do you with these patients
80%
- dont treat
do you treat joint noises?
NO — should be followed but do not require treatment
Etiology of TMD
definition plus 5 examples
A ‘collective term’ embracing a number of clinical problems that onvolve the masticatory musculature, the TMJ’s, and associated craniofacial structures
- Trauma
- Emotional Stress
- Deep pain input
- Parafunctional habits
- Occlusal Factors *
clinical signs of osteoarthritis
crepitis tendernous sometimes mal occlusion and limiting openeing
role of occlusion in TMD
occlusal interferences have been considered as a major risk factor for TMD’s
*OCCLUSAL EQUILIBRATIONS FOR AN IDEAL OCCLUSION TO TREAT TMD’s
Anterior open bite, increased overbite, excessive overjet, premature contacts (interferences), posterior cross bite, Centric relation and Centric occlusion differences are _____what to TMD
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
Current understanding in evidence for role of occlusion in TMD?
Current understanding and evidence based literature fail to demonstrate a causal relationship between these occlusal factors and TMD signs and symptoms
T/F changes in occlusion may cause muscular symptoms
TRUE – like improper crown and filling, changing occlusal vertical dimension, improper occlusal appliances and splints
improper stabilization splint implications?
may create muscle pain and TMJ pain due to sudden non-adjusted contacts
Capsulitis, synovitis, and retrodiscitits implication on occlusion?
can cause affects to occlusion – may cause open bite, occlusal discomfort
Osteoarthritis and RA implication on occlusion?
may cause open bite
Protective co-contraction of muscles implication on occlusion?
percieved a change in occlusion
what can osteoarthritis do to affect occlusion?
can increase overjet and can decrease overbite due osteoarthritis
T/F TMD may cause occlusal changes
TRUE – TMD may cause occlusal changes and therefore any dental treatment should be performed after the problem is resolved
list of TMD JOINT disorders (Five)
- disc displacement with reduction
- disc displacement without reduction
- inflammatory disease
- degenerative joint disease
- Dislocation TMJ - Subluxation
List of TMD MUSCLE disroders
- Protective Co-contraction
- Local muscle soreness
- Myofacial Pain (TrP)
List of TMD MUSCLE disroders
- Protective Co-contraction
- Local muscle soreness
- Myofacial Pain (TrP)
what do you do about joint noised without pain and dysfunction?
FOLLOW these patients - but do not require treatmnet
possible occlusal factors are?
risk factors for TMD
can TMD be observed in ideal occlusion?
yes
patient with non-ideal occlusion has TMD what is the correct order of tx?
do not recommend ortho tx right away - treat TMD then ortho (may result in not even needing ortho)
can TMD affect occlusion?
Yes
T/F TMD can cause occlusal problems that are more severe than non-ideal occlusions affect on TMD’s
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
full range of motion in adult TMJ
40-60 mm of opening
less than 8mm upon protrusive and lateral excursions is also considered limited
disc displacement
disturbances of the normal anatomical relationship between the disc and the condyle
etiology of disc displacement - 4 major ones
- trauma
- parafunctin
- spasm of the superior lateral pterygoid
- disruption of lubrication system
effect of prolonged overload – leads to what?
- affects disc VISCOELASTIC PROPERTIES
- AFFECTS LUBRICATION SYSTEM
- repeatative disc hesitation causes elongation –> disc displacement ANTERIORLY
disc displacement with reduction
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
does disc displacement with reduction require treatment?
describe movements
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
disc displacement without reduction
clinical features
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
sounds when disc displacement without reduction
upon chewing
deviation
any shift of the midline during opening that disappears with the continued opening
deflection
any shift in the midline to one side that becomes greater with opening and DOES NOT disappear at max opening
describe lateral movements in pt. with disc displacement without reduction w/ pain on left side
Left lateral movement = normal
Right lateral movement = LIMITED
cases limit lateral excursive movement on the contralateral side
examples of inflammatory disorders
Synovitis and Capsulitis
synovial inflammation implication on occlusion and treatment?
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
disc displacement with reduction usually displaces where?
TO AFFECTED side
can pts. with displacement without reduction translate?
NO
that is also why we see limited lateral movements to the contralateral side because cannot translate
protrusive deflection to what side with disc displacement without reduction
restricted deviation to the left if the effected side is left TMJ
if patient clenches on tongue blade and has pain where is pain coming from?
Medial pterygoid muscle because muscle is contracting
where as if the pain is relieved then we know it is TMJ issue
imprints of the upper teeth on an occlusal splint/ night guard?
this was a feature of a patient with an acute disc displacement without reduction – NOT GOOD
Lateral movements restricted when?
when opposite side TMJ is messed up
inflammation of the synovial fluid and capsular ligament is called?
Synovitits and Capsulitis
diagnosis of inflammatory disorders
- difficult to diagnose
- usually follow trauma to the tissue
- localized TMJ pain
- pain ecacerbated by function, palpation, and joint loading
- pain may be present at rest - limited range of motion
- fluctuant swelling over affected TMJ
Retrodiscitis
inflammation in the retrodiscal tissue
clenching will increase the pain and there can be limited jaw movement
where can you see malocclusion with patient who has retrodicitis
on IPSILATERAL side (same side) because
osteoarthritis definition what type of joint disease clinical signs radio-graphic signs
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
two inflammatory disorders
- synovitits and capsulitits
2. retrodiscitis
crepitis indicates what
Oseoarthritis / or potentially Rheumatoid
Subluxation
definition
describe clinically
when the CONDYLE is positioned ANTERIOR to the articular eminence
- jaw clicking AFTER opening
- lateral pole can be observed
- depression in the preauricular region
difference between dislocation and subluxation
Sublux- can close
dislocation - pt. cannot close jaw and needs your help
dislocation
definition
describe clinically
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
what you see clinically with dislocated (open-lock) left TMJ
Severe pain
assymetric mandible shifted to the right
cannot close or open
occlusal disharmony
where is condlye positioned in dislocation
ANTERIOR to articualr eminence
list of muscle disorders
- protective co-contraction
- Local muscle soreness
- myofacial pain (trP)
Protective co-contraction
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)
dont resolve muscle co-contraction?
goes to local muscle soreness
causes of protective co-contraction?
poorly fitting crown long dental appointment wide opening dental injection constant deep pain input from tendons, ligaments, joints, teeth and muscles increased emotional stress
implications of protective co-contraction on occlusoin and range of opening?
patient perceives change in occlusion and range of opening decreases
local muscle soreness
describe
causes?
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
clinical symptoms of muscle soreness
- dull, aching pain during function of affected muscle
- no or minimal pain at rest
- tenderness to palaptation
- reduced range of motion, increase of pain on stretching and use
myofacial pain AKA
definition and characterization
triger point myalgia
regional myogenous pain condition characterized by:
- regional dull, aching muscle pain
- presence of hypersensitive bands of muscle tissue known as trigger points
trigger points
localized hardening of muscle tissue that is hypersensative - which typically REFERS PAIN
hypersensative bands of muscle tissues
trigger point in masseter refers?
to the teeth - so do a blcok
what type of response is protective co-contraction?
physiologic
can muscle pain and protective co-contraction cause occlusal changes?
yes
TMD symptoms are most prevelany in what ages?
15-25 years of age
frequency of re-screening
every 6 months
stabalization splints are what type?
permissive splints – allow the teeth to move on the splint unimpeded, allows the condylar head and disk to function anatomically
aspects to the stabilization splint theory
- decrease muscle activity
- allow free centric and eccentric movements - easy to adjust occlusal surfaces
- easy to repair
- long term use (durability)
- Stable, retentive (passive adaption)
- NOT apply pressure to the teeth
- cover all occlusal surfaces - even 3rd molars if present
occlusion with splint what you want during close during lateral during protrusive
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
