TMD Flashcards
What are the most common mandibular fractures in children?
Uni/Bilateral intracapsular or subcondylar fractures
What can result from closed reduction and prolonged immobilization of jaw fractures?
Ankylosis
What occlusal factors are associated with TMD? (8)
Relatively LOW association of Occlusal Factors with TMD however these include:
- skeletal ANTERIOR OPEN BITE.
- steep articular eminence of the temporal bone.
- OVERJET greater ⬆️ than 6 to 7 millimeters.
- SKELATAL class 2 profile.
- hyperdivergent growth pattern.
- CLASS 3 malocclusion.
- UNILATERAL posterior crossbite.
- loss of posterior support. (5 or more missing teeth)
Bruxism effect on TMD?
- Bruxism, clenching, hyperextension, and other repetitive habitual behaviors are thought to contribute to the development of TMD by joint overloading that leads to cartilage breakdown, synovial fluid alterations, and other changes within the joint.
- Bruxism may occur while the patient is asleep or awake; sleep bruxism is a different entity from daytime bruxism. Sleep bruxism has been classified as a SLEEP-RELATED MOVEMENT DISORDER.
- A study of 854 patients younger than 17 years old found the prevalence of BRUXISM to be 38%
Does the extraction of premolars potentially create TMD?
NO
• OCCLUSAL ADJUSTMENT (i.e., permanently altering the occlusion or mandibular position by selective grinding or full mouth
restorative dentistry). A systematic review and meta-analysis demonstrated that occlusal alteration seems to have no effect on
TMD.
• ORTHODONTICS This may include mandibular positioning devices designed to alter the growth or permanently reposition the
mandible (e.g., headgear, functional appliances). There is little evidence that orthodontic treatment can prevent or relieve TMD.
Systemic Factors / Diseases contributing to TMD?
L and AAA
CONNECTIVE TISSUE diseases:
- rheumatoid arthritis,
- systemic lupus erythematosus
- juvenile idiopathic arthritis, and
- psoriatic arthritis
“Lupus and the 3 A’s”
- These systemic diseases occur as a result of imbalance of pro-inflammatory CYTOKINES which causes OXIDATIVE STRESS, free radical formation, and ultimately joint damage.
Other systemic factors may include joint hypermobility, genetic susceptibility, and hormonal fluctuations. Generalized joint laxity or hypermobility (e.g.,ELHER-DANLOS syndrome) has been cited but has a weak association with TMD.
Is a occlusal splint for TMD considered reversible or irreversible?
REVERSIBLE
The goal of an occlusal appliance is to provide orthopedic stability to the TMJ. These alter the patient’s occlusion temporarily and may be used to decrease parafunctional activity and pain.
Occlusal splints may be made of hard or soft acrylic. The stabilization type of splint covers all teeth on either the maxillary or mandibular arch and is balanced so that all teeth are in occlusion when the patient is closed and the jaw is in a musculoskeletally stable position.
What prescriptions have assisted in TMJ relief?
prescription medication (e.g., non-steroidal anti-inflammatory drugs, anxiolytic agents, muscle relaxers).
While ANTIDEPRESSANTS have proved to be beneficial, they should be prescribed by a practitioner familiar with pain management.
Facts regarding TMD treatment
- Every comprehensive dental history and examination should include a TMJ history and assessment.
- Few studies document success or failure of specific treatment modalities for TMD in infants, children, and adolescents on a long-term basis.
- It has been suggested that simple, conservative, and REVERSIBLE types of therapy are effective in reducing most TMD symptoms in CHILDREN.
- COMBINED approaches may be more successful in treating TMD than single treatment modalities
- adolescents undergoing occlusal appliance therapy combined with information attained a clinically significant improvement on the pain index
- Active modalities include participation of the patient whereas PASSIVE modalities may include wearing a stabilization SPLINT.
Irreversible Therapies for TMJ
- Occlusal Adjustment
- Orthodontics
- Surgery
Reversible Therapies for TMD
- Patient Education
- Physical Therapy
- Behavior Therapy
- Prescription Meds
- Occlusal splints
- TMJ arthrocentesis, TMJ injections, nerve blocks, acupuncture, trigger point injections, and off-label use of Botulinum toxin A injections.
Masticatory Muscle Disorders contributing to TMJ
Masticatory muscle disorders:
- muscle pain limited to OROFACIAL region (myalgia, myofascial pain with spreading, myofascial pain with referral, tendonitis, myositis, spasm).
- muscle pain due to SYSTEMIC/CENTRAL disorders (centrally mediated myalgia, fibromyalgia).
- MOVEMENT disorders (dyskinesia, dystonia).
- OTHER muscle disorders (contracture, hypertrophy, neoplasm).
When is TMJ imaging recommended?
TMJ imaging is recommended when there is a recent history of TRAUMA or developing facial ASYMMETRY, or when hard-tissue GRINDING or CREPITUS is detected.
- panoramic radiograph;
- mandible radiographs including oblique views;
- conventional computed tomography (CT) or cone-beam computed tomography (CBCT)
- magnetic resonance imaging (both open and closed mouth to view disc position); or
- ultrasound.
Physical clinical assessment of TMD should include?
- palpation of the muscles of mastication and cervical muscles for tenderness, pain, or pain referral patterns.
- palpation of the lateral capsule of the TMJs.
- mandibular function and provocation tests.
- palpation and auscultation for TMJ sounds.
- mandibular range of motion.
Gender differences in TMD
Although TMD pain in children increases with age in both boys and girls, recent surveys have indicated a significantly higher prevalence of symptoms and greater need for treatment in girls than boys.
The development of symptomatic TMD has been correlated with the onset of PUBERTY in GIRLS.
For ages 16-19 years, 32.5 percent of girls compared to 9.7 percent of boys reported school absences and analgesic consumption due to TMD-related pain.
Headaches appear to be independently and highly associated with TMD in adolescents, with most occurring BEFORE the onset of jaw pain.
