TMD

Question 1

possible outcomes of untreated TMD?

Answer 1

1. bite can change if pain is relieved after the dental treatment

muscle pain -

Question 2

protective co- contraction is

Answer 2

a muscle disorder

- should have a cause assoiciated with it

Question 3

protective co- contraction is

Answer 3

a muscle disorder

- should have a cause assoiciated with it

Question 4

protective co-contraction treatment approach
if tissue injury?
if no tissue injury?

Answer 4

no tissue injury –> treatment should be directed towards to the cause for the c-contraction

• reduce high occlusal contact after recenely cemented crown
• treat irreversible pulpitis
• treat TMJ pain (arthralgia)
• refer for psychotherapy - emotional stress

or tissue injury

• restrict the use of the mandible to within painless limit
• soft diet until pain subsides
• pain medication (NSAIDs)
• no muscle exercise

Question 5

case treatment approach to muscle co contraction

Answer 5

reduce joint pain –
SPLINTS NSAIDs
ice application then switch to moist heat
soft diet - no chewing gum or tough food
***limit mouth opening not to increase pain which may create more muscle contraction

next appt. in 3 weeks

Question 6

give passive stretching exercises?

Answer 6

yes – in tx of muscle co contraction at 3 week follow up

* this is to restore the muscel length and full range of motion – should not cause pain

Question 7

T/F trigger point / myofacial pain typically refers pain?

Answer 7

true

- it is a localized hardening of muscle tissue that is hypersensitive and typically refers pain

Question 8

T/F trigger point / myofacial pain typically refers pain?

Answer 8

true

- it is a localized hardening of muscle tissue that is hypersensitive and typically refers pain

Question 9

myofacial pain tx should begin with

Answer 9

patient education

prevention is best tx too

Question 10

provide patient with exercises when?

Answer 10

once the pain has gone away

Question 11

think about what tx with muscle co contraction?

Answer 11

limit muscle movement until pain go away
- restrict movements in painless limit until resolves

stop dental tx until

Question 12

moist heat for?

Answer 12

20 min 3x a day

then cold application for 5 minutes

+ massage the muscle

Question 13

muscle pain with trigger points treatment

Answer 13

try and release the trigger points
- acupressure with finger pressure for 60-90 seconds then release
moist heat application to the muscles to increase blood circulation
give occlusal guard if parafunction is an additional factor

therapy if stress is present too

musle relaxant - cyclobenaprine 5 mg 3x day for 10 days (max) + NSAIDS (but short term tx)

Question 14

posture control for?

Answer 14

muscle pain with trigger points

- especially important if it is trapezius referring to the angle of the mandible

Question 15

occlusal guard only at night for?

Answer 15

with reduction for retrodiscal tissue adaptation

Question 16

start with ice application with

Answer 16

the joint displacement with reduction

Question 17

no active muscle exercises with?

Answer 17

displacement without reduction

Question 18

overview of the disc ones

Answer 18

adaption of the retrodiscal tissue, ice application, medication NSAIDs, occlusal guard, soft diet, no opening wide

Question 19

passive muscle exercise with?why do them?

Answer 19

osteoarthritis / degeneration of the joint
like retro discitis, synovitis, capsulitis

so limit causing myofibrotic contraction of the muscles

*similar therapy to the disc displacment with reduction

Question 20

if OA cant be managed?

Answer 20

if cannot be managed with conservative therapy, ORAL SURGERY may be required

Question 21

clinical signs of bruxism

Answer 21

tooth wear
tongue and cheek indentations
muscle hypertrophy
radiographically analysis

Question 22

diff approaches to manage bruxism

Answer 22

occlusal splint
medication (clonidine-alha adrenergic agonist used for tx hypertension)
botulinum toxin injections
physical therapy