TMD Flashcards
when does pain become chronic?
> /=3month
4 main orgins of orofacial pain
- musculoskeletal - TMD
- neuropathic - TN, BMS, phantom tooth pain
- neurovascular - migraine, trigeminal autonomic cephagiaas
- odontogenic
what is dysesthesia
partial/comlete loss of sensation with pain
3 types of provocation testing
- tooth sleuth
- TTP
- palpation of area of discomfort
5 ENT red flags
- recurrent epistaxis
- anosmia
- perisitant nasal obstruction/discharge
- objective hearing loss
- lymphaenopathy
OMFS red flags
- near absolute trismus
- erythroplakia, leukoplakia, frank ulceration, oral mucosa
- cranial nerve dysfunction
- previous carcinoma of head/neck
- preauricular mass
- young onset trigeminal neuralgia
- numbness in trigeminal dermatome
most common musculoskeletal facial pain
TMD
symptoms of temporal (giant cell) arteritis
- temporal headache
- > 50yrs
- visual disturbances
- claudication/tiredness when eating
- palpably tener
what is temporal (giant cell) arteritis
localised temporal headache
systemic inflammatory vasculitits
transmural inflammation of intimal + mural hyperplasia –> lumen narrow
3 investigations for temporal arteritis
ESR, CRP, temporal artery biopsy
management for temporal arteritis
urgen systemic steroids
what is a common comorbidity of TMD
migraine
most common neurovascular orofacial pain
migraine
symptoms of migraine
persisitent throbbing for up to 72hrs
nausea, vomiting, photo + photophobia
aggravated by everyday function
+/- aura
most common women 35-45
examples of neuropathic pain
burning mouth syndrome
post SR wisdom teeth
phantom tooth pain
neuralgia
what type of pain is TN
episodic
what type of pain is BMS
continuous
symptoms of trigeminal neuralgia
paroxysmal, stabbing
electric like, hot needle like pain
usually unilateral
talking, chewing, touch, temp change causes pain
TN affect >/= trigeminal nerve dermatomes
investigation for trigeminal neuralgia
MRI - must exclude pathology like MS/tumour
management of trigeminal neuralgia
carbamazepine on titrating dose - profound sodium channel blocker
second line = other anticonvulsants
neurosurgery
what is burning mouth syndrome
persistent burning sensation affecting oral mucosa
what is primary BMS?
+ve history of procedure taking longer than normal
central sensitisation - non-noxious stimuli perceived so they are noxious
possible causes of secondary BMS
drug reaction - ACE inhibitors candidiasis anaemia diabetes xerostomia thyroid dysfunction inadequate tongue space -/C
treatment for primary BMS
top or systemic - TCA, anxiolytics, anticonvulsant
what is phantom tooth pain?
pain following extraction or RCT >/=3 months - injury to primary afferent
do analgesics relieve neuropathic pain?
no
how to tell difference between peripheral + central neuropathic pain
peripheral lockable by LA
central isn’t
symptoms of TMD
pain tenderness to palpation jaw movement limited/deviated//uncoordinated joint sounds evidence of parafunction headaches
how does COMT affect TMD
low COMT - increased pain sensitivity - increased TMD
diagnostic system used for TMD
DC TMD 2014
what is myogenous + arthrogenous pain
myogenous = from muscle arthrogenous = from joint or disc
4 type of TMD
- myalgia
- head attributed to TMD
- arthralgia
- intra-articular disorders
how to examine myalgia
familiar pain - palpate masseter + temporalis
types of myalgai
local myalgia
myofascial pain
myofascial pain with referral
what happens in disc displacement with reduction
snap/pop cause by disc moving forwards infront of condyle
what is the parotid gland relationship with master + buccinator
parotid duct pirerces buccinator
overlies masseter
is buccinator or master deeper?
buccinator
which branch of trigeminal innervates MOM
v3
what nerve is transmitted through fo. ovale
v3
components of anterior branch of V3
mainly motor (MOM) long buccal sensory
components of posterior branch of V3
mainly sensory - general sensation ant 2/3 + mandibular teeth (IAN)
nerve to mylohyoid motor
what is the chorda tympani nerve?
branch of VII
hitchhiker along lingual nerve - ant 2/3 taste
what nerves are in infratemporal fossa?
5, 7, 9
4 muscles of mastication
later + medial pterygoid
masseter
temporalis
what is MMA a branch of?
maxilla artery
what skull bone does the mandibular condyle fit into?
temporal bone - articular fossa + eminence
nerve sensation of TMJ
auriculotemporal nere + masseteric nerve
which pharyngeal arch does the mandible, V and mystical muscles originate?
arch 1
3 ligaments reinforcing TMJ
lateral
sphenomandibular
stylomandibular
restrict movement in certain directions
2 movements of TMJ
hinge - lower compartment, condyle moves, disc stationary
translation - upper compartment, condyle + disc move together
which muscles are used for lateral excursion of mandible
contralateral to working side pterygoids
ipsilateral to working side temporals
action of temporalis
elevation + retraction of mandible
action of med pterygoid
elevation + lateral movement of mandble
action of masseter
elevation of mandible
action of lat pterygoid
protrusion + lateral
3 main muscles involved in elevation/closing
temporalis
med pterygoid
masseter
what is lining of TMJ made from
fibrocartilage
what is arthrocentesis of TMJ?
degenerative change/calcified material can be treated this way
upper TMJ compartment rinsed with saliva or ringers +/- anti-inflammatory drugs
