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HD 4 - dental relevance > TMD > Flashcards

TMD Flashcards

1
Q

when does pain become chronic?

A

> /=3month

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2
Q

4 main orgins of orofacial pain

A
  1. musculoskeletal - TMD
  2. neuropathic - TN, BMS, phantom tooth pain
  3. neurovascular - migraine, trigeminal autonomic cephagiaas
  4. odontogenic
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3
Q

what is dysesthesia

A

partial/comlete loss of sensation with pain

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4
Q

3 types of provocation testing

A
  1. tooth sleuth
  2. TTP
  3. palpation of area of discomfort
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5
Q

5 ENT red flags

A
  1. recurrent epistaxis
  2. anosmia
  3. perisitant nasal obstruction/discharge
  4. objective hearing loss
  5. lymphaenopathy
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6
Q

OMFS red flags

A
  1. near absolute trismus
  2. erythroplakia, leukoplakia, frank ulceration, oral mucosa
  3. cranial nerve dysfunction
  4. previous carcinoma of head/neck
  5. preauricular mass
  6. young onset trigeminal neuralgia
  7. numbness in trigeminal dermatome
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7
Q

most common musculoskeletal facial pain

A

TMD

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8
Q

symptoms of temporal (giant cell) arteritis

A
  1. temporal headache
  2. > 50yrs
  3. visual disturbances
  4. claudication/tiredness when eating
  5. palpably tener
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9
Q

what is temporal (giant cell) arteritis

A

localised temporal headache
systemic inflammatory vasculitits
transmural inflammation of intimal + mural hyperplasia –> lumen narrow

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10
Q

3 investigations for temporal arteritis

A

ESR, CRP, temporal artery biopsy

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11
Q

management for temporal arteritis

A

urgen systemic steroids

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12
Q

what is a common comorbidity of TMD

A

migraine

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13
Q

most common neurovascular orofacial pain

A

migraine

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14
Q

symptoms of migraine

A

persisitent throbbing for up to 72hrs
nausea, vomiting, photo + photophobia
aggravated by everyday function
+/- aura

most common women 35-45

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15
Q

examples of neuropathic pain

A

burning mouth syndrome
post SR wisdom teeth
phantom tooth pain
neuralgia

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16
Q

what type of pain is TN

A

episodic

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17
Q

what type of pain is BMS

A

continuous

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18
Q

symptoms of trigeminal neuralgia

A

paroxysmal, stabbing
electric like, hot needle like pain
usually unilateral
talking, chewing, touch, temp change causes pain

TN affect >/= trigeminal nerve dermatomes

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19
Q

investigation for trigeminal neuralgia

A

MRI - must exclude pathology like MS/tumour

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20
Q

management of trigeminal neuralgia

A

carbamazepine on titrating dose - profound sodium channel blocker

second line = other anticonvulsants

neurosurgery

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21
Q

what is burning mouth syndrome

A

persistent burning sensation affecting oral mucosa

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22
Q

what is primary BMS?

A

+ve history of procedure taking longer than normal

central sensitisation - non-noxious stimuli perceived so they are noxious

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23
Q

possible causes of secondary BMS

A 
drug reaction - ACE inhibitors
candidiasis
anaemia 
diabetes
xerostomia
thyroid dysfunction
inadequate tongue space -/C
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24
Q

treatment for primary BMS

A

top or systemic - TCA, anxiolytics, anticonvulsant

25
Q

what is phantom tooth pain?

A

pain following extraction or RCT >/=3 months - injury to primary afferent

26
Q

do analgesics relieve neuropathic pain?

A

no

27
Q

how to tell difference between peripheral + central neuropathic pain

A

peripheral lockable by LA

central isn’t

28
Q

symptoms of TMD

A 
pain
tenderness to palpation
jaw movement limited/deviated//uncoordinated
joint sounds 
evidence of parafunction
headaches
29
Q

how does COMT affect TMD

A

low COMT - increased pain sensitivity - increased TMD

30
Q

diagnostic system used for TMD

A

DC TMD 2014

31
Q

what is myogenous + arthrogenous pain

A 
myogenous = from muscle
arthrogenous = from joint or disc
32
Q

4 type of TMD

A
  1. myalgia
  2. head attributed to TMD
  3. arthralgia
  4. intra-articular disorders
33
Q

how to examine myalgia

A

familiar pain - palpate masseter + temporalis

34
Q

types of myalgai

A

local myalgia
myofascial pain
myofascial pain with referral

35
Q

what happens in disc displacement with reduction

A

snap/pop cause by disc moving forwards infront of condyle

36
Q

what is the parotid gland relationship with master + buccinator

A

parotid duct pirerces buccinator

overlies masseter

37
Q

is buccinator or master deeper?

A

buccinator

38
Q

which branch of trigeminal innervates MOM

A

v3

39
Q

what nerve is transmitted through fo. ovale

A

v3

40
Q

components of anterior branch of V3

A 
mainly motor (MOM)
long buccal sensory
41
Q

components of posterior branch of V3

A

mainly sensory - general sensation ant 2/3 + mandibular teeth (IAN)

nerve to mylohyoid motor

42
Q

what is the chorda tympani nerve?

A

branch of VII

hitchhiker along lingual nerve - ant 2/3 taste

43
Q

what nerves are in infratemporal fossa?

A

5, 7, 9

44
Q

4 muscles of mastication

A

later + medial pterygoid
masseter
temporalis

45
Q

what is MMA a branch of?

A

maxilla artery

46
Q

what skull bone does the mandibular condyle fit into?

A

temporal bone - articular fossa + eminence

47
Q

nerve sensation of TMJ

A

auriculotemporal nere + masseteric nerve

48
Q

which pharyngeal arch does the mandible, V and mystical muscles originate?

A

arch 1

49
Q

3 ligaments reinforcing TMJ

A

lateral
sphenomandibular
stylomandibular

restrict movement in certain directions

50
Q

2 movements of TMJ

A

hinge - lower compartment, condyle moves, disc stationary

translation - upper compartment, condyle + disc move together

51
Q

which muscles are used for lateral excursion of mandible

A

contralateral to working side pterygoids

ipsilateral to working side temporals

52
Q

action of temporalis

A

elevation + retraction of mandible

53
Q

action of med pterygoid

A

elevation + lateral movement of mandble

54
Q

action of masseter

A

elevation of mandible

55
Q

action of lat pterygoid

A

protrusion + lateral

56
Q

3 main muscles involved in elevation/closing

A

temporalis
med pterygoid
masseter

57
Q

what is lining of TMJ made from

A

fibrocartilage

58
Q

what is arthrocentesis of TMJ?

A

degenerative change/calcified material can be treated this way

upper TMJ compartment rinsed with saliva or ringers +/- anti-inflammatory drugs

HD 4 - dental relevance (12 decks)

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