TMD and Myofascial Pain (Desai) Flashcards
What is the gender predilection for TMJ disease?
Female 2:1
What are the parts of the TMJ?
- Glenoid fossa
- Articular eminence
- Articular disk
- Condyle
What are the ligaments of the TMJ?
- Lateral
- Stylohyoid
- Stylomandibular
What are the muscles of mastication?
- Masseter
- Temporalis
- Lateral Pterygoid
- Medial Pterygoid
What other muscles can present in TMD besides the muscles of mastication?
- Sternocleidomastoid
2. Trapezius
Which imaging will show the articular disk (MRI or CBCT)?
MRI
TMD is what type of phenomenon, and why is that a consideration?
Biopsychosocial. Patient may have underlying problems / stresses that require treatment
What are symptoms of facial pain or jaw pain?
- Pain in jaw joint
- Pain in cheek region
- Pain on jaw movement
- Difficulty opening
- Limitation of jaw function
- Jaw clicking
- Jaw crepitus
- Jaw locking
- Law tiredness
- Jaw stiffness
What are 2 axis of RDC/TMD Classification?
Axis I - physical diagnosis
Axis II - pain related to psychosocial dysfunction and psychological stress
Axis I, Group I concerns physical diagnosis of what TMD etiology?
Muscle disorders
Axis I, Group II concerns physical diagnosis of what TMD etiology?
Disc displacement
Axis I, Group III concerns physical diagnosis of what TMD etiology?
Arthralgia, arthritis, arthrosis
What is the difference between an arthritis and arthritis?
Arthritis is a swelling of the joint with pain (symptomatic).
Arthrosis is bone degeneration with no swelling or pain (asymptomatic)
What is considered a normal mouth opening?
3-4 fingers or about 35-55mm
A restricted mouth opening would be how many fingers?
1-2 fingers
What is covered in a TMJ exam?
- Range of motion
- Lateral and protrusive motions
- Auscultation
- Palpation
- Myofascial
- Occlusion
What is looked for when doing lateral and protrusive movements?
Equal movement to each side
Myofascial pain presents as what pain character?
Chronic aching pain, sharp on mastication / movement
What are 4 treatments for myofascial pain?
- Stretching
- Analgesics
- Muscle relaxants
- Orthotic appliances
Are NTI (Nociceptive Trigeminal Inhibitors) appliances indicated for myofascial pain treatment?
No
What are the characteristics of ideal bite appliances?
- Full coverage on either arch, covering all teeth
- Flat, non-guiding surface
- Allows free movement in all directions
- Even occlusal contacts with opposing arch
What does a deviation to the left during translation of the condyle indicate?
The right joint has full range of motion, possible left joint problem (deviates to problem side)
Normal protrusion is how much?
More than 6mm
Normal lateral range of motion is how much?
More than 7mm
What causes a reproducible click on auscultation or a reciprocal click?
Anterior disk displacement with reduction
What may cause limited opening and possible crepitus but without a click?
Anterior disk displacement without reduction
What inserts onto coronoid process and anterior border of ramus to elevate, retract mandible and clench teeth?
Temporalis muscle
Which muscle goes from zygomatic arch (superficial and deep portions) inserting on the lateral surface of ramus, coronoid process, and angle of mandible to elevate mandible and clench teeth?
Masseter muscle
What muscle goes from the medial surface of lateral pterygoid plate inserting onto the posterior and lower part of the medial surface of the ramus and angle of the mandible to elevate, protrude and laterotrude the mandible and clench teeth?
Medial pterygoid
Which muscles goes from the lateral surface of the lateral pterygoid plate and greater wing of sphenoid inserting on anterior potion of condylar neck and articular disk to protrude mandible and laterotrude mandible, pull articular disk forward?
Lateral pterygoid muscle
What is the difference between myalgia and myofascial pain?
Myalgia is only one muscle. Myofascial pain is general soreness of all muscles.
What is the difference between a “closed lock” and an “open lock”?
Closed is a disk displacement without reduction causing limited opening. Open is a subluxation of the condyle during translation that locks mouth open
What is the term a spot where you press against and when you release there is radiating pain?
Trigger point
What is a common muscle relaxant for myofascial pain management?
Flexeril (cyclobenazprine)
What is an alternative to muscle relaxant Flexeril?
Tricyclic antidepressants low dose (amitryptilline)
What is important in trigger point injections: what you inject or where you inject?
Where you inject
What will dull a click or stop it?
Protrude then open and close
If there is a noise on protrusion is it a closed lock or an open lock?
Open lock / subluxation
What is best treatment for an asymptomatic click (e.g. a click with reduction causing no pain)?
No treatment, condyle will remodel with time
What is the term for when the disk moves anteroinferiorly upon opening and returns to position on closing with resulting symptoms of arthralgia directly over joint, may complain of ear aches, will have click on auscultation and will have a normal range of motion?
Symptomatic disk displacement with reduction
What is the term for when the disk moves anteroinferiorly but does not go back, acts as a doorstop, reducing range of motion, with arthralgia over joint , will have no click on auscultation?
Symptomatic disk displacement without reduction
What does a click mean in the TMJ?
There is reduction
What are 3 ways to manage symptomatic disk displacements?
- NSAIDS to reduce inflammation
- Manage muscle pain
- Ortho appliances
What are some other arthritic conditions in the TMJ?
Osseous ankylosis, synovial chondromatosis, condylar osteochondroma, condylar hypoplasia
What 5 things make up a normal immunologic panel?
- Rheumatoid factor (RF)
- Autonuclear Antibody (ANA)
- Erythrocyte sedimentation rate (ESR)
- SSA
- SSB
