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Semester 3 PM Exam 3 > TMD and Orofacial Pain > Flashcards

TMD and Orofacial Pain Flashcards

1
Q

Axis 1 includes

A

Masticatory mm disorders
Disc displacements
Joint dysfunction

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2
Q

Masticatory mm disorders includes

A

with normal openin

with limited opening

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3
Q

Disc displaceemnt includes

A

With reduction
Without reduction without limited opening
Without reduction with limited opening

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4
Q

Joint dysfunction includes

A

OA
Arthralgia
Osteoarthritis

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5
Q

Masticatory muscles

A

Masseter
Temporalis
Lateral Pterygoid
Medial Pterygoid

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6
Q

Necessary components of central sensitization

A

Abnormal inc of perceived pain in brain
Dec in brains input to inhibit pain
Hyperexcitability in spinal cord neurons
Repetitive firing of pain receptors in periheral NS

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7
Q

Possible micro and macro trauma that could cause damage to disc

A

Dental procedure that requires pronlonged mouth opening
Parafunctional activites
Oral sex

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8
Q

Most common position of displacement of the disc

A

Anterior

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9
Q

If the disc gets injured, prognosis for improvement?

A

Good - is vascularized and innervated

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10
Q

DDWR

A

two clicks occur

Condyle rides on the middle part of the disc with mouth open and rolls off when mouth closes

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11
Q

DDWR - if worsens what can happen

A

DDWOR

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12
Q

If DDWOR occurs with limited opening, what happened

A

The disc moved so ant that the condyle rides up on the disc and biomechanically the TMJ cant fully open

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13
Q

Arthralgia

A

Joint pain

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14
Q

Osteoarthritis

A

Involves inflammatory process

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15
Q

Osteoarthrosis

A

Does not involve inflammatory process but still have joint degeneration

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16
Q

Axis 1 dx related to

A

muscle, disc, joint pathology

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17
Q

Axis 2 dx related to

A

psychological issues that cause or maintain pain

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18
Q

Other causes of orofacial pain that need to be ruled out besides axis 1 and 2

A 
Cervical spine
Cranial nerves
Eyes, ears
Sinuses
Toothache or dental issues
Headaches 
Systemic problems RA
Peripheral neuralgias - trigeminal too
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19
Q

What does complete exam for orofacial pain have to include

A 
TMJ musculoskeletal eval
Psychological exam
Cranial nerve screen
Cervical screen
Systems screen
Heart attack can refer to face
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20
Q

History

A

Have you had pain or stiffness in the face, jaw, temple, in front of the ear, or in the ear in the past month?
Are the symptoms altered by any of the following jaw activities: chewing, talking, singing, yawning, kissing, moving the jaw?
Have you ever had your jaw lock or catch so that it would not open all the way? If so, was this limitation in jaw opening severe enough to interfere with your ability to eat? Have you ever noticed clicking, popping, or other sounds in your joint?

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21
Q

Examples of parafunctional activites

A

Gum chewing
Nail biting
Bruxism (grinding, clenching)

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22
Q

Bx that could irritate TMJ

A 
Leaning head on chin
Forward head posture
Eating hard food
Grinding teeth
Clenching jaw
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23
Q

Scales to rule in/out psychological problems

A

Patient health questionnaire for anxiety and depression

Graded chronic pain scale

24
Q

Medical practitioners with whom you might communicate with

A 
Dentist
Oral surgeon
Speech therapist
Family med doc/internist
EMT
Psych
Nutritionist 
Neurologist 
Rheumatologist 
Ophthalmologist
25
Q

Tests and measures to rule in/out disorders not in axis 1

A 
Cranial nerve testing
Psych exam
Cervical screen
Vital signs
Palpation of temporal artery
Observation
26
Q

Central occlusion

A

Asking them to bite

Normal is mandible will go about half way down - touch equally at molars

27
Q

Crossbite

A

Mandibular teeth are lateral to maxillary teeth on one side and medial on the other side

28
Q

Underbite

A

Mandibular teeth are anterior to maxillary teeth

29
Q

Overbite

A

Maxillary incisors extend below mandibular incisors when jaw is in central occlusion

30
Q

Overjet

A

Measure of how far top incisor teeth are ahead of bottom incisors

31
Q

Mobility - opening

A 
Active without pain
Active into pain
End feel
Resist opening and closing
Measurement - 40 to 50 mm with firm capsular end feel 
3-4 fingers btw teth
32
Q

Limited opening may be cause by

A

mm tightness
capsular tightness
DDWR

33
Q

Lateral movement with opening may indicate

A

restriction on one side, mm tightness or asymmetrical mm contraction of DDWR on one side

34
Q

Mobility - closing

A

Teeth to teeth end feel

35
Q

Lateral deviation

A

Perform AROM before pain, into pain, overpressure with endfell and measure
Normal ROM - mandibular central incisors move lateral to maxilla central incisors 8-11 mm

36
Q

Protrusion/Retrusion

A

AROM to pain, into pain, overpressure, end feel
No measurement for normal ROM - madibular teeth should move past maxillary teeth
Deflection will occur on side of joint pathology with protrusion

37
Q

Palpation

A

TMJ - ant tragus of ear, lateral pole with mouth opening
Cervical spine, boney prominences of face
Mm of mastication

38
Q

Joint noise - listening for clicks and pops

A

Palpate while moving through ROM

Can use stethoscope on TMJ

39
Q

Differential Dx related to noise - clicking on opening and closing

A

DDWR (Sp = .90) or nothing is wrong

40
Q

Differential Dx related to noise - Hx of noise that has now reduced

A

DDWOR with limited opening (Sp = .90) or normal opening

41
Q

Differential Dx related to noise - Hx of noise that has reduced and now no pain

A

DDWR or DDWOR that has healed

42
Q

Differential Dx related to noise - crepitus with pain

A

Joint arthralgia

43
Q

Differential Dx related to noise - TMJ pain without crepitus

A

Joint arthralgia without joint degeneration

44
Q

Temporalis

A

Attaches on coronoid process
Palpate from temporal line of skull, post to ant to ear
Palpate externally to mandibular ramus, slightly open mouth to be able to reach coronoid

45
Q

Temporalis referral patter

A

to upper teeth, temporal area and area around the eye

46
Q

Temporalis - intraoral palpation

A

Follow ant ramus of mandible sup to the coronoid process

47
Q

Masseter

A

Zygomatic arch to ramus of mandible

Palpation of outer angle of mandible - clench teeth

48
Q

Masseter trigger points refer to

A

lower teeth, lateral face, and around eye

49
Q

Medial Pterygoid

A

Palpate externally on medial portion of inf mandible

Resist protrusion to palpate

50
Q

Medial Pterygoid - trigger points refer to

A

ear, ant to ear and cervical spine just post to mandible

51
Q

Lateral pterygoid

A 
Unable to directly palpate
REsist protrusion (inf portion) 
Clench teeth (sup portion)
52
Q

Lateral Pterygoid - trigger points refer to

A

Ear, perauricular area, and lateral face

53
Q

Joint mobility - ligament stress tests

A

Caudal glide - lateral TMJ ligament

Post glide - INtrinsic ligament - ipsilateral deviation with post glide

54
Q

Joint mobility

A

Ant glide
Post glide
Medial and lateral glides

55
Q

Special tests -

A

Power stroke
Unilateral joint loading
Joint compression
VAS related to functional activity

56
Q

Special tests - power stroke

A

Clenching teeth - biting bilaterally on tongue depressors - causes mm contraction but joint is somewhat unloaded
May point to problems more in mm than in joint

Semester 3 PM Exam 3 (3 decks)

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