TMD Exam 2 Flashcards
Myth: People with certain types of _________malocclusion are more likely to develop TMD
- Comment in 2006. They now identified ___ types of occlusion that predisposes to TMD
1. Vertical or horizontal overjets over ______
2. Lateral slides over _____
untreated…some.. 3mm …3mm
Myth: People with excessive _________guidance or no ________guidance are more likely to develop TMD
incisal..incisal
Myth:
People with gross maxillomandibular skeletal ________ are more likely to develop TMD.
-Comment in 2006, Gross _______ can predispose to TMD
disharmonies… disharmonies
Myth: Pretreatment radiographs of both TMJs should be taken to determine the _____ of the condyles in the fosse, and the orthodontic treatment should be directed toward getting the condyles in concentric relation to their _____
position…fossa
Myth: Orthodontic treatment when properly done, usually______ the likelihood of subsequently developing TMD
reduces..
Finishing orthodontic cases according to specific functional occlusal guidelines, will _____ the likelihood of developing TMD
reduce
Myth: The use of certain _______ procedures (bicuspid extraction, incisor retraction, etc.) or appliances (headgear, chin cups, Class II elastics, etc.) may increase the likelihood of developing TMD
-Comment in 2006. These devices can ______a pre-existing TMJ condition.
traditional….aggravate
Myth: Adult patients who have _______ TMD symptoms and some form of occlusal “problem” require some type of occlusal correction in order to get well and stay well
concurrent…
Myth: The retrusion of the mandible because of ______causes (deep overbite, distalizing occlusal contacts) or iatrogenic procedures (chin cups, incisor retraction, retention during growth spurts) is a ____factor in the development of TMD
natural…major
Myth: ______of the mandible causes articular disks to skip forward off the condyles, resulting in internal derangements, especially clicking.
-Comment in 2006. Research shows that posterior condyle position _____ for anterior disc displacement with reduction but NOT for pain or arthritic changes.
Distalization …predisposes
a. If you have a unilateral pivot, then it will pull the condyle down (condyle with the pivot) and give relief to the capsulitis inside
b. Dr. Sears bilateral doesn’t know anatomy
c. Unilateral pivot point diagram
Pivot splint
If you want to move jaw forward use:
a. Anterior repositioning appliance
b. Indications for moving jaw forward:
i. posterior capsulitis
ii. painful pop or lots of locking
if you have a patient that has tooth pain and you weren’t sure if that tooth pain is infection or nerve, what test will determine abscess or nerve pain?
a. Topical anesthesia
i. if pain goes away then it is a peripheral neuralgia
ii. LA block will get abscess or nerve so don’t do that
Which muscle will limit side to side movement
lateral pterygoid
If there is nerve pain it is likely to be:
electric
If you have an Infection it is likely to be:
dull achy pain
It is important to study medications, the difference between migraine and nerve pain meds
-TCA?
- used to treat both migraine and nerve
- Blocks ion channels
Topamax
- ONLY anti-seizure used for migraines
- Anti-seizures- used to treat nerve pain also
- Sodium channel blocker and enhances gaba
- Watch for narrow angle glaucoma, kidney stones, short term memory loss, loss of appetite
Beta blockers used for what?
migraines
*not used to treat nerve pain
Medication used to treat nerve pain:
-Non blockable or sympathetically blockable
- Antidepressants
a. Elavil
b. Pamelor
Medication used to treat nerve pain:
-Alpha Blockers (antihypertensives)
a. Catapres
b. Minipress
c. Hytrin
Medication used to treat nerve pain:
Lidocaine - Repeated sympathetic blocks
a. IV
b. Tablets, mexiletine hydrochloride
Blockable Pain:
-Anticonvulsant and mood stabilizer
a. Tegretol
b. Depakote
Blockable Pain:
Dilantin and Topamax are __________
Anticonvulsant
Lioresal ?
Muscle relaxant
Klonopin
Sedative
What are Neuropathic Pain Medications?
- Tegretol
- Depakote
- TCAs
- Neurontin
- Bacleofen
- Hyr
Medication that is used to treat migraines ?
i. Topamax (anticonvulsant)
ii. Imitrex
iii. Inderal (beta blocker)
iv. Verapamil (calcium channel blocker)
v. Pamelor
what do dentists can do for nerve pain that neurologists don’t do?
a. Local anesthetic Injected (Inferior Alveolar Nerve blocks) blocks continuous/episodic burning to calm nerve down preventing permanent damage
b. Topical anesthetics over the area of neuralgia
i. Place a plastic stent and add topical anesthetic + capsaicin –>the cell that produces pain secretes substance and eventually runs out, which eliminates the nerve pain.
Episodic Tension-Type Headache
-headache pain is accompanied by 2 of the following symptoms?
- MOST COMMON
1. pressing/tightening (non-pulsating) quality
2. bilateral location
3. not aggravated by routine physical activity
Episodic Tension-Type headache pain is accompanied by both of the following symptoms?
- no nausea/vomiting
- photophobia and phonophobia absent or only one present
ii. fewer than 15 days per month w/ headache
iii. no evidence of organic disease
most headaches are tension-type ______%, _____
not _____. dull/achy
feels like _____ band around head activity improves ____
80-90%…bilateral…throbbing…tight…headache
Which headache?
i. lasting 4-72 hours
ii. 2 of the following:
1. unilateral location
2. pulsating quality
3. moderate or severe intensity
4. aggravation by routine physical activity
i. At least 1 of the following:
1. nausea and/or vomiting
2. photophobia & phonophobia
ii. at least 5 attacks fulfilling A, B, and C
iii. no evidence of organic disease
Migraine without aura
Which headache pain is preceded by at least 1 of the following neurologic symptoms?
- visual
a. scintillating scotoma
b. fortification spectra
c. photopsia - sensory
a. paresthesia
b. numbness
c. unilateral weakness
d. speech disturbance (aphasia)
ii. no evidence of organic disease
Migraine with aura
Which headache is severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes
ii. at least 1 of the following on the headache side:
1. conjunctival injection (swelling around eye)
2. facial sweating
3. lacrimation
4. miosis
5. nasal congestion
6. ptosis
7. rhinorrhea
8. eyelid edema
iii. no evidence of organic disease
iv. usually in men who drink/smoke
v. laying down makes it worse - person will be pacing b/c it’s so severe
a. Cluster Headache
What is the headache medication category that is not a pain medication that gets rid of migraines immediately?
Triptans- not a pain med but treats migraines
What is Abortive Therapy ?
Abortive Therapy (used to manage infrequent migraine, less than 5-6 per month)
- Ergotamine/caffeine
- Ergotamine derivatives
- Isometheptene
- Sumatriptan (Imitrex)
Triggers for migraines
a. carbon monoxide
b. MSG
c. cashews
d. aged cheese
e. red wine
f. dairy products
g. food allergies
h. stress, anxiety, depression
i. hunger
j. altitude
k. sleep disturbance
l. dehydration
m. diet
n. environmental and sensory stimuli
o. hormones/changes in estrogen levels in women
p. Drugs
q. Pain in the trigeminal system:
What is the pain in the trigeminal system?
i. Tooth pain
ii. Jaw pain (can also cause tension type headache)
iii. Neck pain (can also cause tension type headache)
iv. TMJ
v. Eye
vi. Ear
______ is the nerve center associated with migraines and also tooth pain, oral pain.
Nucleus caudalis (CN V)
Most accepted theory of migraine etiology is ________
neurovascular
Know the differences between the headaches?
Know the diagnostic red flags
i. Rash, meningeal signs or fever
ii. onset after 50
iii. onset in person w/ HIV or cancer
iv. abrupt onset
v. worsening pain
vi. signs of focal neurologic disease
vii. worst headache ever
viii. first severe headache
______ most effective,specific and sensitive image for disc
MRI
images are best for bone changes
CT
Tomograms are…
diagnostic
Standard of care is NOT the ____(not diagnostic quality)
pano
Transcranial, transpharyngeal and pano are not ______
diagnostic
_____most accurate for TMJ
CBCT
Anterior Reposition Splint (MX)
Temporary recapture of anteriorly displaced disc, allowing it to heal
Disc Recapture
Usually no need, unpredictable and unstable
i. Interrupts nerve transmissions so you can’t clench too tight
ii. Long term use can alter bite
iii. Temporary relief
iv. Tie floss to it so your patient doesn’t swallow it
NTI
Seating appliances:
i. No _______
ii. Not too _____
iii. ____ contact in the anterior
iv. _____ contacts
v. Cuspid guidance
vi. Polish very smooth
vii. Reeval every ____ weeks
rocking.. tight….lighter ..Balanced….2-4
Unilateral Pivot
distracts one condyle as intended
Sears Pivot
a. bad “Dr. Sears needs to go back to dental school and take anatomy again”
i. Hits only in posterior but doesn’t distract both condyles due to anterior position of masseters
Why..stay away from soft splints?
i. Compressible
ii. Easily Destroyed by clenching
iii. Encourages chewing habit with splint in
iv. Can move teeth
Moderate to severe or advancing anterior attrition severity is strongly associated with all _______ TMD models
intracapsular
Occlusal Features of TMD (risk factors?):
Sudden changes in _____ (high crown, etc) can cause TMD problems (Cohen’s opinion)
occlusion
Occlusal Features of TMD (risk factors?):
a. ____ or more missing posterior teeth
i. Orthodontic _____ of premolars within safety threshold
ii. adaptive and compensatory mechanisms ____ harmful effects
iii. Association to Osteoarthrosis may be only _____ to aging
iv. Excludes 3M’s
5..extraction….reduce….secondary
Occlusal Features of TMD (risk factors?):
- Overjet ____
- Overjets above____seen in TMD patients
- Sensitivity is..
- Could be consequences of ..
> 5mm…5mm… rare….disease
Occlusal Features of TMD (risk factors?):
RCP-ICP slides > ____
i. Not usually….
ii. Could be due to….
2mm…
sensitive
disease
Occlusal Features of TMD (risk factors?)
a. Anterior ____ Bite
b. Anterior ____
open..bruxism
What are the “visual” symptoms with migraine w/ aura?
a. scintillating scotoma
b. fortification spectra
c. photopsia
What are the “sensory” symptoms with migraine w/ aura?
a. paresthesia
b. numbness
c. unilateral weakness
d. speech disturbance (aphasia)
