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5th - OD - TMD > TMD - Hx and Exam > Flashcards

TMD - Hx and Exam Flashcards

1
Q

How investigate P/C of pt?

A

SOCRATES
Ask about clicking
Joint noises

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2
Q

What need to find out about clicking?

A

Is it on opening or closing
Temporary or persistent
Associated pain

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3
Q

What other q ask get full hx of disorder?

A 
Is opening limited
Get locking? - open or closing
Change in occlusion
Hx of trauma
Parafunctional activities
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4
Q

What parafunctional activities ask about?

A

Clenching
Grinding
Nail biting

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5
Q

Any medical conditions to be aware of w/ TMD?

A 
Systemic arthritis
Previous malignancy 
Mental health disorder
Fibromyalgia 
Hypermobility syndrome
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6
Q

What is chronic pain?

A

Pain considerable period of time leading psychological distress and behaviour reactions

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7
Q

Risk factors chronic pain?

A 
Predisposing = trauma
Initiating = microtrauma/ strain
Perpetuation = pyschologica. parafunctional
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8
Q

What is fibromyalgia?

A

Pain in musculature and tendons = widespread pain/ sensitivity to multiple tissue sites
Pt low threshold pain = pain develop easily

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9
Q

What is likely cause of fibromyalgia?

A

CNS neurosensory amplification

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10
Q

Example hypermobility condition?

A

Elhers Danlos

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11
Q

Red flag signs when examining for TMJ disorders may suggest malignancy?

A 
Hx cancer - metastasis
Weight loss 
Facial asymmetry 
Neck mass/ cervical lympadenopathy 
Nasal symptoms 
Decreased hearing
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12
Q

What may fever suggest?

A

Septic arthritis
Osteomyeleitis
Tooth abscess

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13
Q

What might unilateral headache/ scalp tenderness sugest?

A

Giant cell arteritis

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14
Q

Contributing factors TMJ disorders?

A

Trauma
Systemic conditions
Parafunction
Abnormal positon

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15
Q

What look for on EO exam?

A 
Muscle hypertrophy - masseter 
Habits - protrusion/clenching 
Poor neck posture
Asymmetry 
Lymph nodes 
Arteries
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16
Q

What look for in IO exam?

A

Signs clenching/grinding

Occlusal assessment

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17
Q

What are signs clenching/gridning?

A

Scalloped tongue
Buccal mucosa ridging
Hypertrophic masseter
Attrition and wear facets

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18
Q

What should be included in muscoskeletal exam?

A

Look ROM - measure active opening/ lateral excursion

Palpitation of MOM

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19
Q

How measure lateral excurusion?

A

Gap between 2 upper and 2 lower incisors

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20
Q

Summary exam for TMJ disorders?

A

EO
IO
Muscoskeletal

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21
Q

Is imaging waranted for dx?

A

Diagnosis often through hx and clinical exam

If crepitus may want OPT

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22
Q

Mainstay of tx for TMJ disorders?

A 
Education
Physical therapy 
Splint therapy 
Medication 
Other
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23
Q

What other methods can be used for tx of TMJ?

A

Psychological
Occlusal adjustment
Botox
Surgery

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24
Q

Aims of TMJ tx?

A

Reduce pain
Increase function
Allow pt management

25
Q

Benefit of early dx?

A

Prevent chronic symptoms

26
Q

What pt education?

A

Explain condition - info sheet/ models
Explain principle of tx
Reassure

27
Q

Practical information to reduce stress/strain jaw muscle?

A 
Avoid habits: clenching, grinding, nail biting, pen chewing, lip sucking, protrusion 
Want pt to be aware oral habits so can reduce 
Keep jaw at rest position
Avoid forward head posture 
Soft diet
Chew slowly
Avoid caffeine 
Avoid repeated/ prolonged mouth opening 
Don't rest chin hands 
SImple analgesic/ NSAIDs
28
Q

What is rest position of jaw?

A

Teeth apart and tongue to roof of mouth

29
Q

What physical interventions can be used?

A

Jaw relaxation to help over activation muscle
Sleep hygiene - sleep pattern related chronic pain
Massage/stretch technique

30
Q

What splints can help?

A

Occlusal splint - removable device of acrylic

31
Q

How do splints work?

A 
Occlusal disengagement 
Maxilo-mandibular realignment 
Restore OVD
TMJ repositioning 
Cognitive awareness
32
Q

Two types of splints?

A

Directive

Permissive

33
Q

Example of directive splint?

A

ARPS

Anterior repositining splint

34
Q

Example permissive splint?

A

Soft bite guard
Anterior bite plane -lucia jig
Stabalisation splint

35
Q

How to ARPs work?

A

Direct mandbile anterior to ICP - providing better condyle disc relationship

36
Q

Indication ARPs?

A

Disc derangement
ANTERIOR DISC DISPLACMEENT
DD +R w/ or w/o intermittent locking

37
Q

Adv of soft splints?

A

Cheap
Easily construction
Well tolerated

38
Q

Disadv soft splints?

A

Difficult to adjust

Can encourage bruxism - increase symptoms

39
Q

Use of Lucia Jig?

A

Anterior bite plane - disclude posterior teeth allow relaxation MOM

40
Q

How to Lucia Jig work?

A

Neuromuscular deprogramming - forget ICP position

41
Q

When should pt not wear Lucia Jig?

A

At night - risk airway obstruction

42
Q

Use of lucia jig?

A

Locate CR

Quick fix for acute symptoms

43
Q

Example of stabalisation splint?

A

Michigan splint = upper

Tanner appliance = lower

44
Q

Use of stabalisation splint?

A

Create artificial ideal occlusion
Uniform contact CR
Canine guidance separate posterior teeth
Anterior guidance separate post teeth in protrusion

45
Q

Clinical stage of providing splint?

A

Imps
Jaw reg in CR
Face bow
Fit splint

46
Q

How should TMJ pt wear splints?

A

Every night
During period increase muscular stress/activity
If severe - day as well

47
Q

First line of tx for pt?

A

Inter-occlusal appliance - usually upper hard acrylic splint

48
Q

Issue partial coverage splints?

A

Overeruption

49
Q

What medications can be used in primary care manage TMD?

A

Analgesia - paracetamol/NSAID

50
Q

What medication can be used in secondary care?

A

Anxolytics

Benzodiazepines

51
Q

Why are anxolytics used?

A

Tricyclic antidepressants e.g amitriptyline

Muscle relaxation

52
Q

Why are benzodiazepines used? What is issue?

A

Muscle relaxation

Highly addictive

53
Q

How can botox help?

A

Botulinum toxin injected muscle to reduce activity

54
Q

Disadv botox?

A

Limited action until neural receptor regenerate

Risk injecting wrong site

55
Q

What is arthrocentesis?

A

Injection of steroid into upper joint space
Synovial fluid washed out
Needs high level of skill

56
Q

What is arthroscopy?

A

Invasive procedure - scope placed upper joint see what going on
Joint can be washed and biopsy taken

57
Q

Is surgery ever indicated?

A

Rarely in joint dysfunction

58
Q

Indication for jaw surgery?

A

Tumours
Condylar hyperplasia
Trauma
Ankylosis

5th - OD - TMD (4 decks)

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