TMD - Hx and Exam Flashcards
How investigate P/C of pt?
SOCRATES
Ask about clicking
Joint noises
What need to find out about clicking?
Is it on opening or closing
Temporary or persistent
Associated pain
What other q ask get full hx of disorder?
Is opening limited Get locking? - open or closing Change in occlusion Hx of trauma Parafunctional activities
What parafunctional activities ask about?
Clenching
Grinding
Nail biting
Any medical conditions to be aware of w/ TMD?
Systemic arthritis Previous malignancy Mental health disorder Fibromyalgia Hypermobility syndrome
What is chronic pain?
Pain considerable period of time leading psychological distress and behaviour reactions
Risk factors chronic pain?
Predisposing = trauma Initiating = microtrauma/ strain Perpetuation = pyschologica. parafunctional
What is fibromyalgia?
Pain in musculature and tendons = widespread pain/ sensitivity to multiple tissue sites
Pt low threshold pain = pain develop easily
What is likely cause of fibromyalgia?
CNS neurosensory amplification
Example hypermobility condition?
Elhers Danlos
Red flag signs when examining for TMJ disorders may suggest malignancy?
Hx cancer - metastasis Weight loss Facial asymmetry Neck mass/ cervical lympadenopathy Nasal symptoms Decreased hearing
What may fever suggest?
Septic arthritis
Osteomyeleitis
Tooth abscess
What might unilateral headache/ scalp tenderness sugest?
Giant cell arteritis
Contributing factors TMJ disorders?
Trauma
Systemic conditions
Parafunction
Abnormal positon
What look for on EO exam?
Muscle hypertrophy - masseter Habits - protrusion/clenching Poor neck posture Asymmetry Lymph nodes Arteries
What look for in IO exam?
Signs clenching/grinding
Occlusal assessment
What are signs clenching/gridning?
Scalloped tongue
Buccal mucosa ridging
Hypertrophic masseter
Attrition and wear facets
What should be included in muscoskeletal exam?
Look ROM - measure active opening/ lateral excursion
Palpitation of MOM
How measure lateral excurusion?
Gap between 2 upper and 2 lower incisors
Summary exam for TMJ disorders?
EO
IO
Muscoskeletal
Is imaging waranted for dx?
Diagnosis often through hx and clinical exam
If crepitus may want OPT
Mainstay of tx for TMJ disorders?
Education Physical therapy Splint therapy Medication Other
What other methods can be used for tx of TMJ?
Psychological
Occlusal adjustment
Botox
Surgery