TMD management

Question 1

What is TMD

Answer 1

Major craniofacial pain problem involving TMJ, MoM and associated HN musculoskeletal structures

Question 2

Types of TMD

Answer 2

Myofascial pain
Internal derangement
Degenerative joint disease
Autoimmune diseases like rheumatoid arthritis, psoriasis etc
Ankylosis of the joint
Dislocation of TMJ
Neoplasm of TMJ bone/cartilage, commonly osteochondroma

Question 3

Challenges in diagnosing TMD

Answer 3

Chief complaint is pain, which is v vague and has alot of potential DDx

Other complaints include:
> limitation in function
> joint sound (internal derangement? degenerative disease?)

Axis I: somatosensory disorder - organic cause like trauma or disease, something is physically wrong with the joint or associated tissues

Axis II: psychogenic disorder - nonorganic cause, nothing wrong with the joint or associated tissues but the patient is highly affected - harder to diagnose and treat

Question 4

Non surgical treatment

Answer 4

Explanation, education
Medication
Occlusal splint - soft to reduce force applied to joint upon function
Physical, behavioral therapy
Psychiatric management

Question 5

Surgical treatment of TMD

Answer 5

ONLY FOR AXIS I

Arthrocentesis
> Lavage (washing out) of joint
> Inject saline to allow for greater mobility of the displaced disc, treating disc derangement
> Can manage osteoarthritis with acute pain as saline removes inflammatory products

Arthroscopy

Open joint surgery for underdeveloped condyle, ankylosis, neoplasm, dislocation, fractured TMJ, internal derangement or osteoarthritis

Question 6

Types of disc derangement

Answer 6

With reduction: displaced with mouth is closed, moves back to harmonious position on opening

Without reduction: displaced when mouth is closed, doesn’t become harmonious on opening, lesser range of motion and painful on opening wide

Anchored disc: disc in original position but stuck