TMD OMFG Flashcards by Tim Agee

What kind of device moves the Jaw Forward?

Upper Splint with a Flange

*aka Anterior Positioning Device

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NTI alleviates what?

Myalgia

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Whiplash can cause TMD

True

*cause

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Nerve pain is never alleviated by what class of drug?

Beta blockers

*anything LOL

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Carbamazapine/Tegretol can treat Migraine

False

this is an Anti-convulsant
the only anti-convulsants that Tx Migraine are Topomax and Depicote

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Highest standard of TMJ imagery:

Minimum standard:

Not diagnostic:

Conebeam CT

Tomography

Pano

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Imaging that shows disc position:

MRI

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What are the master cells for Pain in the brain?

Glial Cells

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Superior Capsulitis will feel better if you bite on what side?

Lateral Capsulitis will feel bette if you bite on what side?

Same side

Opposite side

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Most common cause of Trigeminal Neuralgia

Vessel impingement in the brain

*happens more in older people

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% population w/ at least 1 sign of TMD dysfunction:

% population w/ at least 1 symptom:

% population that need Tx

Ratio Females:Males

75%

33%

5-7%

4:1

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If TMD, % internal derangement:

% arthritis

% masticatory muscle disorder

31%

39%

30%

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There is no specific cause to TMD, but there are contributing factors

Predisposing factors

Initiating factors

Perpetuating factors

True

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5 Predisposing factors for TMD:

Systemic hypermobility (needs more evidence)

Psychosocial factors

Hx of injury

Oral habits

Dental occlusion (rare, 15%)

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2 Initiating factors TMD

Direct trauma

Repetitive micro trauma (clenching, grinding, fingernail biting)

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3 Perpetuating Facors TMD:

Psychosocial factors (stress)

Oral habits

Poor Occlusion

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6 Contributing Factors TMD:

Direct extrinsic trauma

Hyperfunction

Psychosocial factors

Anatomic factors

Systemic disease

Hyperextension

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What is the best image for seeing the disc?

What is the best image for imaging bone?

What is the best for arthritis/bone?

MRI

X-ray

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When a jaw deflects to one side, is this muscle or joint?

Joint

*ADD w/o reduction

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Poor occlusion is a common cause of TMD

False

*15%

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NTI is used for what?

Myalgia (muscle pain)

*anterior bite has less muscle contraction, but it will still put pressure on the condyles

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If the occlusion on a stabilization splint is balanced by a splint, but the pain is locking/knocking/popping and painful what is the correct option?

Reposition Forward with a Flange (anterior repositioning device)

*listed for other info

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Are bite changes usually necessary for TMD Tx?

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What is the most important part of the Exam?

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What is the main function of the Lateral Pterygoid?

Protrusion Lateral excursions *also depressor

Does Anterior disc displacement w/ reduction limit opening?

No *only w/o

If you have a joint problem can you also have a muscle problem?

Of course *most pts have 4-5

If you have a limited opening with a soft infeel you have a...

Muscle problem

When you have referred pain, what is the name for what's going on in the brain? What nucleus?

Convergence Trigeminal nucleus adelas

Know the anatomy of where the mm. are on a diagram

Fo sho

Tissue covering the superior surface of the condyle Tissue making up the disc

Fibrocartilage Dense fibrous CT

Which mm. are elevators? Which are depressors?

Temporalis, masseter, medial pterygoid Infrahyoid, suprahyoid, lateral pterygoid

What is the 1st Tx for severe muscle pain?

Home instructions (moist heat, relaxation, stretching, etc)

Sharp pain can be what?

Nerve or joint

Which type of pain is electric shock? What pain can be sharp? Muscle pain is normally...

Nerve only Nerve or Joint Dull

Migraine/neurovascular pain is usually perpetuated by what?

Pounding/heartbeat

Myofascial pain Myalgia Myositis Spasm

Referred Muscle (not referred) Trauma Intense

Tooth w/ pain post-RCT, what should you do? | extraction, refer, topical...

Topical anesthetic

``` If the occlusion on a stabilization splint is balanced but the pain has recently increased w/ popping/locking, the next treatment: Balance the splint Add pivot Make the splint thinner Reposition forward with a flange ```

Reposition forward with a Flange *this is an Anterior Repositioning Device

How far forward do you bring an Anterior Repositioning Device? (forward w/ flange)

enough to where they aren't popping

A splint that tries to distract the condyle bilaterally but is not effective b/c of the position of the Masseter muscle is what?

Bilateral Pivot *never use

A splint that repositions the Mandible forward to relieve pressure on the posterior attachment

Anterior Positioning Appliance *for some reason referred to as the forward w/ flange

A splint that has been shown to successfully reduce clenching pressure and masseter pain but is NOT appropriate for relieving joint pain

Anterior Bite Appliance/NTI *also relieves headaches

A splint that creates even contact, covers all the teeth, and relieves both joint and muscle conditions?

Stabilization Appliance *aka nightguard, CR appliance

``` Tx of long term, with normal Tx, w/o response, you should: put on opioids re-assess diagnosis Surgery Ortho ```

Re-assess *very difficult, most practitioners take Dx and try different Tx for it

What tests diagnose Superior Capsulitis?

????? WTF?????

What class of meds do we use for joint/tendon pain?

Anti-inflammatories

Migraine meds can be Beta blockers, ending in... and which 2 Anticonvulsants?

LOL Topomax, Depicote

Powerful Narcotics can be used for ____ days side effect:

3-14 days Constipation

Powerful Narcotics can be used for ____ days side effect:

3-14 days Constipation

Name 5 muscle relaxants to Tx Muscle Pain:

Flexeril Zanaflex Skelaxin Baclofen Robaxan

3 meds for Non-blockable/sympathetically blockable Neuropathic Pain

Elavil (amitriplyline) Pamelor (nortryptyline) Alpha blockers (Clonidine, Prazocin, Hytrin)

Neuropathic pain can be treated with Lidocaine

True

6 meds for Blockable Neuropathic pain: note: combos also used

Tegretol (carbamzepine) Liorisal (Baclofen) Depakote (Valproate) Dilantin (Phynytoin) Konopin (Clonazepam) Topomax

11 meds for Neuropathic Pain:

Tegretol Depakote TCA's Gabapentin (Neurontin) Baclofen Hytrin/minipress Gabatril Topamax Trileptal Lamotrigine Dilantin

11 meds for Neuropathic Pain:

Tegretol Depakote TCA's Gabapentin (Neurontin) Baclofen Hytrin/minipress Gabatril Topamax Trileptal Lamotrigine Dilantin

Abortive migraine meds include what class? his fave Beta Blocker: Ca channel blocker: 2 anti-convulsants: SNRI w/ TCA:

Triptans Inderal (lol) verapamil topamax, depakote pemelor

Abortive migraine meds include what class? his fave Beta Blocker: Ca channel blocker: 2 anti-convulsants: SNRI w/ TCA:

Triptans Inderal (lol) verapamil topamax, depakote pemelor

What is the best/most specific imaging for disc/TMJ

MRI

If a jaw deviates to one side, it is joint and...

ADD w/o reduction

Whiplash causes TMD

yes

NTI is for

Myalgia

Pt has popping/locking, what splints?

Anterior repositioning Unilateral splint w/ flange

CR to CO slide greater than _____, TMJ problem

over 2mm

soft end feel: hard end feel:

pry open, goes more (Muscle) pry open, goes no further (ADD w/o reduction or coronoid locked over zygoma)

What kind of pain can refer?

Myofascial

Temporalis trigger points: Masseter: SCM: Trap/posterior cervicalis: Lat Pterygoid:

Mx ant, PM's, molars ear, lower molars, above rt eye ear, above eye, eye, occiput temple, ear, eye zygoma, TMJ, eye

Intrinsic TMJ ligament: 2 Extrisics:

Temporomandibular Stylomandibular, Sphenomandibular

Stylomandibular: Sphenomandibular: Temporomandibular:

Styloid process, angle Mn Spine of sphenoid, Lingula prevents Mn from being pushed back

Condyle articulates in what zone?

Intermediate

measurements: Posterior zone: anterior zone: intermediate zone:

3mm 2mm 1mm

Most TMD cases are both joint and muscle

True

Stabilization appliances reduce forces by ___% but do not increase _____

70% joint space

Stabilization appliances reduce forces by ___% but do not increase _____

70% joint space

What type of movement pain is Joint?

Closing

___% of the population has 1 sign __% has 1 symptom __% needs Tx

75% 33% 5-7%

__% pts in office will have non-tooth related pain

40%

rotation: sliding/displacement:

inferior superior

Lateral ROM: Protrusion: opening:

10-12mm 8-10 mm over 40 mm

Use pain meds for migraine

false

use propanolol/beta blockers/inderall for nerve pain

False *migraine only

Tegretol/carbmazeinipine is not used for what? used for?

Migraine trigem neuralgia *this is an anticonvulsant

What splint for Superior Capsullitis? What splint for Posterior Capsulitis? Use bilateral pivot for what?

unilateral pivot anterior repositioning splint/unilateral w/ flange never

A lateral slide of more than ___mm is significant

2mm

Anterior bruxing, anterior open bite, sudden changes in occlusion cause TMD

False *all PREDISPOSE

Penny: Best bone image: best for soft tissue:

CT (not x-ray) MRI