TMD OMG Flashcards
Unilateral Splint
*brings one side down
Pivot Splint
Migraine Headach is hereditary, has multiple triggers, and is Hypersensitivity of what?
Trigeminal Nerve
Trigeminal nerve pain associated with TMD is highly associated with what hereditary hyperexcitability disorder?
Migraine
A Pivot Splint creates a teeter totter effect side to side that can pull down the ________ on one side to alleviate ________
Condyle
Capsulitis
Anterior Repositioning Appliance does what?
Treats what?
Moves jaw forward
Posterior capsulitis/locking on the disc
De-afferentation pain
Phantom pain
What kind of test can we do to determine Nerve Pain location?
Topical anesthesia
What is the most common type of headache?
*gets better w/ activity
Tension
*migraine does NOT get better w/ activity
Use peripheral topical anesthetic for…
This wouldn’t help for…
Topcal =
Peripheral nerve pain
Abscess tooth
Nerve pain
Which muscle would limit side to side movement?
Lateral Pterygoid
Severe unilateral orbital headache that makes you want to bang head against the wall
*more men
Cluster headache
Nerve pain is more likely to be what type?
Sharp, shooting, electric
Infection pain is more likelyto be…
Dull, achy
Drug class that can Tx Migraine AND Nerve pain:
Tricyclic antidepressants
Cutaneous allodynia
Light touch pain associated w/ Migraine
5 Tx’s for TTH (tension type headaches)
PT
Antidepressants (tricyclics)
Muscle relaxants
Biofeedback
Trigger point injections
3 Tx’s for Migraines:
Reduce triggers
Reduce body response to triggers (biofeedback/meds)
Abortive (meds/interventions)
Topomax used for what?
Why?
Migraine
Anti-convulsant
What drug is good at stopping Migraines?
Triptans
4 Prophylactic Tx’s for Migraines:
Amitriptlyline
Beta Blockers
Ca channel blockers
Clonidine/coproheptadine/methysergide/naproxen
4 abortive Tx’s for Migraine:
Ertgotamine (caffeine)
Ergotamine derivatives
Isometheptene
Sumatriptan
Symptomatic relief for Migraines can be from aspirin, acetaminophen, codeine, etc
True
Beta Blockers can be used for Migrain and Nerve pain
False
***migraine only
What is the only anti-seizure med to Tx migraine?
Topomax
Triptans are a _______ therapy for Migraines
They are not a _____ med
Abortive
Pain
Hormones, CO, sensory overload, foods/beverages, drugs, stress, etc
Triggers for Migraine
Tx for TTH (tension type headaches)
PT
Biofeedback
TCA, trigger point injections
Muscle relaxants
Tx for Migraine
Reduce all triggers
Reduce body’s response to triggers (biofeedback, meds)
Abortive Tx’s. (meds/interventions)
If you have more than ____ migraines/month, consider Prophylaxis
6/month
3 categories of pharmacologic relief for migraines
*for test, should be able to name some in each category
Prophylactic
Abortive
Symptomatic
Large, myelinated, tactile, proprioceptive nerve types:
A alpha
B beta
A gamma
Small myelinated, pain pricking, touch warmth, cold
Nerve types
A delta
Unmyelinated, pain, burning, itch, warm, cold nerve type
C
5 comorbidities of Sleep Apnea
Overweight
Snore
Large neck (15/17)
Always tired
Persistent headaches w/ no obvious cause
TTH must have 2 of what 3 symptoms?
Non-pulsating pressing/tightening
Bilateral
Physical activity doesn’t aggravate
Nausea/vomiting and photophobia aren’t associated with what type of headache?
TTH
TTH have no evidence of organic disease and is fewer than 15 days/month
True
Migraine w/o aura lasts how long?
Location?
Quality?
Aggravated by what?
4-72 hours
Unilateral
Pulsating
Physical activity
Migraine WITH aura, headache is preceded by 1 symptom that is Visual (3):
Or sensory (4):
Scintillating scotoma, Fortification spectra, Photopsia
Paresthesia, numbness, unilateral weakness, speech disturbance (aphasia)
If topical doesn’t work, you might have Neuritis, Traumatic neuralgia, and Neuroma
True
Beta blockers are used for Migraine but not ________
Nerve pain
*otherwise, similar Tx
4 “favorite” drug used for Migraines:
Inderal 20 mg
Verapamil 40 mg
Pamelor (TCA, Na blocker, noradrenergic, seritonergic)
Topamax 15 mg
Cluster Headache is ______ and lasts _______
And has 1 of the following: conjuctival infection, facial swelling, lacrimation, miosis, nasal congestion, ptosis, rhinorrhea, eyelid edema
Unilateral, 15-180
Develops most often in women in menarche or early 20’s
Occurs at the time of menstruation for ____% of female sufferers
Affected by the life cycle events and therapeutic interventions and historically it is difficult to Tx
Menstrual Migraine
60%
True
5 diagnostic Red Flags for Headaches:
Rash/meningeal signs/fever
After 50
HIV/cancer
Worsening pain
Focal neurologic disease
What is the most accepted theory on migraine pathogenesis?
Neurovascular
People w/ certain types of untreated malocclusion are more likely to develop TMD
What types of occlusion predispose to TMD?
False
Vertical/horizontal overjets greater than 3mm
Lateral slided greater than 3mm
If you get an Aura, this is always migrain
True
*never TTH
Cluster headache will often wake you up in middle of night
True
Sinus headache is really rare, when is the only time you get?
Fever, gunk coming out of nose
People with excessive incisal guidance or no incisal guidance are more likely to develp TMD
False (this is a myth)
The only 2 Anticonvulsants used for migraines:
Others used for nerve pain
Depicote
Topamax
As dentists you can prescribe these things for Migraines as long as you are competent
True
People with gross maxillomandibular skeletal disharmoniesa are more likely to develop TMD
Modification…
False (myth!)
Can but are NOT more likely to predispose to TMD
Pivot is the Teeter-Totter effect, pulls down and is for what disorder?
Lateral
Sometimes tinnitis can be addressed by making a splint than moves the condyles forward
True
Pretreatment radiographs of both TMJ’s should be taken to determine the position of the condyles/fossae, and ortho Tx should be directed toward getting condyles in concentric relation to their fossa
False (myth)
***Ortho Tx is Contraindicated, remember
Ortho Tx, when properly done, usuallly reduces the likelihood of subsequently developing TMD
False (myth)
*doesn’t cause, doesn’t cure
Finishing ortho cases according to specific functional occlusal guidelines will reduce the likelihood of developing TMD
False (myth)
The use of certain traditional procedures (bicuspid extraction, incisor retraction) or appliances (headgear, chin cups, class II elastics) may increase the likelihood of developing TMD
False (myth)
Although, devices CAN aggravate pre-existing TMJ condition
Adult pts who have concurrent TMD symptoms and some form of occlusal “problem” require some type of occlusal correction in order to get well and stay well
False (myth)
The retrusion of the mandible b/c of natural causes (deep overbite, distalizing occlusal contacts) or iatrogenic procedures (chin cups, incisor retraction, retention during growth spurts) is a major factor in the development of TMD
False (myth)
Distalization of the mandible causes articualr disks to slip forward off the condyles, resulting in internal derangements, especially clicking
False (myth)
***comment: Posterior condyle position Predisposes for anterior disc displacement with reduction but not for pain/arthritic changes
Posterior/distalization of the mandible predisposes for what?
but not for what?
anterior disc displacement with reduction
pain/arthritic changes
Controlled studies fail to demonstrate any association between _______ and TMD signs/symptoms
However, new research indicates a ____% relationship
occlusal interferences
15%
TMD conditions, other than condylar auto-repositioning secondary to intracapsular arthrosis, are not associated with any _______
However, slides greater than ___mm are significant
slide length or assymetries
3mm
Occlusal guidance patterns are not associated with TMD symptom provocation or conversely health
True
Parafunction appears to be universal and is not associated with TMD development or symptomology in healthy individuals
With what exception?
True
Anterior bruxing is a Predisposing factor
Sudden changes in occlusion can often cause TMD
True
*like a crown
Dental attrition is not associated with TMD, with what exception?
Anterior Bruxism
4 Parameters of Normal Occlusion:
Neutral
No anterior open or crossbite
Overjets less than 5mm, Slides less than 2 mm
No notable attrition
Parameters of Occlusion for TMD prediction in patients
*3 things
Anterior Open Bite
over 2mm slides, over 5mm overjet
5 or more missing/unreplaced Posterior Teeth (excluding 3rd Molars)
Morphologic malocclusion is often a consequence of TMD
However,
False
intracapsular TMJ diseases
There is no evidence for Prophylactic TMD Tx
There is no evidence for Phrophylactic occlusal therapy
True
True
Occlusal factors explain only a small part of TMD, contributing ___%
Etiologic interpretations can’t be drawn from prevalence based models
Isolated single occlusal variables have little predictive value
TMD requires multiple sets of multifactorial models and factor combos are disease specific
15%
True
True
True
Stabilization appliance is a Nightguard
True
What 3 adverse effect do all appliances have?
Caries
Soft tissue health
psychological dependence
Anterior positioning appliance does what?
pulls forward
Anterior Bite appliance, aka NTI, disoccludes where?
This has what 4 adverse effects?
Posterior
Anterior open bite from Posterior eruption, increase joint loading, ant mobility, aspiration
NTI =
also used for what?
Anterior Bite Appliance
migraines
Posterior Bite Appliance has what 2 potential Adverse effects?
intrusion of posterior teeth
change in condylar position
A pivot appliance may _____ the pivot tooth
Intrude
Resilient appliance is a protective Athletic appliance than may have what 2 adverse effects?
increase bruxisim
irritate soft tissue
Distraction appliance increases discal space/recaptures displaced disc and may _____ the teeth
Intrude
Appliance that may irritate soft tissues and not last long
Hydrostatic appliance
