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Occlusion and Mastication > TMD - Temporomandibular disorders > Flashcards

TMD - Temporomandibular disorders Flashcards

1
Q

What is the definition for Temporomandibular disorders (TMD)

A

A group of conditions affecting the temporomandibular joint and/or the muscles of mastication

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2
Q

Are TMD’s more common in females or males?

A

females

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3
Q

what is the prevalence of TMD in the population?

A

10-15% of the population

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4
Q

what age range is the peak incidence of TMD

A

18-44

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5
Q

When taking a TMD history, what questions would you ask about pain?

A
  • What is the character of the pain? Persistant background aching pain, free from pain apart from in function, short lived sharp pain
  • Where is the pain? Jaw, ear, in front of the ear, temple?
  • What affects the pain? Jaw movement, function (eating, talking etc), para function (grinding teeth)
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6
Q

What are parafunctional habits?

A

Abnormal oral habits which negatively affect the oral cavity
Thumb sucking, grinding, mouth breathing, nail biting etc

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7
Q

What noises are you looking for in a TMD history?

A

Clicking, snapping, popping, crepitus (grinding, crunching)
noises present on jaw movement
in the past 30 days prior to appointment

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8
Q

What is crepitus?

A

Crepitus is a crackling, crunching, grinding, or grating noise that occurs when a joint is flexed.

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9
Q

What questions about movement are you asking in a TMD history?

A

Any restriction opening
Interfering with ability to eat
Locking - intermittent or persistent?, Open or closed lock? able to release with manoeuver?

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10
Q

What is an open and closed locked jaw?

A

open - jaw is locked with jaws apart and cannot close past a certain point
closed - jaw cannot open past a certain point

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11
Q

What habits are you asking about in a TMD history?

A

clenching
grinding
chewing/biting habits
musical instruments
singing

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12
Q

What are the co-morbidities that may be involved with TMD

A

Fibryomyalgia
chronic pain
psychological factors (stress, anxiety, depression)

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13
Q

How can fibryomyalgia impact TMD?

A

likely to increase susceptibility to TMD becoming a chronic condition

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14
Q

How do you carry out an examination of the lateral poles of TMJ?

A

Stand behind the patient and locate the TMJ by asking patient to open and close
Ask if there is any pain of tenderness
Ask the patient to open and close their mouth 3 times and report any feelings of discomfort, any familiar pain?
3 repetitions each of opening, closing, lateral, protrusive movements
Feel for any clicking, popping, snapping, crunching, grinding noises

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15
Q

How do you palpate the temporalis muscle?

A

Stnd behind the patient
ask the patient to clench their teeth together and feel just above the ear towards the eye
Does the palpation elicit the patients familiar pain?

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16
Q

How do you palpate the masster?

A

stand in front of the patient
bimanual palpationPalpation of the masseter muscle
- You stand in front of the patient
- Bimanual palpation
- Place two fingers inside the patient’s cheek and two fingers outside the patients cheek
- You can ask the patient to clench their teeth together to check you have located the masseter muscle accurately
- Then you ask them to open their mouth very slightly to relax the muscle
- You will palpate at its origin, midpoint and insertion
Remembering when palpating these muscles to ask the patient when they experience then pain and if it’s the familiar pain

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17
Q

How do you assess mouth opening?

A

Check for any deviation on opening
Asses the extent of opening
- record maximum unassisted opening and assisted opening (using a ruler)
- the normal is 40mm including the incisal overlap

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18
Q

What are you looking for when assessing the intra-oral soft tissues?

A

the presence of ridging buccal mucosa at the level of occlusal plane
scalloping of border of tongue - both suggestive of an active parafuncitonal habit (clenching, grinding, tongue thrusting)
Tooth wear

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19
Q

What investigations would you carry out for suspected degeneritive changes of the TMJ?

A

cone beam CT of TMJ

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20
Q

What investigations would you carry out for suspected disc displacement?

A

MRI

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21
Q

What are the 2 main classifications for TMD diagnosis?

A

Pain related TMDs
Intra-articular TMDs

22
Q

What are the subtypes of Pain related TMDs?

A

Myalgia
Arthraligia

23
Q

What are the subtypes of Myalgia?

A

Local myalgia
Myofascial pain
Myofascial pain with referral

24
Q

What is the subtype for Arthralgia?

A

Headache related to TMD

25
Q

What is the description for Myalgia?

A

Pain of muscle origin, affected by jaw movement, function or parafunction
AND
Replication of this pain on provocation testing of the masticatory muscles (palpation of temporalis and/or masseter)

26
Q

What would present in a history of a patient with myalgia?

A

Pain in jaw, temple, in front of the ear or in the ear
AND
Modified with jaw movement, function or parafunction

27
Q

What would you find in an examination for a patient with myalgia?

A

Confirmation of pain location(s) in the temporalis or masseter muscle
AND
familiar pain in masseter or temporalis muscle with at least one of the following provocation tests:
- palpation of temporalis or masseter muscle
- maximum unassisted or assisted opening movements

28
Q

What would your diagnosis be if the patient has pain in the temporalis and/or masseter muscle when palpated or on opening?

A

Myalgia

29
Q

What is local myalgia?

A

muscle pain localised to the site of palpation

30
Q

What is myofascial pain?

A

The muscle pain extends beyond the site of palpation, but remains within the boundaries of the muscles being palpated

31
Q

What is myofascial pain with referral?

A

On palpation the pain extends beyond the boundaries of the muscle being palpated

32
Q

What is the description of arthralgia?

A

Pain of joint origin
In dental terms
affected by jaw movement, function or para function and replicated by provocation testing of the TMJ

33
Q

What history would a patient with arthalgia present?

A

Pain in the jaw, temple, ear or in front of the ear in the past month
and the pain is modified with jaw movement, function and parafunction

34
Q

What is the difference between myalgia and arthralgia?

A

myalgia - pain of muscle origin
arthralgia - pain of joint origin

35
Q

On examination, what would a patient with arthralgia present with?

A

Confirmation of pain location in area of TMJ(s)
and familiar pain on palpation of the lateral pole or familiar pain on maximum unassisted or assisted opening, right or left lateral or protrusive movements

36
Q

What are the subtypes of intra-articular TMDs?

A
  • Disc displacement with reduction
  • Disc displacement with reduction with intermittent locking
  • Disc displacement without reduction with limited opening
  • Disc displacement without reduction without limited opening
  • Degenerative joint disease
  • Subluxation
37
Q

What is the description for disc displacement with reduction?

A

The disc is anterior to condyle head and moves back to correct positioning on opening
Often appears with clicking, popping, snapping noises

38
Q

What history would a patient with disc displacement with reduction present with?

A

History of ‘noise’ in the past 30 days on movement/function
or patient reporting with any noise during examination

39
Q

On examination, how may a patient with disc displacement with reduction present?

A

Noises during opening AND/OR closing movements on palpation during at least one of three jaw openings
and closings
and
noises during at least one of three repetitions of left or right lateral or protrusive movements

40
Q

What is the description of disc displacement without reduction with limited opening?

A

the disc does not reduce with opening (remains anterior to condyle head)
persistent limited mandibular movement which does not reduce when the patient or clinician performs a manoeuvre - closed lock

41
Q

What history would a patient with disc displacement with reduction present with if they have disc displacement without reduction?

A

jaw locked so that the mouth would not stay open all the way
limitation in jaw opening significant to limit jaw opening and interfere with ability to eat

42
Q

on examination how would a patient without reduction with limited opening present?

A

maximum assisted including (passive stretch) movement <40mm including vertical incisal overlap

43
Q

What is the description of degenerative joint disease?

A

A degenerative disorder involving the joint characterised by deterioration of articular tissue (cariliadge) with concomitant osseous changes in the condyle and/or articular eminence

44
Q

what history would a patient with degenerative joint disease present with?

A

history of ‘noise’ in past 30 days on jaw movement or in function
or
patient report of any noise during examination

45
Q

On examination how would a patient with degenerative joint disease present?

A

Crepitus detected with palpation during at least one of the following: opening, closing, right or left lateral movements or protrusive movements

46
Q

What is the description for subluxation (open lock)?

A

A partial dislocation of the jaw
- hypermobility disorder involving the disc condyle complex and the articular eminence
- when the mouth is open the condyle complex is anterior to the articular eminence and is unable to return to a normal closed position without a manipulation manoeuvre
- if the patient can manoeuvre the joint back into position = subluxation
- if assistance of clinician is required = luxation (true dislocation)

47
Q

What history would a patient with lubluxation present with?

A

In the past 30 days, experiencing jaw locking or catching in a wide mouth open position (even momentarily) - so couldnt close their mouth
without a manipulative manoaurvre

48
Q

On examination how would a patient with subluxation present

A

no examination findings required but if disorder present at time of clinical examination then:
Inability to return to a normal closed mouth position from a wide open position without the patient performing a manipulative manouevre

49
Q

What conservative management can be done for TMDs?

A
  • rest and relaxation
  • modify diet
  • avoid wide mouth opening
  • regular application of gentle heat (chronic conditions)
  • regular application of cold pack (acute onset pain and/or restricted mouth opening)
  • jaw exercises
  • NSAIDs e.g. ibuprofen if not contra-indicated 14 day course
  • Muscle spasm or disc displacement without reduction with limited opening = diazepam 5 day course
50
Q

When would you refer a TMD case?

A
  • chronic TMD symptoms lasting for more than 3 months
  • persistent or worseneing symptoms despite primary care treatment
  • an uncertain diagnosis
  • marked psychological distress associated with symptoms and/or occlusal preoccupation (persistent hyperawareness or hypervigilance of their bite)
  • unexplained persistent pain or chronic widespread
51
Q
A

Occlusion and Mastication (5 decks)

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