TMJ Disorder Flashcards
what are some different names for TMJ dysfunction?
- TMJ dysfunction
- Myofascial pain dysfunction
- Pain dysfunction syndrome
- Facial arthromyalgia
- Costen’s syndrome
what is the blood supply of the TMJ?
deep auricular artery (branch of 1st part of maxillary artery)
what nerves supply the TMJ?
- auriculotemporal
- masseteric
- posterior (deep) temporal nerve
what part of the articular disc of TMJ is innervated?
area in the bilaminar zone
What are examples of degenerative diseases that cause TMD?
- osteoarthritis (localised)
- rheumatoid arthritis (generalised/systemic)
What are causes of TMD?
- myofascial pain
- disc displacement
- degenerative diseases
- chronic recurrent dislocation
- ankylosis
- hyperplasia
- neoplasia
- infection
What are the types of disc displacement that can cause TMD?
- anterior with reduction (disc returns to original place)
- anterior without reduction (disc does not return to original place, stuck in front of condyle permanently)
what are examples of neoplasia that can cause TMD?
- osteochondroma
- osteoma
- sarcoma
what is ankylosis of TMJ?
TMJ is totally fused to base of skull, no jaw movements
how does hyperplasia of TMJ present?
One condyle grows more than the other
- patients have a facial asymmetry
What is the pathogenesis of TMD?
- inflammation of MOM
- trauma of joint
- stress
- psychogenic
- occlusal abnormalities
Why might the muscles of mastication be inflamed?
parafunctional habits
What areas of social history may contribute to TMD?
- occupation
- stress
- home circumstances
- sleeping pattern
- relationships
- habits
what are some intra-oral signs of parafunctional habits?
- cheek biting
- linea alba
- tongue scalloping
- occlusal NCTSL
what are common clinical features of TMD?
- females > males
- age 18-30y/o
- intermittent pain of several months or years
- muscle / joint/ ear pain
- trismus/locking
- clicking popping joint noises
- headaches
- crepitus
what does crepitus indicatr?
late degenerative changes
what conditions are sometimes confused as being TMD?
- dental pain (third molars)
- sinusitis
- ear pathology
- salivary gland pathology
- referred neck pain
- headache
what reversible treatment is involved in treating TMD?
- patient education
- physical therapy
- medication
- splints
what medications are used to treat TMD?
- NSAIDs
- muscle relaxants
- tricyclic antidepressants
- masseter botox
- steroids
What advice would you give to a patient with TMD to help improve their condition?
- reassurance
- soft diet
- masticate bilaterally
- no wide opening
- no chewing gum
- don’t incise foods
- cut food into small pieces
- stop parafunctional habits
- support mouth on opening (e.g yawning)
what are some examples of physical therapy that may be used to help treat TMD?
- physiotherapy
- massage/heat
- acupuncture
- relaxation
- TENS
- hypnotherapy
what types of splints may be used to treat TMD?
- bite raising appliances
- anterior repositioning splints
what is a specific name of splint that can help TMD by raising the bite?
Wenvac splint
what irreversible treatment is sometimes involved in treating TMD?
- occlusal adjustment (rare!)
- TMJ surgery
what different types of TMJ surgery are there?
- arthrocentesis
- arthroscopy
- disc-repositioning surgery
- disc repair/removal
- high condylar shave
- total joint replacement
How might patients with internal derangement of the TMJ present?
painful clicking of TMJ
what is the most common cause of TMJ clicking?
anterior disc displacement with reduction
Explain the movement involved in anterior disc displacement with reduction?
- disc initially displaced anteriorly to the condyle during opening
- as jaw opens, condyle slides down but is blocked by this disc
- patients will hear a loud pop (painful usually) and this is the disc slipping back behind condyle
- jaw now free to move normally
what are the signs/symptoms of anterior disc displacement with reduction?
- jaw tightness/locking
- mandible may initially deviate to affected side before returning to midline
What can happen if anterior disc displacement with reduction is left untreated?
it can eventually progress to osteoarthritis
