TMJ Disorders Flashcards
Who wrote an article in 1934 that associated TMD issues to ear pain, tinnitus, ear fullness, and swallowing difficulty?
James Costen
What are the Common Symptoms of TMD?
- Joint Pain
- Headache
- Earache
- Face pain
- Limited or asymmetric jaw movement
- Joint sounds
•A collective term embracing a number of clinical problems that involve the masticatory musculature, the TMJ, or both
TMD
Costen presumed the cause of TMD to be changes in the dental condition mainly due to ______
tooth loss
_____ nerve Runs just posterior to the mandibular condyle.
auriculotemporal nerve
Loss of _____ caused pressure to be placed on the auriculotemporal nerve, due to erosion of the of the glenoid fossa, and thinning of the tympanic plate of the temporal bone.
VDO
In what time period were these things true?
•Only a few dentists were interested in managing these pain problems
•Most common therapies were bite raising appliances which were first suggested and described by Costen
1930s and 40s
In what time period were these things true?
•Dental profession begins to question the effectiveness of these appliances
•Dentists became more interested in treating these problems
•Dentists begin to implicate occlusal interference as the major etiologic factor
•This led to equilibrations to attempt to achieve optimal occlusion
•BB McCollum and Charles Stuart
1940s and 1950s
In what time period were these things true?
•Scientific Investigation began•Used EMG to attempt correlation
•electromyography (EMG) measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle. During the test, one or more small needles (also called electrodes) are inserted through the skin into the muscle.
•Role of Occlusion in TMD gained in popularity
1950s
In what time period were these things true?
•More scientific investigation into TMD and there are more opinions as to the cause became evident
1960s
What were the 4 major etiologic factors in the 1960s of TMD?
- Occlusal factors
- Interferences
- Prematurities
- Emotional Stress
________ measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle. During the test, one or more small needles (also called electrodes) are inserted through the skin into the muscle.
electromyography (EMG)
In what time period were these things true?
•Advances in Imaging Techniques
•Tomography
•Arthrography
•Computer Tomography
•Magnetic Resonance Imaging (1980)
•Resulted in Improved Visualization of Intracapsular structures
1970s
In _______, The disc is visualized between the joint compartments after they are filled with contrast media. The shape and position of the disc are first assessed in a closed mouth position. Deformity of the disc can range from slight to extensive. The sagittal projection allows assessment of anterior disc displacement in relation to the condyle. Uses dye
Arthrography
_____ is an invasive method and requires the use of ionizing radiation. Making a reliable diagnosis regarding sideway disc displacement without CBCT examination is difficult. Fluid injection into the joint can impair joint function during the examination
Arthrography
In case of _______ injections, transient increase in pain (steroid flare), mild headache and facial flushing can occur. Patients with diabetes can experience a short spike in blood glucose level.
corticosteroid
In what time period were these things true?
•Early during this time period, the profession looked at capsular disorders as the main problem.
•Surgeons began to remove the disc and place silane prosthetic discs.Huge failures with these. Many were done here at UMKC.
•Late during this time period, the profession felt capsular problems were not the only cause
1980s
In what year did ADA hold a conference on examination, diagnosis, and management of TMD
•Recognized some patients developed a lingering chronic painful illness with unpredictable treatment response
1982
In what year was there a Workshop held by ADA
•Resulted in guidelines for the profession including:
•Established educational guidelines
•Clinical diagnostic criteria
•Research diagnostic criteria
1989
UMKC in what year?
•Each department taught TMD differently
•Some departments would not speak to each other
•Oral Surgery still did silastic implants for TMD
•Oral Medicine was convinced that TMD was totally related to a patients emotional status. Would only do counseling for patients
2000
In what time period were these things true?
•New information on sleep studies become available to the profession
•Better imaging becomes available to aid in the diagnosis, the use of the CBCT makes the computerized tomography at the fingertips of the practitioner
2000s
In the year ______
•Sleep disorders come into more study.
•Treatment based on the use of conservative, reversible and evidence based therapeutic modalities
•Very bright, D1 students take class in Occlusion and Fixed Prosthodontics at UMKC
2020
Any clinical finding associated with a TM disorder. May not be reported by the patient.
TMD Signs
The following are some TMD \_\_\_\_\_: •Limited opening •Enlarged muscles •Deviated opening •Clicking •Crepitus (grinding joint noise) •Bite changes
signs
•Any sign of which the patient was aware and therefore reported
TMD symptoms
The following are some TMD \_\_\_\_\_: •Facial pain •Headache •Tinnitus •Ear fullness •Pain with function •vertigo
TMD symptoms
In Okeson’s study, 41% of populations studied reported at least one _____
symptom
In Okeson’s study, 56% showed at least one _____
clinical sign
Okeson estimates _____ % of population has some TM disorder
40-60%
Is there a cause and effect relationship proven to be an association between occlusion and TMD?
No
Signs that are present, but unknown to patents are called _______
subclinical
\_\_\_\_ study: •Examined 739 students aged 18-25 •76% had one or more signs •26% reported a symptom related to TMD •50% had signs not reported as symptoms •Signs that are present, but unknown to patents are called subclinical. •10% had symptoms severe enough to seek treatment •5% made up normal TMJ patients
Solberg study
Most TMD symptoms are reported in the _____ aged population.
20 to 40 age
Certain posterior contacts can increase the activity of the ______ muscles
elevator
In ______ occlusal contacts, all four muscles were active
Bilateral occlusal contacts
Eliminate balancing contacts, and only the _____ muscles were active
working side
Eliminate working contacts so that only the cuspid touches, then only the ______ muscle is active
temporal
How do occlusal interference affect muscle symptoms?
An occlusal interference becomes chronic
Muscle response is altered
The muscle tries to avoid the damaging contact
The muscle has an adaptive response
Muscle pain can develop
•Acute changes (such as a new crown high in occlusion) can result in a _____ response.
muscle pain
_____can lead to loading by muscles to the joint
•Orthopedic instability
What are the forms of treatment for TMD?
- Patient Education
- Analgesics
- Physical therapy
- Exercise therapy
- Splints
- Stabilization
- Repositioning
- Occlusal therapy
_____ activity of the masticatory muscles include chewing, speaking, and swallowing
Functional Activities of Masticatory muscles
_____ activity of the masticatory muscles include Clenching or grinding of the teeth
•Normally will occur on a subconscious level
Parafunctional activities
The following activities are examples of \_\_\_\_\_ activity occurring During the Day •Clenching •Grinding •Cheek, tongue biting •Finger thumb sucking
Parafunctional activity
The following activities are examples of _____ activity occurring during sleep
- clenching
- bruxism
Parafunctional activity
A diurnal or nocturnal parafunctional activity including clenching, bracing gnashing , and grinding the teeth.
Bruxism
The parafunctional grinding of teeth
•An oral habit consisting of involuntary rhythmic or spasmodic non functional gnashing, grinding or clenching of teeth, in other than chewing movements of the mandible, which may lead to occlusal trauma-called also tooth grinding, occlusal neurosis.
Bruxism`
Sleep related _____ is an oral activity characterized by grinding or clenching of the teeth during sleep, usually associated with sleep arousals.
bruxism
What are the 4 activities characterized by bruxism?
Clenching
Bracing
Gnashing
Grinding
- Occurs at night
- Force of clenching can exceed voluntary force on the teeth
- Causes severe wear of the teeth
Bruxism
Maximum clenching test averages _____ during the day between the max/man incisors.
62-85 lbs
Maximum clenching test averages ____ during sleep, _____x greater between the max/man incisors.
130-340 lbs; 2.2 to 4X
Maximum clenching test averages ____ between the molars during the day (when awake).
185 lbs
Maximum clenching test averages ____ between the molars during the night (when sleeping).
740 lbs
Characterized by a clenching type activity and is associated with psychosocial factors and a number of psychopathological symptoms.
Awake bruxism
What are the 4 etiologies of bruxism?
- Emotional stress
- Medications
- Predisposition to bruxing
- CNS disturbances
Do Occlusal Contact Patterns influence nocturnal bruxism?
No
Patient denied ever having his teeth in this relationship, but the wear facets match up
Cross over bruxism
