TMJ Lecture

Question 1

What is facial arthromyalgia?

Answer 1

TMJ pain

Question 2

What are the types of Chronic Primary Oro-facial pain?

Answer 2

• TMJ pain (facial arthromyalgia)
  -Atypical facial pain (PIFP)
  -Burning mouth syndrome
  -Atypical odontalgia (PDAP)

Question 2

What is the most common chronic primary oro-facial pain?

Answer 2

TMJ pain (facial arthromyalgia)

Question 3

The ICD-11 classification of chronic pain 2019 mentions pain present for how long?

Answer 3

Pain present for 3 months or longer

Question 4

The ICD-11 classification of chronic pain 2019 has what 2 types of significant impairment? And give examples.

Answer 4

Have significant functional and emotional
impairment

E.g. depression, anxiety, increase frustration or
anger that may interfere with everyday living

Question 5

What is the 2020 Revised Definition of Pain?

Answer 5

An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.

Question 6

Define Nociplastic Pain

Answer 6

Nociplastic pain is defined by the IASP as “pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain”

Question 7

In the Biopsychosocial model, name Axis 1 and Axis 2.

Answer 7

• Axis 1 – physical signs and symptoms
• Axis 2 – psychosocial symptoms

Question 8

List the things needed in a structured history.

Answer 8

• Site, descriptors
• Duration, Pattern, exacerbating / relieving factors
• Psychosocial history
• Co-morbidities

Question 9

What are the 5 questions involved in the Trismus checklist?

Answer 9

• Opening less than 15mm and progressively worsening
  -Absence of a history of clicking
  -Pain of non-myogenic origin (e.g. neuralgia)
  -Swollen lymph glands
  -Suspicious intra-oral soft tissue lesion

Question 10

What is the management when the answer is ‘yes’ to the options in the trismus checklist?

Answer 10

Refer to OMFS for urgent assessment

Question 11

What is intra-articular joint disorder?

Answer 11

disc displacements with / without reduction and with / without locking

Question 12

Name a type of degenerative joint disorder?

Answer 12

osteo /rheumatoid arthritis

Question 13

Give examples of pain related TMD and headaches

Answer 13

myalgia,
myofascial pain,
headache attributed to TMD,
arthralgia

Question 14

Describe the full SOCRACTES related to TMJ

Answer 14

• Site – TMJ, muscles of mastication, within the ear
• Onset – Can be sudden or gradual
• Character – aching, deep, continuous with potential acute flare-ups
• Radiation – to ear, angle of jaw, temple, teeth
• Associations and alleviating factors – rest, analgesia may help, dynamic movements worsen
• Time course – can worsen through the day or night but often continuous
• Exacerbating factors – chewing, yawning, prolonged mouth opening
• Severity - variable

Question 15

Give 4 examples of TMD Mis-Diagnoses

Answer 15

• Otalgia – mainly by GMPs due to overlap of signs and symptoms
• Toothache – upper molars (temporalis
  attachment)
• Persistent idiopathic facial pain (PDAP)
• Acute and chronic maxillary sinusitis

Question 16

Name the 4 types of ways that TMJ problems can affect patients

Answer 16

• Work
• Financial
• Social (eating, talking)
• Sleeping

Question 17

Give 4 Consequences for dentist- TMJ problems

Answer 17

• Time without financial benefits
• Frustration
• GPs took ownership and keen to manage but unsure how
• Lack of communication between GPs and Dentists

Question 18

Describe the 4 Steps of Patient Intervention in the Guided Self-Management Approach

Answer 18

• Step 1- What is “managing my chronic
  orofacial pain” all about? - Education
• Step 2- Understanding how the pain is
  affecting me
• Step 3- My programme – physical / psych self-regulation
• Step 4- Continuing to manage my pain

Question 19

How does patient centred interviewing work?

Answer 19

1. Need Diagnosis
2. Establish impact
3. Set Target Goals
4. Relapse Prevention and Discharge

Question 20

Describe the flow chart to reverse the TMD habit

Answer 20

Diagnose
Identify Habits / Pain Triggers
Reversal of Habits / avoidance of triggers
Relapse Prevention and Discharge

Question 21

Give some examples about Physical Self-Regulation in TMJ disorders

Answer 21

• Soft diet, avoid activities that involve wide opening (yawning) until pain reduction
• Clenching and grinding reversal - techniques
• Massage of muscles and / or heat / cold
  packs
• Posture control – sleeping on back

Question 22

What is the difference between myalgia vs myofascial pain?

Answer 22

Myalgia= pain within muscles

Myofascial = pain can radiate outside muscles (musculoskeletal system), can also affect thin connective tissue around them