TMJ Pain

Question 1

What pain hx should take TMJ pain?

Answer 1

Use SOCRATES
Ask pt to point to where pain coming from
Severity of pan

Question 2

Where is true TMJ pain felt?

Answer 2

Preauricular area

Question 3

Where is myofascial pain more likely to be felt?

Answer 3

Pt will point to cheek, May talk about radiation to temporalis

Question 4

What is expected characteristic of myofascial pain?

Answer 4

Chronic dull ache

Question 5

What does early morning pain suggest?

Answer 5

Nocturnal bruxing habits

Question 6

What question ask if clicking?

Answer 6

Is it during opening or closing of mouth

Question 7

What is different between locking in closed or open position

Answer 7

Closed lock suggest meniscal displacement
Open lock suggest dislocation

Question 8

What is an important question to ask TMJ patients (relevant for provision of restorative care)

Answer 8

If any limitation in mouth opening

Question 9

What parafunctional habits should ask Pt about?

Answer 9

Bruxism, clenching, chewing pens, biting nails or chewing gum

Question 10

What questions would you ask to see if musco-skeletal cause?

Answer 10

Any hyper mobility pathologies - Ehlers-Danlos (lead to recurrent dislocation)
Any arthritis - osteo/ rheumatoid/ juvenile

Question 11

What question ask if dislocation?

Answer 11

When/ how many times
Did pt manipulate self or go to hospital?

Question 12

Why is asking about occlusion important?

Answer 12

AOB can develop secondary to condylar pathology

Question 13

What are 3 main things to remember when examining for TMJ?

Answer 13

Look
Feel
Move

Question 14

What should look for during TMJ exam?

Answer 14

Facial asymmetry
Swelling
Enlarged massetr

Question 15

What should look for IO during TMJ exam?

Answer 15

Signs occlusal wear
Scalloping/ linea alba on buccal mucosa
Check stability of bite
Deviation on opening

Question 16

What should feel for during TMJ exam?

Answer 16

Palpate TMJ for tenderness and clicking
Palpate massester/ temporalis for tendrness

Question 17

What should move during TMJ exam?

Answer 17

Measure mouth opening
Check lateral excursions
Record as can use as comparison

Question 18

What would diagnosis be if LHS clicking and pain worse in morning?

Answer 18

TMJD of predominantly myofasial component

Question 19

How to explain TMJD?

Answer 19

Explain, this and in particular myofascial pain is often a chronic condition. Explain that stress can lead to clenching/ nocturnal bruxing

Question 20

General management of TMJD?

Answer 20

Symptom control
Rest
Stress management

Question 21

How control symptoms in TMJ?

Answer 21

NSAID - oral or topical (not for long-term use)
Heat/ cold packs
Massages

Question 22

Who should NSAIDs not be used in?

Answer 22

Asthma
Gastric ulcer
Renal impairment
Allergy
Pregnancy

Question 23

What are local measures that can be done?

Answer 23

Rest jaw
No habits - avoid biting nails/ pens/ chewing gum
Stress management

Question 24

What does clicking w/o locking suggest?

Answer 24

Anterior meniscal displacement w/ reduction

Question 25

How to manage true disc displacement?

Answer 25

Fabrication occlusal splint - generally for lower teeth
Advised to wear nightly

Question 26

What is best design of occlusal split for disc displacement?

Answer 26

Splint for lower teeth
Bite raising appliance to reduce load on tissues around muscles

Question 27

Difference between splint and mouth guard?

Answer 27

Splint made hard acrylic and covers occlusal surface of teeth
Mouth guard soft acrylic and covers crown and gignvae

Question 28

When refer?

Answer 28

Ref to OS/ maxfax if symptoms > 3 months or not responding tx in primary care