TMJ Pain Flashcards
What pain hx should take TMJ pain?
Use SOCRATES
Ask pt to point to where pain coming from
Severity of pan
Where is true TMJ pain felt?
Preauricular area
Where is myofascial pain more likely to be felt?
Pt will point to cheek, May talk about radiation to temporalis
What is expected characteristic of myofascial pain?
Chronic dull ache
What does early morning pain suggest?
Nocturnal bruxing habits
What question ask if clicking?
Is it during opening or closing of mouth
What is different between locking in closed or open position
Closed lock suggest meniscal displacement
Open lock suggest dislocation
What is an important question to ask TMJ patients (relevant for provision of restorative care)
If any limitation in mouth opening
What parafunctional habits should ask Pt about?
Bruxism, clenching, chewing pens, biting nails or chewing gum
What questions would you ask to see if musco-skeletal cause?
Any hyper mobility pathologies - Ehlers-Danlos (lead to recurrent dislocation)
Any arthritis - osteo/ rheumatoid/ juvenile
What question ask if dislocation?
When/ how many times
Did pt manipulate self or go to hospital?
Why is asking about occlusion important?
AOB can develop secondary to condylar pathology
What are 3 main things to remember when examining for TMJ?
Look
Feel
Move
What should look for during TMJ exam?
Facial asymmetry
Swelling
Enlarged massetr
What should look for IO during TMJ exam?
Signs occlusal wear
Scalloping/ linea alba on buccal mucosa
Check stability of bite
Deviation on opening
What should feel for during TMJ exam?
Palpate TMJ for tenderness and clicking
Palpate massester/ temporalis for tendrness
What should move during TMJ exam?
Measure mouth opening
Check lateral excursions
Record as can use as comparison
What would diagnosis be if LHS clicking and pain worse in morning?
TMJD of predominantly myofasial component
How to explain TMJD?
Explain, this and in particular myofascial pain is often a chronic condition. Explain that stress can lead to clenching/ nocturnal bruxing
General management of TMJD?
Symptom control
Rest
Stress management
How control symptoms in TMJ?
NSAID - oral or topical (not for long-term use)
Heat/ cold packs
Massages
Who should NSAIDs not be used in?
Asthma
Gastric ulcer
Renal impairment
Allergy
Pregnancy
What are local measures that can be done?
Rest jaw
No habits - avoid biting nails/ pens/ chewing gum
Stress management
What does clicking w/o locking suggest?
Anterior meniscal displacement w/ reduction
How to manage true disc displacement?
Fabrication occlusal splint - generally for lower teeth
Advised to wear nightly
What is best design of occlusal split for disc displacement?
Splint for lower teeth
Bite raising appliance to reduce load on tissues around muscles
Difference between splint and mouth guard?
Splint made hard acrylic and covers occlusal surface of teeth
Mouth guard soft acrylic and covers crown and gignvae
When refer?
Ref to OS/ maxfax if symptoms > 3 months or not responding tx in primary care
