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DMOP > TMJ PATHOLOGY & DIAGNOSIS > Flashcards

TMJ PATHOLOGY & DIAGNOSIS Flashcards

1
Q

OROFACIAL
PAIN PREVALENCE
* –% of general population
reported pain in the head,
face or neck. (1)
* –% reported facial pain in the
previous 6 months (2)
* –% reported headaches in
the previous 6 months

A

10
12
26

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2
Q

OROFACIAL PAIN
PREVALENCE
* –% of general population in
America experienced 1 of 5
ofofacial pain types in the past 6
months (3)
* –% reported Toothache
* –% reported Temporomandibular
Joint (TMJ) pain
* –% reported face or cheek

A

22
12
5
1.4

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3
Q

OROFACIAL PAIN
PREVALENCE
* –% of patients reporting to an
orofacial pain center had pain
sources beyond the trigeminal
system (i.e. chronic low back pain)

A

81

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4
Q

MEDICAL CONDITIONS COMORBID
WITH TMD
(7)

A
  1. Fibromyalgia
  2. Chronic fatigue syndrome
  3. Headache
  4. Gastoesophgeal reflux disorder
  5. Irritable bowel syndrome
  6. Multiple chemical sensitivity
  7. Post-traumatic stress disorder
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5
Q

DIAGNOSTIC CRITERIA FOR
DISC DERANGEMENT DISORDERS
(2)

A
  1. Disc displacement with reduction
  2. Disc displacement without reduction:
    acute & chronic
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6
Q

DISC DERANGEMENT DISORDERS
 Articular Disc Displacement:
(3)

A
  1. Abnormal relationship/misalignment of articular
    disc and condyle.
  2. Displacement is usually anterior or anteromedial
    direction.
  3. Pain or mandibular symptoms are not specific
    for disc derangement disorders.
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7
Q

DISC DISPLACEMENT WITH
REDUCTION
(4)

A
  1. From a closed mouth position, the “temporarily”
    misaligned disc reduces or improves its
    structural relation with the condyle during
    translation resulting in a joint noise (clicking or
    popping).
  2. Reciprocal click (opening/closing click)
  3. Asymptomatic clicking does not require
    treatment.
  4. Also called internal derangement
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8
Q

ETIOLOGY:
DISC DISPLACEMENT WITH
REDUCTION
(5)

A
  1. Macrotrauma- direct trauma/injury to the jaw
  2. Microtrauma-chronic bruxism
  3. Poor lubrication
  4. Lateral pterygoid hyperactivity
  5. Joint hypermobility/Ligament laxity
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9
Q

DISC DISPLACEMENT WITH
REDUCTION
 Diagnostic Criteria (must be present):
(3)

A
  1. Reproducible joint noise occurring during
    opening & closing.
  2. Soft tissue imaging reveals displaced disc
    which improves its position during
    opening.
  3. Absence of extensive degenerative bone
    changes
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10
Q

DISC DISPLACEMENT WITH
INTERMITTENT NON-REDUCTION
 Diagnostic Criteria (must be present):
(4)

A
  1. Persistent limited mouth opening <35mm with
    hx of sudden onset and PAIN.May last
    seconds to a few minutes.
  2. Deflection to affected side on mouth opening
  3. Marked limited laterotrusion to the
    contralateral side (if unilateral disorder)
  4. Patient can apply pressure to the affected
    joint, relax and wait for disc to reduce
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11
Q

DISC DISPLACEMENT
WITHOUT REDUCTION
(4)

A
  1. Disc is non-reducing or permanently
    displaced.
  2. Disc does not improve its relation with
    the condyle on translation.
  3. “closed lock”
  4. MRI shows no disc recapture on mouth
    opening
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12
Q

DISC DISPLACEMENT WITHOUT
REDUCTION (ACUTE)
 Acute:
1. What is it?
2. Secondary to 3
3. Pain is often present when
4. Deflection?

A

Sudden & marked limited mouth opening due
to jamming or fixation of disc .
disc adhesion, deformation, or
dystrophy.
attempting to open
mouth.
Straight line deflection to affected side on
opening

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13
Q

DISC DISPLACEMENT WITHOUT
REDUCTION (ACUTE)
 Diagnostic Criteria (must be present):
(4)

A
  1. Persistent limited mouth opening <35mm
    with hx of sudden onset
  2. Deflection to affected side on mouth
    opening
  3. Marked limited laterotrusion to the
    contralateral side (if unilateral disorder)
  4. MRI reveals displaced disc without
    reduction. X-rays show no extensive
    osteoarthritic changes.
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14
Q

DISC DISPLACEMENT
PROGNOSIS

A

The Majority of patients with Disc displacement with reduction do
not progress to disc displacement without reduction!!
A longitudinal study evaluated 155 TMJs that had baseline
diagnoses of Disc Displacement With Reduction who received
no treatment; 137 (88.4%) had no change in diagnosis 7.9 years
later; this is consistent with previous studies which have found
that the classic model of DDWR progression to another internal
derangement (such as Disc Displacement Without Reduction ) is
uncommon

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15
Q

ARTHROCENTESIS
(4)

A
  1. Needle is inserted into the superior joint
    space and lactated Ringer’s solution is
    used to distend joint space. Done under
    IV sedation.
  2. A second needle is then placed into the
    superior joint space and the TMJ is
    lavaged.
  3. During arthrocentesis, the jaw can be
    gently manipulated to increase range of
    motion since patient is sedated.
  4. Local anesthetic &/or steroids are
    injected at completion of procedure for
    pain management
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16
Q

ARTHROCENTESIS
 Once procedure is done, patient will need

A

physical
therapy and possibly an anterior repositioning splint
to keep disc from becoming non-reducing and to
help prevent re-formation of fibrous adhesions or
capsular constriction.
 The disc may displace in the future

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17
Q

ARTHROCENTESIS
INDICATIONS
For treatment of intra-articular joint
restrictions of jaw movement. Examples
follow:
(2)

A
  1. Acute closed lock with limited ROM that
    does not resolve. Best success occurs if
    procedure is done within 2-3 weeks
    following jaw locking.
  2. Acute pain in TMJ not responsive to
    medications and conservative treatment
    (i.e. splint therapy , physical therapy or
    intra-articular steroid injection).
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18
Q

DISC DISPLACEMENT WITHOUT
REDUCTION (CHRONIC)
 Diagnostic Criteria (must be present):
(3)

A
  1. Hx of sudden onset of limited mouth
    opening that occurred > 4 months
    ago
  2. MRI reveals displaced disc without
    reduction.
  3. Hard tissue imaging reveals no
    extensive osteoarthritic changes
19
Q

DISC DISPLACEMENT
WITHOUT REDUCTION (with limited
opening < –)

A

35mm

20
Q

ARTHROSCOPY
1. Allows visualization of
2. … can be used through the
arthroscope to correct problem.
3. What is it?
4. — can be used to eliminate
adhesions, inflamed tissue, & incise tissue
within the joint.

A

glenoid fossa and
superior aspect of disc
Forceps, scissors, sutures, medication,
needles, cautery probes, burs and
shavers
Small cannula is inserted into the
superior joint space & is connected to a
TV camera and video monitor
Lasers

21
Q

ARTHROSCOPY
 Arthroscopy surgically corrects a variety of
intracapsular disorders including:
(2)

A
  1. disc displacement without reduction,
    hypomobility as a result of fibrosis or
    adhesions, degenerative joint disease
    and hypermobility. It is useful for minor
    debridement and lavage, incision of
    minor adhesions, and biopsies
  2. Patients receive physical therapy
    following surgical treatment
22
Q

INDICATIONS FOR ARTHROSCOPY
(2)

A
  1. Chronic TMJ pain with limited range of opening that
    has failed to respond to conservative treatment or
    arthrocentesis
  2. Always re-evaluate patient prior to arthroscopy
23
Q

ARTHROSCOPY
1. A recent prospective, randomized clinical
trial found

A

arthroscopy no better than
physical therapy in the treatment of
restricted jaw range of motion and pain due
to intraarticular disease.
2. Upper joint space lavage may be ineffective
in decreasing pain & increasing mouth
opening in patients treated for disc
displacement without reduction.
3. Clearly, further research is needed to
determine the appropriate application of
arthroscopy and adjunctive technologies
such as the laser.

24
Q

INFLAMMATORY DISORDERS
(2)

A
  1. Synovitis/capsulitis/arthralgia
  2. Polyarthritides
25
Q

SYNOVITIS/CAPSULITIS
(ARTHRALGIA)
 Inflammation of synovial lining of TMJ due to trauma or
infection
 Diagnostic Criteria (must be present):
(2)

A
  1. Localized TMJ pain exacerbated by function (esp.
    posterior or superior loading)
  2. No extensive osteoarthritic changes seen on x-rays.
26
Q

SYNOVITIS/CAPSULITIS (ARTHRALGIA):
 Minor Criteria (may be present):
(6)

A

 Localized TMJ pain at rest
 Limited ROM secondary to pain
 Fluctuant swelling (due to effusion) that
decreases ability to occlude on ipsilateral
posterior teeth.
 Ear pain
 Bright MRI signal when fluid is present

27
Q

SYNOVITIS AND CAPSULITIS
(ARTHRALGIA)
1. Inflammation of the — structures
2. Occurs after
3. — pain in TMJ
4. — of TMJ increases pain
5. — over capsule increases pain

A

synovial
trauma, bruxism or wide opening
Continuous
Movement
Palpation

28
Q

SYNOVITIS AND CAPSULITIS
(ARTHRALGIA)
(3)

A
  1. Limited mandibular opening due to pain
  2. Edema can cause inferior displacement of the
    mandible due to swelling creating a
    malocclusion. Edema is visible on MRI of TMJ.
  3. Posterior teeth do not occlude on closing
29
Q

RETRODISCITIS
 Inflammation of
 Occurs following
 Occurs after
 Constant

A

retrodiscal tissue
(posterior attachment)
trauma, bruxism or wide
opening
constant clicking or
dislocation
deep pain

30
Q

POLYARTHRITIDES
(6)

A
  1. Rheumatoid arthritis
  2. Juvenile arthritis
  3. Ankylosing spondylitis
  4. Psoriatic arthritis
  5. Infectious arthritis
  6. Gout (crystal-induced disease)
31
Q

POLYARTHRITIDES
DIAGNOSTIC CRITERIA
Must be present:
(4)

A
  1. Pain with jaw function
  2. Point tenderness on TMJ palpation
  3. Limited range of motion secondary to pain
  4. Radiographic evidence of extensive TMJ changes
32
Q

POLYARTHRITIDES
DIAGNOSTIC CRITERIA
 May be present:
(4)

A
  1. Any of characteristics of osteoarthritis
  2. Pain while mandible is at rest
  3. Positive laboratory serology test (rheumatoid factor,
    sedimentation rate, antinuclear antibody- ANA)
  4. Crepitus (grinding noises) with condylar translation
33
Q

NON-INFLAMMATORY DISORDERS
(2)

A
  1. Osteoarthritis
  2. Osteoarthrosis
34
Q

OSTEOARTHRITIS DIAGNOSTIC
CRITERIA
 Primary: All of the following must be present:
(4)

A
  1. No other identifiable etiological factor
  2. Pain with jaw function & movement
  3. Point tenderness on TMJ palpation
  4. Radiographic evidence of structural bony change (not as
    extensive as seen in inflammatory arthritis)
35
Q

OSTEOARTHRITIS
May be present:
(2)

A
  1. Limited range of motion, deviation to the
    affected side
  2. Crepitus or multiple joint noises
36
Q

OSTEOARTHROSIS
(4)

A
  1. Chronic arthritis of non-inflammatory character
  2. No pain report or pain on palpation
  3. Coarse crepitus in TMJ during any movement
  4. NO radiographic degenerative changes
37
Q

ARTHRALGIA
(3)

A
  1. Pain with jaw function
  2. Pain on TMJ palpation
  3. No TMJ noises
38
Q

DENTAL
MANAGEMENT
OF
OROFACIAL
PAIN PATIENTS
(5)

A
  1. Keep appointment shorter than 1-2
    hours. Frequent rest periods during
    appointment.
  2. Limit jaw opening when possible.
  3. Use sonic scaler/Cavitron when possible
    to expedite hygiene appointment.
  4. NSAIDs or Tylenol 30 minutes prior to
    appt and for 24h (if no
    contraindications).
  5. Ethyl chloride spray during appointment
39
Q

skipped
ARTHRALGIA
TREATMENT

A

REST (i.e. soft/liquid diet x 2 wks)
HEAT/ICE THERAPY (10 min. 2x/day)
ELIMINATE PARAFUNCTIONAL HABITS
NSAID’s
Occlusal
Guard
(if clenching)
Arthroscopy
Steroids (intra-
articular)
Steroids

40
Q

POTENTIAL PROBLEMS RELATED TO
DENTAL CARE IN OROFACIAL PAIN
PTS
(2)

A

 Oral hygiene may be less than optimal due to
restricted range of motion &/or pain on opening
(i.e. flossing).
 Patient’s pain may increase following hygiene
appt. due to length of time required to keep
mouth open (i.e. digastric & inferior lateral
pterygoid may result in referred pain to TMJ,
maxillary sinus, & mandibular incisors).

41
Q

POTENTIAL PROBLEMS RELATED TO
DENTAL CARE IN OROFACIAL PAIN
PTS
 Clenching/bruxism may cause teeth to be sensitive to
—
 Restricted range of motion & muscle tiredness may make it
difficult for patient to —
 Sensation of malocclusion may occur due to —

A

percussion and temperature changes (i.e. hot or cold).
remain open for extended period of
time.
Trigger Point
tension with shortening of muscles seen in Myofascial Pain.

42
Q

POTENTIAL PROBLEMS RELATED TO
DENTAL CARE IN OROFACIAL PAIN
PTS
 — may occur during dental appointment. If OPEN
LOCK, get Oral Surgeon immediately to reduce mandible.
 Clicking sounds in the TMJ may result from dysfunction of
the — muscles (i.e. extended opening).

A

Locking
lateral pterygoid

43
Q
A

DMOP (15 decks)

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