TMJD/Pain Flashcards
What are 6 types of Physiotherapy Tx for TMJD?
- Ice Packs
- Superficial Heat Packs
- Short-Wave Diathermy
- Therapeutic Ultrasound - THERMAL or NON-THERMAL
- Exercises (E.g. Rocabado 6 by 6)
- Biofeedback (E.g. Electromyography - showing Px when grinding/clenching)
Before using a Splint to test Px in RCP, what 2 other techniques are first tried?
- Bimanual Manipulation (Dawsons method)
- Lucia Jig
SOFT Splints may be made for TEMPORARY use (e.g. night or sports guard) what are the advantages (2) and disadvantages (2) of its use over HARD Splints?
ADVANTAGES:
- Good for emergencies (quick to make, involve less equiptment and require less accurate anatomy records)
- Cheap
DISADVANTAGES:
- Temporary! Will wear and need replacing
- “Spongey” = Encourages more bruxism
What are the 4 examinations/screening tests used for TMJD?
- JointPlay (Place thumb and index finger on lower and upper arch, feel movement on opening - Elastic or Stiff?)
- EndFeel (Movement of joint - Smooth or Rough?)
- Static Pain Test (Pain when held still and asked to move?)
- Dynamic Pain Test (Pain on movement?)
Other than 4 screening tests done on clinic, what other diagnostic aids can be used for TMJD diagnosis? (4)
- Radiographs (Panoramic, Lateral Oblique, CBCT, MRI)
- Electromyography (EMG) - Bitestrip measuring muscle movement (grinding)
- Thermography (Inflammation)
- USS (Sonography)
What are some:
- Psychological (1)
- Anatomical (6)
- Neuromuscular (4)
causes of TMJD pain?
PSYCHOLOGICAL
Type A personality & Stress/Anxiety → Parafunctional habits
ANATOMICAL
- Congenital (e.g. Aplasia, Hypo/Hyper-plasia)
- Disk Dearrangement Disorder (+/- Reduction)
- Inflammatory (e.g. Sinusitis)
- Osteoarthritis
- Ankylosis
- Fracture
NEUROMUSCULAR
- Trigeminal Neuralgia
- Inflammation (e.g. Myositis)
- Myospasm
- Local Myalgia - Investigate Temporal Arteritis
What are HARD Splints made from?
What are the 2 main types - which is best and why?
Heat Cure Acrylic
- FULL Coverage - “Michigan” (Upper) & “Tanner” (Lower - Skeltal Class III malocclusion)
- PARTIAL Coverage - “Anterior” & “Posterior”
FULL Coverage best as Partial may encourage over-eruption of non-covered teeth…
What is meant by Temporomandibular Dysfunction?
What are the 3 cardinal signs?
“A group of disorders of the Temporomandibular joint and its musculature”
- Pain (in and around joint)
- Sounds (clicking or crepitus)
- Limited movement
What is the difference between Articulation and Occlusion?
(define both)
OCCLUSION = STATIC position of teeth/jaw - Incisal/Molar/Skeletal
ARTICULATION = DYNAMIC movement of the teeth against eachother - Lateral/Protrusive/Retrusive
Outline the steps in producing a Splint…
- Impression in RCP → Cast and articulated onto semi-adjustable articulator (+/- Lucia Jig) using Facebow record
- Open incisal pin to allow 2-3mm posterior tooth clearance
- Mark Splint outlines: (2mm bucally, 1mm palatally & horse-shoe not covering palate)
- Wax up splint: “Mutually protected occlusion” RCP = ICP & SMOOTH SURFACE
- Add Canine Ramps → Canine Guidance
- FPF → Heat Cure Acrylic
- Lightly blast occlusal surface with 25-micron Aluminium Oxide to allow easy occlusion marking in mouth and test working/non-working side interferences (will come back looking polished)
What is meant by the “Pantograph Reproducability Index” (PRI)?
Are we concerned by a HIGH or LOW PRI?
The reliability/reproducability of movements in the condyle or MOM (Posterior Guidance)
LOW PRI = Unable to reproduce repeat border movements (True pathology in Joint or “Guarded” MOM movement)
HIGH PRI = Reproducable border movements (No problems)
What are the 3 main aims of Physiotherapy for TMJD?
Which type of TMJD would we usually use this type of treatment for?
- Relieve Pain
- Reduce muscle spasms and stiffness
- Re-educate muscle and joint movement → Maintained/Improved Jaw function
Mainly used for MYOGENOUS (Muscle) Origins
What are the 3 broad aetiology groups of TMJD?
- Psychological
- Anatomical (Arthrogenous)
- Neuromuscular (Myogenous)
Myogenous-origin TMJD is usually treated in GDP, when would it be referred?
If “Chronic Pain”:
- Pain over 6 months
- Changing behaviours & quality of life
- Depression
What is the final stage in making a splint (after FPF)?
What are 3 reasons we do this?
Lightly blast the splint occlusal surface with 25 microns Aluminium Oxide
- Easier marking when checking occlusion in Px
- Identifies working/non-working side interferences (will appear smooth)
- Identifies if patient has been wearing their splint!
