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1. Introduction Flashcards

1
Q

In a study, adults in the two most severe pain groups were likely to have (better/worse) health status, use (more/less) health care and and suffer from more_ than loss with less severe pain

A

worse…more…disability

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2
Q

Describe the transition from acute to chronic pain

A

More exposure to acute pain changes the brain chemistry and predisposes patients to chronic pain conditions

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3
Q

What causes the transition from acute to chronic pain

A

unclear

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4
Q

Up to _ in _ children and adolescents experience weekly musculoskeletal pain

A

1 in 3

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5
Q

Describe the prevalence of children that suffer from a chronic pain condition

A

20-46%

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6
Q

_% of children suffer from abdominal pain disorders

A

20%

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7
Q

T/F Pain is under-treated in kids and adolescents

A

t

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8
Q

Prevalence for constant/frequent pain in the US varies from as low as _% to as high as _%

A

11-47%

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9
Q

Measuring “persistent pain” is defined as

A

self-reported pain “every-day” or “most days” for the past 3 months

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10
Q

_% of American adults suffer from persistent pain

A

19%

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11
Q

(Women/Men) suffer from persistent pain more

A

women

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12
Q

What factors influence the rate of reporting of persistent pain

A
  • Race
  • Eduction
  • Health indicies (i.e anxiety/depression/fatigue)
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13
Q

The National Pain Strategy seeks to…

A

reduce the burden and prevalence of pain and to improve the treatment of pain

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14
Q

What are the universal features of TMDs

A
  • TMJs and masticatory muscles pain
  • Joint sounds
  • Restricted function
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15
Q

What is needed to make a dx of TMD

A
  • Interview with patient (good history)
  • Clinical exam
  • X-rays
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16
Q

What are the different treatment options for TMD

A
  • Biobehavioral therapy
  • Interocclusal appliances
  • Occlusal therapy
  • Physical therapy
  • Pharacological therapy
  • Surgical therapy
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17
Q

About what % of the population actually has TMD

A

10%

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18
Q

TMD involves what structures

A
  • TMJ (the joint)
  • masticatory muscles
  • All associated tissues
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19
Q

Define TMD

A

A GROUP OF musculoskeletal and neuromuscular conditions that involve the TMJ, masticatory muscles and all associated tissues

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20
Q

(Males/Females) have a higher prevalence of TMD (How much higher)

A

females ~2x higher

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21
Q

During what age is TMD most frequently diagnosed

A

During reproductive years (de cline after 40 y/o and post-menopause)

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22
Q

Define incidence and prevalence

A

Incidence= predicted number of people with TMD

Prevalence= Actual number of people with TMD

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23
Q

Which is higher the prevalence/incidence of TMD

A

Prevalence (this is counterintuitive)

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24
Q

Why is the prevalence higher for TMD than the incidence

A

Because TMD is a chronic condition and thus takes time to develop

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25
OPPERA will follow people for _yrs to monitor their TMD condition
7
26
Main risk factor for TMD is
genetics
27
Incidence rate of TMD according to OPPERA is
3.9% / year
28
(Women/men) report more frequent, severe, and longer duration pain
women
29
(Women/men) are more prone to acute pain
men- women are more prone to chronic pain
30
Myofascial pain patterns in females are modulated by what factors
- Oral contraceptives - Reproductive hormones - Exogenous hormones
31
Describe how estrogen affects the levels of TMD pain
low estrogen levels (and at times of rapid estrogen change) --> peak pain
32
Describe times in the body when estrogen levels in women are high and low
High -Pregnancy Low -post-partum
33
Describe the pain in women with TMD with hormonal fluctuations
symptomatic TMD without impairing mastication
34
Why might estrogen play a role in TMD pain
Increased estrogen --> increased inflammaiton --> increased TMD pain
35
What are the genes that influence the presence of TMD and assoicated pain
ESR1 and ESRRB
36
What is the most common Dx in TMD patient and community populations
Patient=myofascial pain with or without mouth opening limitation Community=disc displacement with reduction
37
Rank the following in order of least to most common | Disc derangement, muscle disorders, joint disorders
Joint, disc, muscle
38
Rank the races in order of highest to lowest incidence of TMD - Asian - African american - White
- AA - White - Asian
39
What genetic markers predict TMD onset
none
40
What genes are associated with the clinical, psychological, and sensory phenotypes assoc. with TMD onset
SCN1A | ACE2
41
What is the role of the SCN1A gene
encodes the alpha subunit of the voltage gated Na channel involved in propagation of action potentials
42
Role of ACE2
angiotensin I converting enzyme (increase risk of HTN)
43
What are the different theories about the etiologies of TMD
- Dental and occlusal etiologies - Skeletal abnormalities - Psychophysiological - Bruxism and other parafunctions
44
T/F People with TMD also commonly have premature occlusal contacts
t
45
T/F Occlusal trauma can lead to TMD development
F (correlation doesn't equal causation)
46
T/F loss of posterior support could be linked to a higher incidence and severity of arthritis in the TMJ
t
47
Limitations for the theory that occlusal forces attribute to TMD
- Based on clinical observations of reduction of symptoms after occlusal intervention - Distribution of occlusal characteristics in non-symptomatic patients - Placement of experimental occlusal/placebo are not associated to the development of symptoms
48
Evidence for occlusal disharmony as a primary etiology for TMD (does/doesn't) exist
doesnt
49
A major limitation in the studies that looked at occlusion as an etiology for TMD was
Terms such as "disharmony" are used without an adequate definition leading to research that is not reproducible
50
What type of interferences are associated with TMD in multiple studies
mediotrusive
51
TMD caused by skeletal abnormalities theory- describe it
Pain is caused when our anatomy deviates from some theoretic idea
52
Deviations in our skeletal anatomy that attributes to TMD (according to the theory) includes what abnormalities
- Poor body alignment - Head posture - Concentricity of the condyle in the fossa - Misalignment of the cranial bones
53
Limitations of the skeletal abnormality theory includes
- Bias - Lack of longitudinal studies - Lack of clinical trials
54
Describe the psycho-physiological model of etiology for TMD
People with stress/poor coping skills and parafunction have the most pain
55
Define parafunction
any non-functional use of the motor system including... - Grinding - Clenching - Posturing - Holding - Using objects excessively - Musical instruments
56
Describe the correlation between parafunction and TMD
high prevalence of bruxism in TMD patients
57
What is the etiology of the most common TMDs
unknown
58
Describe the difference between Axis I and II
Axis I -Clinical TMD conditions Axis II -Pain related disabilities and psychological status
59
What are the condiitons that fall under asix I
- Myalgia - Arthralgia - Myofascial pain with referral - Heache attributed to TMD - Disc displacement with reduction - DDw/R with intermittent locking - DDw/oR with limited opening - DDw/oR W/o limited opening - Degenerative joint disease - Subluxation
60
Look at the pictures on slide 65 describing the location of the disc with DDw/reduction, DD w/oR and osteoarthritis
ok
61
T/F TMDs rarely progress into something worse
T (often remitting, self-limiting or fluctuating
62
Independent risk factors for first-onset TMD are
- Pre-existing pain conditions - Sleep disturbance - Cigarette smoking
63
Strong predictor of TMD includes evoked pain from
Jaw opening | Muscle and TMJ palpation
64
The strongest predictor of TMD incidence is
oral parafunction
65
Women with positive disc displacement have (higher/lower) energy densities
higher

TMD (13 decks)

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