11. Diagnosis in FPD Flashcards
(107 cards)
1
Q
How do you modify treatment for an epileptic? (2)
A
- Metal occlusal surfaces
- Short appointment
2
Q
What happens for patients with Xerostomy?
A
Higher caries incidence
3
Q
What happens with patients with diabetes?
A
Higher incidence of periodontal disease
4
Q
What happens with patients with HIV?
A
Higher incidence of periodontal disease
5
Q
What happens to patients with hyadantoin treatment?
A
Gingival hyperplasia
6
Q
What are the pathologies that might make us modify treatment?
A
- Epilepsy
- allergies
- xerostomy
- diabetes
- HIV
- hydantoin
- sjogren syndrome
7
Q
What is the helkimo test? (4)
A
Sum of points evaluating:
- movement limitation
- pain during movement
- muscular pain
- TMJ pain and the function
8
Q
What is does a 0 helkimo test mean?
A
No TMDs
9
Q
What is does a 1 helkimo test mean?
A
- Mild TMD
- 1-4 points
10
Q
What is does a 2 helkimo test mean?
A
- moderate TMD
- 5-9 points
11
Q
What is does a 3 helkimo test mean?
A
- severe TMD
- 10-25 points
12
Q
Where is muscular palpation done? (3)
A
- into the bulk of the muscle
- against a hard plane (some bone nearby)
- at the insertion of the ligament
13
Q
How do you check the pain threshold of the patient? (2)
A
- palpate mastoid process
- or vertex
14
Q
How do you palpate the temporal muscle? (2)
A
- along muscular fibers
- from front to back
15
Q
How to you palpate the tendon of the temporal muscle ? (2)
A
- with index finger over the ramus of the mandible
- towards coronoid process
16
Q
How do you palpate the deep part of the masseter muscle?
A
15mm in front of the tragus, below the zygomatic arch
17
Q
How do you palpate the superficial part of the masseter muscle? (3)
A
- Over the ramus ofthe mandible.
- From back to front.
- Craniocaudally.
18
Q
How do you palpate the masseter intraorally?
A
one finger intraorally and another extraorally
19
Q
What does bilateral pain of the masseter muscle mean?
A
Indicates clenching
20
Q
What does unilateral pain of the masseter muscle mean?
A
May be due to an interference
21
Q
What is the first muscle to usually be affected my TMDs? (2)
A
Lateral pterygoid
- can sometimes pull from the disc displacing it
22
Q
How do you palpate the lateral pterygoid?
A
Little finger at the bottom of the upper vestibule behind retromolar process
23
Q
How do you palpate the medial pterygoid?
A
- difficult
- only lower insertion, below the lower border of the angle of the mandible
24
Q
How do you palpate the SCM?
A
Along the muscle
25
How do you palpate the posterior belly of digastric muscle?
- Palpation with little finger ebtween posterior corder of the ramus of the mandible and the SCM
- Head of patient to the front and downwards
26
Muscular pain occurs either at: (2)
- maximal stretching of the muscle
| - maximal contraction
27
Apart from painful muscular points, you should assess these in a functional examination:
- Muscle hypertrophy.
- Face asymmetries.
- Muscle hypertonicity.
- Spasm.
28
Functional limitation of muscular movement: Soft end feel? (3)
- Muscles allow 2 mm stretching.
- The opening can be increased when applying some force
over the jaw.
- Painful.
29
Functional limitation of muscular movement: Hard end feel? (3)
- Articular problem, not muscular.
- The mandible can’t be opened more, even when a gentle
force is applied.
- The opening can not be forced.
30
Functional limitation of muscular movement: Maximum mouth opening? (5)
- Less than 40 mm interincisal opening.
- Due to pain and spasm of elevatormuscles.
- Protrusion and lateralities.
◦ Usually not limited (8mm) due to muscles.
◦ Unless lower lateral pterygoid is highly affected.
31
Functional examination: opening-closing path? (3)
- more than 22mm defelction
| - muscular or articular problem
32
Functional examination: opening-closing path muscular problem?
Variable deviated path
33
Functional examination: opening-closing path articulation problem?
always the same path
34
What is the more frequent pathology in joint examination?
- Muscular pathology (more frequent)
| - articular pathology
35
What is the most frequent articular pathology when doing joint examination?
Intracapsular pathology
36
Where does articular pain come from?
Usually not the articular surface, but from the surrounding tissues
37
How do you externally palpate articular pain
- palpation of the lateral part of the condyle
| - index and middle fingers in front of the tragus
38
What are the two kinds of articular pain palpation? (2)
- External (laterally)
| - Internal (posteriorly)
39
When externally palpatating articularly, what does pain indicate?
Capsulitis or synovitis
40
How do you internally palpate for articular pain?
Little finger into external auditory canal pushing forward
41
If there is pain when internally palpating for articular pain, this indicates... (2)
- retrodiscitis (very common)
| - posteriot capsulitis or synovitis
42
Articular sounds: what is a click?
Single explosive sound
43
Articular sounds: what is a crepitus??
Continous grating noise
44
How can you hear articular sounds?
- With the bell of the phonendoscope
- while preforming opening-closing or eccentric movements
- lateral palpation
45
What can cause click articular sounds?
- disc-condyle incoordination
| - during disc recapturing
46
What does it mean if there is a click articularly during opening? (2)
◦ Indicate anterior functional displacement of the
disc.
◦ Milder stage the nearer the MI point.
47
What does it mean if there is a click articularly during opening-closing? (4)
◦ Reciprocal click (or clicking)
◦ Indicate disc dislocation with reduction
◦ Early on opening, late on closing usually
◦ More advanced stage
48
A click sound during mediotrusion indicates...
medial disc dislocation
49
What are the causes of crepitus sounds? (3)
- Due to wear of the articular surfaces.
- TMJ Osteoarthrosis.
- Rx to see this: Schüller’s transcranial radiography.
50
What is the problem when there is a maximum mouth opening of less than 40mm with hard end feel ? (2)
- articular problem
| - probably an anterior disc dislocation without reduction
51
What is the problem when there is a mediotrusion of less than 8mm?
Probably an anterior disc dislocation without reduction
52
What is the problem when there is lateral deflection of the mandible during protrusion?
deflection towards the affeted side (DDwoR)
53
What is considered a pathological deflection during opening-closing ?
more than 2mm
54
If there is a reduction during opening-closing: (2)
- The deflection ends again at the midline.
| - Deflection during the opening path
55
If there isn't a reduction during opening-closing:
- The deflection doesn't get back to the midline
| - disc displacement without reduction -> affected condyle only rotates-> deflection to the affected side
56
What is considered urgent in preprosthetic treatments?
Pain or infection
57
What pathologies require urgent treatment? (4)
- Acute pulp diseases (pulpitis).
- Periodontal abscesses.
- Tooth fractures.
- Acute TMDs (trismus).
58
What malocclusions require immediate treatment: (2)
- Fremitus.
| - Any occlusal contact clearly harmful to the patient.
59
What do we do if an anterior tooth needs to be extracted?
- Provisional immediate denture (Fixed or removable) prepared in advance
Then:
- removable denture
- maryland bridge
- provisional bridge
60
Third molars and attached gingiva?
- Hardly ever have attached gingiva at buccal and lingual surfaces
61
Should we extract third molars for bridges? (3)
Yes unless:
- They're in perfect condition
- risk to inferior alveolar nerve
62
When extracting third molars, possible extrusion of the antagonist can cause: (2)
- prematurities
- inadequate contact point: food impactation
*therefore extract antagonist too
63
How long should you wait after extraction?
6m-1year
64
What happens if you dont wait the recommended time after extraction for prosthetic treatment? (3)
- bone resorption can still happen
- gingival level migration
- separation between pontic and gingiva
65
What happens if you wait more than a year after extraction for prosthetic treatment?
Tooth migrations
66
What are the stages of periodontal treatment? (3)
1. initial treatment
2. surgical treatment (if needed)
3. maintenance
67
What occurs in the initial periodontal treatment? (3)
- prophylaxis
- scaling and root planning
- correction of overcontoured margins of restorations and other iatrogenic irritants
68
What happens 2 months after scaling and root planning?
Reevaluation and decision:
- surgical treatment
- more SRP
- prosthetic treatment
69
What happens during the 2 months after scaling and root planning? (3)
- Evaluation of the commitment of the patient with it’s oral health.
- Stabilization of the gingival tissues
- Very important for any prosthetic treatment to
succeed.
70
How should you check occlusal equilibration?
- mount cast in CR
| - eliminate contacts on the casts
71
When should we not do occlusal equilibration? (2)
- more than 4 contacts
| - eliminating one contact can lead to another appearing
72
When should you do occlusal equilibration? (5)
- Only for occlusal contacts clearly harmful to
the patient.
- Fremitus.
- Extrusions that might interfere with the
denture.
- Unevenness of the occlusal plane.
- Lack of occlusal stability
73
How long after a fistula/abscess treatment should you wait for prothetic treatment?
6 months
| *be sure of the remission of the pathology
74
When should you do an endo therapy of vital teeth? (4)
- When cast post-and-core is needed (retention).
- Extrusions.
- Great tooth inclinations.
75
How long after an endo therapy of a vital tooth should you wait before prothetic treatment?
1 month
76
How long after an apicectomy should you wait before prothetic treatment?
6 months for full healing
77
What is the disadvantage of an apicectomy? (3)
◦ Low crown-to-root ratio.
◦ Unaesthetic scar.
◦ Sometimes increases tooth
mobility.
78
Should you extrude or intrude teeth to increase the ferrule effect?
extrude
79
How long after periodontal surgery can you do prothetic treatment?
• Only gingiva has been
touched: 1 to 3 month
• Gingiva and bone: 6month
80
How long should you wait after any surgery to do prosthetic treatment?
2-3 months
81
How do you treat TMDs? (4)
- physiotherapy
- pharmacotherapy
- psychological support
- Occlusal splint
82
What physiotherapy should be done to treat TMDs?
- massage
- therapeutic exercises
- TENs
- infrared light
83
How do massages help TMDs?
Increases the heat and helps
| eliminating toxins during the contraction
84
How do therapeutic exercise help TMDs?
To help recover the
function; limiting the movements, opening
and closing
85
How do TENs help TMDs?
Transcutaneous electrical nerve stimulation, to reduce the pain and stimulate
the tone of the muscles
86
How do infrared light help TMDs?
Creates a heat that improves
the blood-flow, the oxygenation and relaxes
the muscles.
87
Whats the purpose of pharmacotherapy in treatment of TMDs (3)
- To reduce the psychological tension.
- To relax the muscles.
- Allow maneuvers needed during the treatment.
88
Types of pharamcotherapy for TMD?
Cold/heat
• Muscle relaxant, robaxisal®, myolastan ®.
• Sedative and tranquilizer, can help the doctor reduce
the pain, benzodiazepines.
• Analgesic, not very useful to relieve acute pain,
paracetamol.
• Anti-inflammatories
• Vasoactive drugs: for vascular migrains
• Infiltrations in the affected areas
89
How does heat impact TMDs? (3)
- can creates changes over the neuromuscular
system
- increase of the blood-flow and the capillary permeability.
- When muscular tension, pain and rigidity of the joints
90
How does cold impact TMDs? (5)
- anaesthetic effect, reduces spasms and the bloodflow
- reducing the local inflammatory response
- oedema,
- haemorrhage.
- When jaw movements are limited associated to active
therapy
91
Psychological support for TMD (3)
• Stress and Anxiety are a cause and consequence of
TMDs.
• Psychologist.
• Psychiatrist.
92
What does occlusal splinting for TMD achieve?
Alters mandibular position and contact pattern of teeth
93
How occlusal splinting for TMD work? (3)
• It hasn’t been proved what makes them work.
• It has been stated that it’s because it resets
neuromuscular patterns.
• Synonymous of occlusal device.
94
What are the indications of occlusal splinting for TMD? (7)
- Relaxes the muscles.
- Helps reducing the pain.
- Allow to handle the patient
during the treatment.
- Treatment for TMD`s.
- Occlusal stabilization.
- To prevent the occlusal
trauma.
- Reduce tooth wear.
95
What is occlusal splinting for TMD effective at and not effective at?
* Very effective at reducing muscular pain.
| * Poorly effective to reduce joint sounds.
96
Whats the objective of occlusal splinting for TMD? (5)
- Relax muscles of the stomatognathic system.
- Provide orthopedic stability to TMJs.
- Lower grinding/parafunctional activity.
- Protect periodontium from occlusal trauma.
- Prevent wear of the dentition.
97
What is the procedure of occlsal splinting for TMD? (2)
- Occlusal record at final VD in CR position
- The purpose is to take the condyle-disc-fossa to
an optimum position
98
What is needed before occlusal splinting for TMD
Physiotherapy and pharmacology to be able to treat the patient
99
How do you occlusally splint when its impossible to record CR? (2)
- Approximate CR.
| - Posterior adjustments to the splint or new splint.
100
Hwo do you manufacture occlusal splints? (3)
Heat curing acrylic resin
- good mechanical properties
- allows adjustments
101
What splint do you need for night-time bruxism for TMD?
Upper splint
102
What splint do you use for day-time bruxism for TMD?
Lower splint
103
Design of the occlusal splint for TMD? (3)
- Retention: survey line.
- Avoid contact with periodontium (plaque
gathering) .
- Flat occlusal surface
104
What occlusal scheme do you use for occlusal splint TMD?
- Mutually protected articulation
| - soft canine and anterior guidance
105
How should the contacts be in a TMD occlusal splint? (3)
- even contacts
- no tooth without occlusal contact (prevents extrusions)
- minimum possible VD (not making the splint weak) - to prevent myotatic reflex
106
What is the time of use for an occlusal splint for TMDs? (2)
- depends on the patient
| - bruxist patients: forever
107
Do occlusal splints have MI at CR? (2)
- Rarely achieved the first time:
| - Adjustments to the splint.
