Temporomandibular Disorders (TMD) and Orthodontic Treatment P1

Question 1

DEFINITION OF TMD

Answer 1

TMD is a collective term embracing a number of clinical problems that involve the masticatory musculature, the TMJs, or both.

Question 2

TMD etiology

Answer 2

TMD comprises a group of related disorders with multifactorial etiology including psychological , hormonal , genetic , traumatic , and occlusal factors .

• Research suggests that depression, stress, and sleep disorders are major factors in the etiology of TMD and that parafunctional activity can contribute to muscle pain and spasm .

Question 3

Orthofunction vs Pathofunction

Answer 3

Question 4

TMD may be associated with:

Answer 4

1. stressful habits
2. emotional disorders
3. structural malrelationships
4. trauma to the face or head
5. occlusal disharmonies
6. other medical problems

Question 5

TMD can be associated with:

Answer 5

1. headaches
2. non-painful muscle hypertrophy
3. abnormal occlusal wear
4. osseous alterations of the joints

Question 6

The most common clinical markers of TMD in the general population are:

Answer 6

1. limited range of mandibular motion
2. muscle and TMJ tenderness
3. TMJ sounds

Question 7

Women vs men
Who seeks care for TMD more often?

Answer 7

It seems for unclear until now reasons that more woman than men seek care for TMD.

Question 8

Which is the main etiology behind TMD?

Answer 8

It has been documented in US pain clinics that 85% to 92% of TMD problems are mainly muscular .

Question 9

TMD can be divided into:

Answer 9

1. INTERNAL DERANGEMENTS OF THE DISC AND RELATED STRUCTURES
2. DISORDERS OF THE CHEWING MUSCLES
3. DEGENERATIVE JOINT AND BONE CONDITIONS
4. DEVELOPMENTAL ABNORMALITIES

Question 10

INTERNAL DERANGEMENTS OF THE DISC AND RELATED STRUCTURES

Answer 10

Sagittal view of the TMJ in a closed-mouth position

Question 11

INTERNAL DERANGEMENTS OF THE DISC AND RELATED STRUCTURES

Answer 11

Sagittal view of the TMJ in an open-mouth position

Question 12

INTERNAL DERANGEMENTS OF THE DISC AND RELATED STRUCTURES

Answer 12

Anterior disc displacement with reduction

Question 13

INTERNAL DERANGEMENTS OF THE DISC AND RELATED STRUCTURES

Answer 13

Anterior disc displacement without reduction

Question 14

INTERNAL DERANGEMENTS OF THE DISC AND RELATED STRUCTURES

Answer 14

Anteromedial disc displacement without reduction

Question 15

INTERNAL DERANGEMENTS OF THE DISC AND RELATED STRUCTURES

Answer 15

TMJ during ICP [reconstructed from MRI]

Question 16

DISORDERS OF THE CHEWING MUSCLES

Which are the 4 paired muscles of mastication?

Answer 16

Question 17

DISORDERS OF THE CHEWING MUSCLES

Which muscle is shown?

Answer 17

The lateral pterygoid muscle

Question 18

DISORDERS OF THE CHEWING MUSCLES

Which muscles are shown?

Answer 18

Muscles of the suprahyoid region

Question 19

ETIOLOGICAL AND STRUCTURAL CLASSIFICATION OF MUSCULAR DISORDERS

Primary myofacial and muscle pain dysfunction

Answer 19

1. Myalgia due to localized acute muscular injury
2. Myalgia due to chronic sustaining parafunctional activity
3. Myalgia due to chronic sustaining postural factors

Question 20

ETIOLOGICAL AND STRUCTURAL CLASSIFICATION OF MUSCULAR DISORDERS

Secondary to internal TMJ derangement

Answer 20

1. Muscle tension
2. Muscle spasm/protective splinting
3. Muscle inflammation (myositis)
4. Myofascial pain and trigger points
5. Fibrosis/contracture
6. Atrophy

Question 21

The role of Orthodontics in TMD

Answer 21

The role of Orthodontics in TMD has been extensively debated, with some authors claiming that orthodontic treatment can cause TMD, while others advocate orthodontic appliance therapy to manage TMD.

Question 22

consensus view regarding orthodontics and TMD

Answer 22

After considerable discussion in the literature, the consensus view is that orthodontic treatment , either alone or in combination with extractions, cannot be reliably shown to either “cause” or “cure” TMD .

Question 23

development of TMD & methods for prevention

Answer 23

1. The development of TMD cannot be predicted .
2. Once TMD is present, TMD cures cannot be assumed or assured .
3. No method of TMD prevention has been demonstrated.
4. TMD are primarily a pain management problem .

Question 24

Multiple strategies for controlling TMD pain:

Answer 24

1. teaching the patient how to reduce oral habits, stress and anxiety - biofeedback
2. applying physical therapy and exercises to restore function (neck, shoulders, TMJs)
3. using acetosalicylic acid or ibuprofen for their analgesic and anti-inflammatory effects
4. use of intraoral splints